Case series: Psychosocial challenges of female youth within the Irish Travelling community

Case series

Patient A is a 19-year-old girl known previously to CAMHS. She has a history of overdose, self-harm and depression. Significant triggers for her mental illness are linked to familial disharmony. Patient A interprets herself as not fitting into her family, her sisters tend to bully and exclude her. There is a strained relationship with her parents who separated when she was 9 years old, her mother is described as distant and has a history of depression. Her father has a history of domestic violence towards her mother and can react to her difficulties by making a joke or trivialising her symptoms. He views patient A as not needing mental health input.

At age 17 patient A was sexually assaulted and she has been fearful of going outside following this attack. She had stopped attending school and discontinued her favourite hobbies. Her father continued to bring her to events enjoyed by many of the travelling community including fairs and family gatherings, however she had stopped engaging at such events. Patient A explained to CAMHS that the assault had ‘shamed’ her and she felt judged by her community. She was trialled on sertraline and fluoxetine with consideration given to starting venlafaxine however medications did not relieve her symptoms. CAMHS attempted to engage her in psychology and community groups which were all declined. Patient A described feeling mistrustful of medical and social work services and for this reason was defensive at times during her visits to CAMHS. She became isolated from others and within her family.

Background difficulties include discrimination from ‘settled’ people in Ireland, poverty and poor attachment with limited emotional support due to parental mental illness. Patient A discussed feeling hopeless regarding her prospects of marriage and work in future. The family continue to follow the traditional traveller lifestyle and identify strongly with this.

Patient B was referred for CAMHS inpatient admission in March following polypharmacy overdose. This suicide attempt had been precipitated by bullying and familial discord, her family had moved locations following serious assault of her mother by relatives. Two years ago the patient suffered sexual assault by a peer, she feared reporting this abuse as she did not wish for retaliation from the Travelling community or to be known as ‘used’ or ‘dirty’. Patient B was diagnosed with ADHD in 2019 and had been successfully trialled on concerta XL however a trial of fluoxetine had not improved symptoms of low mood. In 2020 she began to abuse cannabis and alcohol which she has since discontinued. This adolescent has required crisis intervention on many occasions.

Her family history involves trauma and mental illness. Her mother has a diagnosis of bipolar disorder and childhood sexual abuse. Her mother discussed suffering post-natal depression following the birth of the patient, she had wished for a boy and felt she had ‘left down’ her family by having a girl. Patient B’s parents separated when she was 4 years old and since then her father has been turning up in chaotic circumstances and is inconsistent. He suffers from addiction to heroin and has a history of engaging in criminal activity. Patient B’s paternal grandfather died of alcoholic liver failure in 2019 and her paternal uncle committed suicide was patient B was age 6 years. Her maternal grandmother has a history of depression and alcohol dependency, she lives with the patient. There are many instances which patient B has witnessed involving her grandmother’s intoxication, her mother’s self-harm and her father being violent. Patient B continues to worry that her father will overdose in future.

Patient B’s family live in council accommodation nearby other members of the Irish Travelling community. Patient B continues to attend school although can be inconsistent at periods. She spends her spare time with her male cousin from the Travelling community and his friends. She feels ‘safe’ with this group as her cousin will ‘protect’ her. He tends to fend off the attentions of other adolescent Traveller males who approach patient B with suggestive talk regarding desired sexual relationships. Patient B is determined not to follow the Traveller tradition of marrying early. She recalls being ‘in training’ which involves home tuition of household and childminding skills from a young age to be ready for life. ‘Traveller men have all the freedom, what they say goes’. The family continue to enjoy social traditions within the Travelling community.

Patient C is 15 years old and is ‘half-Traveller’. Her father was brought up in the Travelling community and her mother is from the non-Travelling or settled community. She was admitted to a CAMHS unit following a hanging attempt requiring I.C.U admission. Her suicide attempt was triggered by chronic bullying by her peers at school, grief due to her grandfather’s death and she had suffered an attempted sexual assault 2 months previously. She had attempted suicide three times over the previous 4 months escalating in severity. Trials of sertraline and risperidone were unsuccessful in the community.

