Mental health of Irish-born people in Britain

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Introduction
Background
The Irish experience in Britain
Employment
Housing
Older Irish-born people
Gender
Racism
The criminal justice system
Statistics
Suicide and self-harm
Diagnosis and assessment of mental ill-health
Treatment/services
Good practice 
Useful agencies
Further reading
References

Introduction

In recent years there has been growing concern within the Irish community, Mind and other agencies and professionals working in the mental health field about the mental health of Irish people in Britain.

Irish people have the highest rates of admission to psychiatric hospitals in the UK. [1] They are almost twice as likely to be hospitalised for mental distress than their native-born counterparts. Because of an absence until recently of an Irish ethnicity category in census data these statistics refer only to Irish born people and therefore neglect second and third generation people.

It is not possible to compare UK figures with Ireland due to differences in data collection, availability of support in rural area, absence of community services and differences in in-patient stay. Evidence suggests that the incidence of schizophrenia is not in excess of rates found elsewhere [2] [3], and that admission rates in Ireland are skewed by the acute psychiatric bed availability, few inpatient or community care facilities and poverty, unemployment and isolation in rural areas. [4]

For many Irish people, living in Britain can be just as difficult as it is for people from visible minorities, i.e., people from African Caribbean and Asian backgrounds. They have experiences of prejudice and discrimination, which are similar to people from Africa, the Caribbean and the Indian sub-continent, yet they are not considered to be in need of culturally-sensitive services.

The dominant understanding of racism in Britain is seen in terms of a black-white dichotomy. Irish people are often classified with the indigenous population or with other white minorities, as a result Irish issues often remain invisible. The absence of an Irish ethnicity category in the census means that only Irish-born people are counted and this statistical invisibility impacts on planning and provision of services for this community. The absence of census data results in a lack of research evidence to support claims for services to meet specific needs. The inclusion of the Irish in the “white” category denies the distinctiveness of Irish culture and presumes that mainstream services can provide adequate care.

A development worker from the Federation of Irish Societies concluded that services that recognise the distinct culture of Irish-born people are in short supply. [5] Irish-born people are statistically more likely to be socially disadvantaged, experience high levels of physical and mental health problems and long term disability, and are also grossly over represented as users of the psychiatric services. [6] [7] [8] Research also shows that Irish men are the only migrant group whose life expectancy worsens on emigration to England. [9]

This factsheet aims to give an overview of how the mental health of the Irish community is negatively affected by many factors, including racism.

It highlights examples of racism within the psychiatric service and how it exacerbates mental distress. It is also intended to help raise awareness of the discrimination and the disadvantage experienced by Irish people.

Background

Irish people have been migrating in significant numbers to Britain for the last two centuries.

The 1991 national census recorded 774,310 Irish-born people living in Britain. In 1911 there were 550,040 and in 1981 there were 606,851. [10] By 1991, the national census indicated that there were 886,934 Irish-born people in Britain, of which around two thirds were from the Irish Republic.

Irish-born people now make up approximately 1.5 per cent of Britain’s population. When people of Irish parentage are included, the figure rises to 2.5 million, that is, 4.6 per cent of the population [11] making Irish-born people in Britain, the largest migrant minority in Western Europe.

The Irish, like other minority groups are not homogenous, and come from different socio-economic groups. Differences stem from religious origin, place of birth, whether from a town or a rural background, age, and time in Britain etc. Some will originate in Northern Ireland, others from the Irish Republic and many who identify as Irish will have been born in the UK. Irish people have also intermarried or formed unions with people from other communities and a significant number will identify with one or more aspects of their mixed heritage.

Irish people who are gay or lesbian, disabled, elderly, homeless or with mental health problems experience additional discrimination in wider society and sadly all too often within their community.

Over half the population of Irish-born people in Britain live in London and the rest in major metropolitan cities. These are the traditional areas of Irish settlement, although in recent years there has been a trend to move outwards from these areas.

The Irish experience in Britain

Irish-born people, who have emigrated from their own country to find employment and make a new life, have contributed to the development of industry, commerce and services in Britain. Patterns of migration for Irish-born people differ from other groups in that men and women migrated alone rather than in families.

