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(iii) Barriers for Vulnerable Groups and Individuals

In document Mental Health & Social Inclusion (Page 73-79)

4.40 Certain groups in society are more vulnerable to experiencing mental ill-health and discrimination. These include women, refugees and asylum seekers, ethnic minorities, Travellers, disadvantaged children and young people, as well as some vulnerable older people, lone parents, isolated rural groups, gay, lesbian and bisexual young people, those with multiple disabilities, people with intellectual disabilities, the deaf, people with physical disabilities, prisoners, homeless people and those with complex needs. Combined with a marginalised position in society, the risk of mental ill-health and increased social disadvantage contribute to and are affected by higher levels of discrimination (WHO, 2005a). However, there is a lack of data and research on the needs of and provision of services for many of these groups (Amnesty International, 2003a/b/c) and particularly those with co-morbidity including addiction. Some of these groups are examined below, but others will be discussed later in the report in relation to

particular initiatives or areas of good practice.

Across the Life Cycle

4.41 There are vulnerable points in the lifecycle for both men and women in relation to mental health. Young people are especially vulnerable. According to the Youth Council of Ireland and Barnardos, in making their presentations to the Project Team, 20% of children have a mental disorder at any one time and 4% have a severe disorder. This is coupled with a high youth suicide rate and self-harm rate and lengthy waiting lists for assess- ments. Fitzgerald (2007: 1) notes that“rates of suicide among young people have increased and at the same time there has been an increase in the proportion of suicides diagnosed as having suffered from depressive disorders.”Suicide accounts for 30% of deaths in the 15 to 24 year age

19 Information supplied in a submission from Amnesty International (Irish Section).

group and a variety of psychosocial disorders tend to rise or peak during the teenage years (Fitzgerald, 2007). Adolescents are under the most pressure and the suicide rate particularly among males is an indicator of high stress levels (The Irish Times, 2007).

4.42 However, some older people face particular challenges as well. It was noted by one submission that ageist attitudes towards older people and the stigma related to mental ill-health will need to be addressed in order to“encourage community action for older people with mental ill-health.” Another submission commented:“ … mental illness is often perceived as “a sign of weakness and … mental illness is often perceived as a sign of weakness and … this stigma inhibits sufferers from seeking help. Furthermore, this may be compounded by a misunderstanding of the nature of older age on the part of the health and social care professionals. Many perceive mental disorders as a natural part of growing older

and,as a result, they may be unwilling to initiate a comprehensive treatment package.”

Gender

4.43 Gender “runs like a fault line, interconnecting with and deepening the disparities associated with other important socio-economic determinants such as income, employment and social position”(WHO, 2001:2). The Women’s Health Council (2005:15) argues that“women are more likely to be affected by stressful events and traumas, especially in relation to physical and sexual abuse which can cause serious physical and mental health repercussions.”Gender-based violence is a risk factor for mental ill- health that disproportionately affects women. Anecdotal evidence in Ireland suggests that women may be referred to mental health services and/or prescribed medication without receiving support for the cause of their depression or anxiety, the violence they continue to live with or have experienced19

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4.44 However, there are particular difficulties for men as well as they tend to be more reluctant to seek help and support for their health problems, including mental health problems (McKeown and Clarke, 2004). Men are much more likely to abuse tobacco, alcohol or drugs. Alcohol-related health problems are a major cause of illness and death in young men. There are also difficulties faced by older isolated men in rural areas as outlined by the Outreach Worker of the Mevagh Men’s Education Initiative (Bradley, 2006). He notes the importance of strengthening community as a way of countering loneliness and depression.

Gays, Lesbians and Bisexual People

4.45 A report by Dillon and Collins for GAYHIV Strategies and the Northern Area Health Board in 2004 concluded from an overview of research that lesbians and gay men show an increased risk of psychological stress and negative mental health associated with prejudice, discrimination and isolation. Young men and women of same-sex orientation have been identified as one of a number of high-risk groups for youth suicide – they are six times more likely to engage in suicidal behaviour than their heterosexual peers (Ferguson et al,1999). Young gays, lesbians and bisexuals can experience social isolation, discrimination and social exclusion. Rural isolation was identified as being particularly problematic. One submission noted the following:“ … some young LGB [lesbian, gay and bisexual] people are rejected by their families when they come out, and this can cause serious social isolation. For others, because they live in rural or even remote areas of the north east, they can be very isolated … This can fuel the cycle of depression, anxiety, alcohol-dependence and low self-esteem.”