There is a family history of anxiety but no history of known mood disorder or substance misuse. Her father left the community as a young man as he disliked the lifestyle and discrimination he faced from others. Patient C did not know of her background until late childhood, she has witnessed other children being bullied for their ‘Traveller accent’ in the past. Patient C discussed that if both of her parents were members of the Travelling community ‘they would have to stick with it (remain in the Travelling community), no choice’. Patient C does not wish to be part of the Travelling community as she interprets some members as being aggressive. She acknowledges that some members of the Travelling community can gain a ‘bad reputation’ and how this is ‘unfair’. The family own their home and live beside a Travelling community family who have become close friends and ‘like family’.

Patient C hopes to go to college and work with children in future. She does not wish to be ‘set up’ with a partner for marriage and does not wish to have many children. She described how Traveller men leave school early and follow their fathers career path whether that be horse trading, roofing, tarmacadam work or ‘hawking’, the selling of scavenged copper. She described how men from the Irish Travelling community ‘try to find a woman’ and ‘then it all repeats’, meaning the cycle of leaving school, traditional work roles, marriage in adolescence and the creation of large families. Patient C does not seem to have accepted her Traveller roots and may be conflicted by some related identity confusion. She prefers to spend time with adolescents from Travelling families who have become integrated in the settled community and fears being bullied or judged by others.

Discussion

Statistics and focus group findings indicate the difficulties experienced by the Travelling community, 82% have experienced suicide of an immediate or extended family member, only one in 10 travellers continue to enjoy their nomadic lifestyle and 62% are unemployed (O’Mahony, 2017). Irish Travellers encounter the same challenges known to the general population and other minority groups in Ireland however they experience increased difficulties more frequently compared to other groups (McKey et al., 2020). Such challenges include discrimination, exclusion, domestic violence and limited opportunities in society (McKey et al., 2020). The reason for increased adversity is thought to be due to their treatment as third-class citizens in Irish society (McElwee et al., 2003). The Travelling community in Ireland tend to be considered below other minority groups who have a more distinct and less intertwined history with the settled community (McElwee et al., 2003). Such disadvantage translates down the generations and results in a people susceptible to mental illness.

The shared experience of hardship in the Travelling community does result in a close-knit group who are determined to keep hold of their rich traditions and customs (Cavaliero, 2016). There are many positive aspects to this community including their identity, specific culture and multi-generational talents (Cavaliero, 2016). In a modern society which is becoming more desolate and technology dependant, the Irish Travelling community are retaining their close connections and values. The need for socio-cultural retention within this community is upheld by the male and older members of the Travelling community however the young females have been developing a different narrative (Cavaliero, 2016). Despite the many positives of the traditional Travelling community, female adolescents within the community are beginning to voice a desire for a more complete education and options outside the home (Cavaliero, 2016). This change is in line with societal development and modern focus on feminist ideology, inclusiveness and higher standards of achievement in education and work (Cavaliero, 2016).

Much research refers to the Travelling community as a whole or concentrates on the mental health difficulties of traveller men. There is limited research on adolescent females within the Travelling community who tend to suffer much adversity due to traditional gender roles, prejudiced attitudes and limited options (Abdalla et al., 2010). Poverty and discrimination struggles are a constant concern for traveller women in general and such struggles have become endemic (Hodgins et al., 2006). Young women are primed to follow a culture where the main events in life are centred around training for marriage and child rearing (Abdalla et al., 2010). The numbers of women availing of alternative lifestyles including living with a partner, remaining single or entering education, training or work are low (Duggan-Jackson, 2001; O’Mahony, 2017).

The cases outlined contained a theme of a desire to avoid early marriage as each adolescent involved perceived women in the Travelling community to have no voice or options. Patient B and C hope to avail of educational opportunities and work outside the home. Patient B particularly did not agree with the role of women in traveller culture. It must also be acknowledged that women do hold a special position within Traveller communities as they support the family emotionally through financial difficulty, discrimination, illness and exclusion (Abdalla et al., 2010). Men provide money, enterprising skills and represent their family (Villani & Barry, 2021). The female care-giver role does however cause increased pressure as women must scaffold and sustain the family, which can result in these women being vulnerable to expressed emotions resulting in increased risk of violence (Hodgins et al., 2006). Eighty-one percent of female travellers experience domestic violence (Cemlyn et al., 2009). Patients A and B had both witnessed or experienced assaults within their home and community towards women. Each case included family history of mental illness, trauma and social adversity which is experienced throughout the family and extended community.