Many Irish-born people, on their arrival to Britain, despite being white and English speaking, experience culture shock, alienation and racism. A sense of loss and feelings of alienation are common experiences shared among all minority groups. As with other minority groups the combination of social and cultural needs increases the likelihood of mental distress. The colonial relationship between Ireland and England has shaped the beliefs and the behaviour of Irish people and contributed to feelings of inferiority which are easy to reject in Ireland, but more difficult to ‘throw off’ living in England. Such conflicts occur when Irish people are confronted by negative stereotypes. They are faced with the choice of either ignoring or confronting them. Either way can be a recipe for distress.

Most ethnic monitoring programmes do not contain a separate category for Irish people. The net result is that that the Irish community continues to be excluded from attempts to tackle discrimination within Britain. Mary Tilki, Community Care Officer, Federation of Irish Societies and Diverse Minds National Advisory Panel Member argues there is a need for accurate data based on ethnic monitoring of Irish people to determine overall patterns of mental illness. It is imperative that we have information on community morbidity, the access to and uptake of current services, and pathways to care. It is also essential to examine factors such as compulsory detention and treatment, as well as referrals to and from the forensic system.

Employment

There are figures that have indicated that Irish people are twice as likely to be unemployed and more likely to be involved in manual, unskilled and personal service employment (44.5 per cent compared with 28.2 per cent British people). [12] A high proportion of Irish men who migrate to Britain are unskilled workers and seek employment in the building industry, where employment is often erratic and conditions are often unhealthy. A major disadvantage of a lifetime of work in the construction industry is that many Irish men are in poor physical health and unable to work. They have not paid insurance contributions and end up without pensions in their old age or when ill. Their work history makes them suspicious of authority and therefore reluctant to access services.

It is important to understand the role of the pub for men who have spent a life in the construction industry. It was where they found work and lodgings as well as a central point for socialising and seeking safety from hostility and isolation. The need to move around England for work has meant that many have never set down roots and have no supportive relationships in time of need. Sadly the conviviality of the pub has led to problem drinking for some whose working life ended abruptly with occupational injury poor health or redundancy.

Irish women tended to migrate alone and, although they obtained varied employment, many worked as domestics or in nursing occupations. Changes in patterns of employment mean that minority-ethnic women are now more likely to be in part-time work on fixed-term contracts or in casual employment. Long unsociable hours, poor pay and the need to send money home to support the family meant that many Irish women also never married. Those Irish women who did marry were also more likely to marry non-Irish men and more likely to give up paid employment when their children are small. This can lead to social isolation and economic dependence. The pressure to preserve culture and for children to do well has been difficult for all ethnic minority women, and Irish women have experienced the additional stress of racism and discrimination through their children.

All these factors contribute to the high levels of mental health problems, particularly depression , in Irish women. Thus in later life many Irish people have few social support networks or community links. Inadequate social support networks in Britain not only contributes to poor health but can also delay recovery and impair rehabilitation. [13]

Patterns of migration have changed since the 1980s with a reduction in numbers and much return migration. The majority of migrants are well-educated, highly-qualified and in search of career development before returning home. However a significant number of young unskilled people with a range of mental health and substance related problems continue to arrive in England’s cities.

Housing

The 1991 census revealed that Irish people are far more likely to reside in the private rented sector. This frequently equates to shared accommodation which is in poor condition. Hostel figures were also disturbing, with a third of all hostel occupancies in inner London being taken by Irish people and a quarter in outer London. [14]

Homelessness among the single Irish is an acute problem. A survey of housing in London showed that 36 per cent of residents in short stay hostels were Irish but only 4 per cent of those securing permanent accommodation from hostels were Irish. More than 30 per cent of homeless people encountered on the street were Irish. [15]

In the absence of up to date research, statistical data from the Irish agencies working in the UK indicate poor housing and living conditions, homelessness, low paid employment, unemployment and harassment as major problems for Irish people. [16] The Irish often make up the largest single group sleeping rough in Britain’s cities, and are more than twice as likely to be admitted to hospital with a diagnosis of mental illness as the indigenous population. [17]

Older Irish-born people

Unlike other minority ethnic groups the Irish community in Britain is disproportionately older and there is widespread evidence of material and social disadvantage. [18] This disparity also occurs in mental ill-health.According to the 1991 census, 58 per cent of the Irish community was over 45 and 22 per cent were of pensionable age. This is in marked contrast with the profile of the “New Commonwealth” population with 27 per cent aged over 45 and 6 per cent of pensionable age. [19] [20]

As with the host community, women outnumber men, but there is a significant difference in that Irish men are more likely to suffer long-term limiting disability. [21] There is a recognised link between physical and mental illness in old age and this must contribute to some of the depression experienced by older Irish-born people. [22] Irish older people become socially isolated because of ill health, poor housing, reliance on public transport and fear of crime. They have few social support systems and are reluctant to access culturally insensitive mainstream services.