Travellers

4.46 There has been increased focus on the mental health needs of Travellers. At the HSE West Conference onAddressing the Mental Health Needs of Minority Ethnic Groups and Asylum Seekers in Ireland, a key issue which emerged was accommodation and its effect on mental health, particularly the lack of access to the wider community of many halting sites. The lack of trust between Travellers and health care workers was noted as a barrier as was the stigma attached to accessing mental health services (HSE West, 2006). The Traveller Health Unit Eastern Region has recently established a Mental Health Sub-Group to examine the key issues including access to services, barriers to mental health and the apparent rise in suicide rates. In addition, the forthcoming All-Ireland Traveller Health Study has been commissioned by the Department of Health and Children in conjunction with Northern Ireland’s Department of Health, Social Service and Public Safety.

Prisoners

4.47 While the incidence of mental ill-health in prisons has already been briefly mentioned in Chapter 2, the difficulties experienced by ex-prisoners with mental health needs are often unmet (NESF Report No. 22, 2002). Their needs were singled out by one of the submissions received. It noted that: “[There is a] lack of continuity of care for people leaving prison who may have had access to limited psychiatric services while in prison but there tends to be no link in with community psychiatric services prior to release and no follow-up upon release — that tends to be left to agencies such as PACE.”

20 Information supplied by the HSE.

Migrants, Asylum Seekers and Refugees

4.48 One of the most unknown of these groups is emerging ethnic

communities (Moran, 2005). In England, despite similar prevalence levels of mental health problems to the wider population,“people from ethnic communities are six times more likely to be detained under the Mental Health Act than white people”(Social Exclusion Unit, 2004). CAIRDE, a voluntary organisation working to reduce health inequalities of ethnic minorities in Ireland, has recently produced a report (2006) outlining participative work with ethnic minority groups in inner city North Dublin. It revealed a low engagement with mental health services, despite over a third (38%) expressing feelings of stress, depression and anxiety. The HSE’s National Intercultural Health Strategy(HSE, forthcoming 2007) aims to ensure that provision of health services is equal, accessible, and culturally sensitive and appropriate to meeting the needs of minority ethnic communities. A number of mental health issues emerged during the consultations which informed development of the strategy, with asylum seekers, refugees and Travellers reporting a range of mental health needs and concerns around their particular situations. At the same time, the mental health needs of many migrant workers — often living in isolated, vulnerable circumstances — appear to be an emerging issue20

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4.49 The Women’s Health Council (2006) argue that many ethnic minority women find themselves in situations of isolation, poverty and exploitation which leads them to experience high levels of stress, anxiety and

Conclusions

4.50 This chapter outlined some of the main general barriers to social inclusion for the entire population and then identified those barriers most experienced by people with mental ill-health and vulnerable individuals and groups. From a population health perspective, there are broad determinants of mental health which are found at personal, social and community levels. We can diminish our risk of experiencing mental ill- health by strengthening individual, community and societal supports.

4.51 One central conclusion is that mental health for individuals is promoted by equipping them with the emotional resources and skills to cope. These can be developed and supported from an early age, and across the lifespan in continuing education programmes, focusing on self-development and life skills.

4.52 In social terms, relationships are central to positive mental health, from early family attachment through to broader social networks. Building friendships and intimate relationships is something that can be supported through community groups and activities, volunteering, and online social network sites. The recent Report from the Taskforce on Active Citizenship (2007) outlined ways of increasing community involvement and these are welcomed and supported by the Project Team. In addition, key barriers at this level are inequality and discrimination which can act as a deterrent to social cohesion. The Project Team welcomes the ongoing work of the Equality Authority in tackling inequality.

4.53 The local community is also central to positive mental health, not only in terms of safety, being free from violence, good housing, work and living conditions, but also in terms of extending social networks to community attachment and belonging. Everyone has basic living needs, but a healthy and fulfilling life embraces mental health and in turn, our positive mental health embraces our community. Further details on community initiatives which are effective in fostering mental health can be found in Chapter 9.

4.54 Barriers to inclusion are particularly strong for those with experience of mental ill-health. These include stigma and discrimination and lack of access to employment and adequate income. Some of the most vulnerable groups at risk of greater social exclusion through mental ill-health are prisoners, homeless people, ethnic minorities, Travellers, young people and those in isolated rural areas. There is also a need to focus particularly on those with complex needs who experience a revolving door to exclusion; for example, from psychiatric care or prisons to homelessness; and those with dual diagnoses, such as addiction and mental ill-health.

4.55 One of most critical of these barriers is employment as this has been shown to be a key gateway to inclusion for all adults of working age. This is of particular significance for those with a mental disability as research shows that the vast majority of them are not working. In addition, the longer they are off-work, the more likely they are to become socially excluded. Chapters 6 and 7 examine strategies in relation to training, work and meaningful occupation.

In document Mental Health & Social Inclusion (Page 73-79)