Young women in the Travelling community are estimated to be twice as likely to suffer mental health issues as compared to men in the travelling community (Cemlyn et al., 2009). A total of 62.7% of traveller women suffer from poor mental health as compared to 19.9% of non-traveller females (Mental Health Reform, 2014). Much mental illness is attributed to suffering ethnic as well as sexual prejudice (Abdalla et al., 2010). Their position in society can leave such young women vulnerable and at risk of assault from inside and outside the Travelling community (Department of Health, 1995). In addition to vulnerability to assault, female youth have difficulties with understanding normal physical processes which results in susceptibility to sexual difficulties (Condon et al., 2019). Pre-marital sexual activity is a taboo topic resulting in reduced discussion among females which can result in a lack of information in sexual health and functioning (Condon et al., 2019). Males and elders within the community tend to advise younger members which can result in a lack of uptake of offered services, many men view the HPV vaccine as a ‘slur upon their daughters’ purity’ (Condon et al., 2019).

Other hardships include experiences of abnormal grief and loss, there is a higher risk of suicide and early death in the Travelling community who feel the loss of loved one’s keenly (Tobin et al., 2020). Traveller women are fearful regarding their families’ and their own mortality. Although largely psycho-social, Irish travellers have significant biological risk factors for mental illness namely genetic factors and inter-generational susceptibility which is known to contribute to disorders like depression and psychosis (Gilbert et al., 2017). Many traveller women deal with stress by increased smoking of nicotine, covert alcohol use and hope to avoid mental health services (Hodgins et al., 2006).

The position of women in travelling traditions can led to the women being central to life and the family with the potential to be leaders but hardships endured result in feelings of frustration and powerlessness (McElwee et al., 2003). In this world of modern technology, ethical practice and focus on women’s rights, females in such communities can feel conflicted between their identity, heritage and their position in the world (Villani & Barry, 2021). Women are encouraged to enter all positions and aspects of society in modern Ireland. This can be difficult when discrimination towards the travelling community is still commonplace and acceptable (Cemlyn et al., 2009; Jackson et al., 2017).

The most promising way for young female travellers to promote awareness and build their future is through education. In 2015, research showed that 13% of travellers completed second level schooling (Pavee Point, 2015). Advocates for the Travelling community within education and mental health services is on ongoing need (Villani et al., 2021). Strong leadership is needed from within the Travelling community to represent their concerns at a political and community level. Studies have reported that youth should remain attached to the Travelling community while progressing through life as the identity and social supports provided are a protective factor for their mental health and wellbeing (Pavee Point, 2015). Within mental health services, adolescents within the Travelling community should be monitored with consciousness given to their particular risk factors. The numbers of Irish Travelling community accessing CAMHS in Ireland makes up 3% of the CAMHS case load which validates the need for CAMHS services to be attentive to this cohort (Pavee Point, 2018). Outreach services for adolescents at high risk of suicide has been advised for prevention of higher death rates (Abdalla et al., 2010). The holistic approach of psychiatric teams can add to the security of the community by aiding creation positive relationships within school and community.

There continues to be minimal published research on the Irish travelling community and few published works focus on the vulnerabilities of adolescent girls within the travelling community (Watters et al., 2020). Further research on this topic would inform future practice and interventions in mental health services for such a marginalised high-risk group.

Conclusion

The Irish Travelling community are susceptible to increased mental health issues due to their experiences of disadvantage and exclusion in their position within society. This is despite protective factors including a strong culture and close relationships. Traveller adolescent females are particularly vulnerable due to increased restriction within their lifestyles. The literature and cases outlined discuss limited options for education and socialisation for Traveller females within a domestic role and a modern shift towards an increased desire in Traveller females to vary their lifestyle. Mental health services and communities can support female youth within the Irish Travelling community by recognition of their difficulties within the context of their culture and community.