Intended for healthcare professionals


Gypsy, Roma, and Traveller groups need more equitable mental healthcare, says report

BMJ 2023; 382 doi: (Published 29 September 2023) Cite this as: BMJ 2023;382:p2260
  1. Emma Wilkinson
  1. Sheffield

The NHS needs to do much more to overcome the stark inequalities facing Gypsy, Roma, and Traveller communities in England—particularly on poor mental health outcomes—a report from the NHS Race and Health Observatory has concluded.1

There is widespread fear and mistrust among the communities towards public services, and waiting lists and digital access can form further barriers to care, the report produced in collaboration with the University of Worcester found.1 Despite a clear need, a lack of tailored health services, poor cultural understanding of the problems faced, and a paucity of granular data all hamper access to mainstream NHS services, it concluded.

Romany and Traveller people have a rate of suicide that is up to seven times higher than the general population. Among several recommendations is that the Department of Health and Social Care and NHS England develop a national comprehensive strategy for mental health that considers the unique experiences of these communities.

One matter identified in the report is a considerable amount of shame and stigma associated with poor mental health among Gypsy, Roma, and Traveller groups.

Many Gypsy, Roma, and Traveller people have led traumatic lives and have often experienced discrimination and racism from an early age, highlighting the importance of trauma informed approaches to build understanding between professionals and members of the community, it added.

Those experiences should be explicitly considered in NHS England’s upcoming framework for action on inclusion health, the report added. National and local health systems should also ensure that mental health and suicide prevention policies take specific account of the needs of these communities.

The report took evidence from six locally organised and targeted services offering mental health services to Gypsy and Traveller communities in Cambridgeshire, Hertfordshire, Ireland, Leeds, Lincolnshire, and York to identify best practice. But it was hard to assess the impact as the organisations are not resourced or supported to collect or analyse data. Funding for the organisations was often charitable, rather than through the NHS or local authorities, and short term, the report found.

Habib Naqvi, chief executive of the NHS Race and Health Observatory, said the report “lays bare the mental health problems and stigma” faced by Gypsy, Roma, and Traveller communities and the challenges they face in accessing services. “We are pleased to have co-produced with these communities a clear set of practical, tangible actions and recommendations for more equitable mental healthcare provision,” he said.

Focus needed on suicide prevention

The report noted that in 2022, the charity Friends, Families, and Travellers found that of 89 suicide prevention plans in England, only five mentioned Gypsy, Roma, and Traveller communities and only two listed any action plan strategy.

The five year suicide prevention in England plan published earlier this month gives two mentions to Gypsies, Roma, and Travellers but does not afford them priority status or include them in its associated action plan.2

Josie O’Driscoll, chief executive of GATE Herts, a community led organisation working to normalise and destigmatise mental health problems, said, “Gypsy and Traveller communities are rarely considered in local policies and strategies and while we are delighted that we are recognised as an at risk group in the newly published suicide prevention strategy, it doesn’t go far enough. A lot more needs to be done to tackle entrenched inequality and serious disparities.”

The Department of Health and Social Care and NHS England were approached for comment.