Positive Steps online
Supporting race equality in mental healthcare
Mental health and the Irish community > Background
Because of the practice of including the Irish in the overall White "ethnic" category, and the assumption that ethnicity is related to skin colour, it is often forgotten that the Irish community is the UK's largest immigrant ethnic minority. There is widespread evidence that the experience of Irish people in Britain is more akin to other, more visible, minority ethnic populations than the White majority. As with other minority ethnic communities, the Irish are more likely to live in London and the South East and other major urban centres.
Like any minority ethnic community, the Irish are not a homogeneous group. Many people who identify as Irish were born in Britain. Significant numbers have mixed parentage and take pride in expressing their dual cultural heritage. Irish Travellers have a distinct cultural heritage with language, customs and traditions which often set them apart from other Irish people. The age profile of the Irish community is an older one, with large numbers in the post-pension age group. For a range of different reasons associated with migratory patterns, occupational history, marriage, divorce and premature death, Irish people are more likely to live alone. As such Irish people and in particular those who are older can experience social isolation and have limited support networks in times of illness.
Despite significant evidence of success and affluence among Irish people, social, economic and housing disadvantage follows a broadly similar pattern to other minority groups. Although not as overt as in the past, anti-Irish racism still persists in the form of "Irish jokes" and stereotypes around alcoholism. This impacts at individual level, making people angry, uncomfortable, rejected and even feeling inferior. A lack of understanding of Irish culture on the part of healthcare practitioners, can affect diagnosis, treatment and recovery from mental illness.
Research has shown repeatedly that Irish people in Britain have excessive rates of admission for all diagnostic categories of mental illness, (Walls 2004) and consistently and significantly higher rates of psychological ill-health (Erens et al 2001), particularly depression and anxiety (Sproston and Nazroo 2002, O' Connor and Nazroo 2002).
The Count Me In Census 2005 demonstrated that the profile of Irish inpatients was different to other groups in that Irish admissions were more likely to be aged 50 and over and less likely to be under 24. The 2006 census shows lower rates of GP referral, higher rates of self-referral, admissions via A&E and significantly elevated rates of referral through the criminal justice system. The 2006 census demonstrated double than average rates of seclusion and higher levels of admission to medium and high secure wards.
Mental health and the Irish community > Key mental health issues for the Irish community
- General: invisibility and exclusion, anti-Irish racism, stigma, negative stereotypes.
- Social risk factors: poverty, unemployment, loneliness and isolation, homelessness, poor living and working conditions, discrimination within the criminal justice system, low levels of social support
- Health: high rates of depression and anxiety, higher risk of psychiatric morbidity, high levels of consultation with psychological problems, high incidence of childhood trauma, perceived alcohol misuse, misdiagnosis and potential dual diagnosis, high suicide rates.
- Service issues: lack of knowledge of services (especially men), delay in seeking help, low or late uptake of services, prevalence of stereotyping
- Spotlight on suicide: High rates of suicide have been recorded among Irish people in England for several decades (Harding and Maxwell 1997, Neeleman et al 1997). During 1999-2003 suicide and undetermined deaths among Irish men and women were 39% and 40% higher than average (De Ponte 2005). The pattern is replicated in figures for parasuicide especially among Irish women. There are particular concerns among Irish community organisations about high suicides in prison, especially among Irish Traveller men.
- Spotlight on alcohol: Alcohol is a sensitive issue in the Irish community. The stereotype of the drunken Irish is inappropriate and offensive but is a factor in low or late uptake of health services, dissatisfaction with care, misdiagnosis and ineffective poor treatment. However, despite some of the highest levels of abstention in Europe, alcohol problems do exist in sections of the Irish community and need to be handled sensitively. Socio-economic, cultural and structural factors all play a part in alcohol misuse among Irish people in Britain (Tilki 2006). Poor physical health, social exclusion, homelessness and discrimination are all linked to alcohol related ill-health. There is community evidence that Irish people use alcohol as a form of medication to deal with the symptoms of underlying mental illness and there is also a suggestion that an alcohol related diagnosis may be more acceptable than a mental illness one (Walls 2004). The potential link between alcohol and suicide for Irish people living in the UK should not be under-estimated.
- Spotlight on faith: It is invariably assumed that Irish people are all Catholics and deeply religious. While the majority of people from the Republic of Ireland are born and raised as Catholics and many practice their faith, others are nominal in relation to church attendance and some have actively rejected their faith. People from Northern Ireland are more likely to be Protestant although like other religious groups they vary in the extent to which faith is personally important or practised. Many Irish people who were abused in institutions by clerics have actively rejected their religion. There is a tendency to assume that the mental health problems of Irish people arise from a state of "Irish Catholic guilt". While this may be true for some, such assumptions neglect the importance of faith in coping with distress and mental illness. Older people and especially women tend to be more religious but many who have lapsed from their faith often return to it when they are distressed. Prayer, rituals and devotions to different saints provide a source of support to Irish people when they are ill.
Mental health and the Irish community > Hints and tips: Delivering inclusive and effective mental health care for the Irish community in Britain.
- Identify whether there is an Irish community organisation in your locality, consult them and involve them in assessing need, planning, delivery and evaluation of mental health services.
- Locate your Community Development Worker or one of the specific Irish Community Development Workers to advise on assessing need, planning, delivery and evaluation of mental health services.
- Develop culturally appropriate outreach strategies to target hard to reach Irish people with mental health problems.
- Proactively involve Irish service users in consultations and recruit members of the Irish community to trust boards, local tribunal bodies etc
- Seek the advice of the Federation of Irish Societies on training for cultural competence
- Explore partnerships with Irish voluntary sector organisation, commissioning culturally appropriate services where possible.
- Erens B., Primatesta P., Prior G. (2001) The Health Survey for England 1999. London. The Stationery Office.
- Harding S., Maxwell R. (1997) Differences in mortality of migrants. In F. Drever and M. Whitehead. Health Inequalities. Decennial supplement, No 15, pp 108-21.London. The Stationery Office.
- Nazroo J, King M ( 2002) Psychosis - symptoms and estimated rates in Sproston K., Nazroo J. (2002) Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC). Quantitative Report. London. The Stationery Office
- De Ponte p (2005) Deaths from suicide and undetermined injury in London. London Development Centre for Mental Health and London Health Observatory.
- O' Connor W., Nazroo J. (2002) Ethnic differences in the context and experience of mental illness: A qualitative study London. The Stationery Office
- Tilki M (2006) The social contexts of drinking among Irish men in London. Drugs: Education, Prevention and Policy 13 (3) pp247-261
- Tilki M., (2003) A study of the Health of the Irish-born people in London : The relevance of social and socio-economic factors, health beliefs and behaviour. Unpublished PhD Thesis Middlesex University.
- Walls P (2004) Irish mental health in England: The evidence. Appendix 1 and 2, in Consulting the Irish community on Inside Outside : Improving mental health services for Black and Ethnic Minority Communities in England - the community response and its evaluation. Report commissioned by the Federation of Irish Societies and funded by the Department of Health