Gender

Despite the common British stereotype of Irish ‘Paddies’ and ‘Micks’, Irish women have outnumbered men in Britain for most of the twentieth century. In 1991 there were 417,027 Irish-born women and 371,253 Irish-born men in England and Wales. [23]

Research conducted in Haringey by Paddy Walls, a counsellor who works with Irish women in London, found that Irish women were over-represented in psychiatric admission rates especially in the 25-44 age band. [24] They had the highest incidence of admission for depression and were also likely to be given a secondary diagnosis of alcohol abuse. Irish women (and men) suffering from depression were significantly more likely to have attempted suicide and some on a number of occasions.

Paddy Maynes, has also stated: “Irish women I see are suffering from panic attacks, depression, suicidal tendencies, guilt and isolation – Irish culture doesn’t encourage us to confront that, to be upfront about our emotional difficulties, to take time to say ‘I feel this’, so we tend to resort to the easiest ways of repressing them, like with tranquillisers.” [25]

Irish men in Walls study had high admission rates for schizophrenia and secondary diagnosis of alcohol abuse. Although more research is needed there is some evidence that Irish men are more likely to be referred to services by the police and the courts.

Racism

Mind believes that mental health problems can be caused by many factors; oppression in the form of racism is undoubtedly one such factor. The social conditions of Irish-born people and of people from other minority ethnic communities must be considered in any assessment of the health of these communities. It has been established and proven that Irish-born people face discrimination in the fields of employment, health, housing and education. [26] This means that like other minority ethnic groups, Irish-born people are often denied access to, or given second-rate opportunities in these areas. These conditions must contribute to mental distress.

The criminal justice system

The Irish are usually ignored in the context of studies of minority ethnic groups and the criminal justice system. Like people from the African-Caribbean community, Irish-born people experience considerable police harassment.This occurs under the remit of the Prevention of Terrorism Act and gives the police powers to stop, search and detain without supporting evidence. Police harassment can fall into two categories. One is specifically targeted in relation to Northern Ireland and the operation of the Prevention of Terrorism Act. However, the other, which is much more widespread, may be part of a pervasive set of anti-Irish attitudes in the British police force. Many instances were reported to agencies of police attack and abuse of Irish-born people triggered by hearing Irish accents or names. [27]

Statistics

Irish-born people are more than twice as likely as native born people to be hospitalised for mental distress. [28] In the case of men, the number of Irish-born admissions is more than triple the figure of English people and other minority ethnic groups. [29]

Irish psychiatric admissions are concentrated in the 25-44 age band, with rates within this age band reaching 76 per 10,000 for Irish women and 35 per 10,000 for Irish men. [30] The rate of admissions for England was 5.5 per 10,000 population.

Irish-born people are over-represented in most diagnostic categories, but the figures for depression and alcohol-related disorders are particularly striking. Men and women born in the Republic of Ireland have approximately nine times, and women seven times, the rate of alcohol-related disorders.

Rates of admission to hospital for depression show that those born in the Republic of Ireland have two and a half times the rate of their British born counterparts. [31] The incidence of schizophrenia, anxiety and, to a lesser extent, personality disorders are also higher than in most groups. [32]

The Brent survey also found that there was a disproportionate number of Irish-born people compulsorily detained under the Mental Health Act and ECT was more likely to be administered to Irish patients. There is evidence of the under-use of expensive non-physical, preventative therapies or talking treatments such as counselling, psychotherapy or group therapy.

In an analysis of admissions to psychiatric hospitals in the London Borough of Brent and the City of Westminster in the year to March 1991, Irish-born people comprised 15 per cent of clients with identifiable origin, while the local Irish population was 8.7 per cent (census 1991). [33]

In 1996, a report of the Irish population in Haringey, London, found that Irish women were particularly over-represented, with an admission rate of 40 per 10,000 population. [34]

Some psychiatric admissions may be due to misdiagnosis informed by negative cultural assumptions. [35]

The high admission rates have an impact in terms of transient housing, low incomes, social relationship difficulties.

Mary Tilki argues that “ culturally-sensitive provision is central for all minority groups but there is a distinct resistance to Irish sensitivity”. [36]

Suicide and self-harm

Research has shown that of all ethnic groups in Britain, the Irish have the highest rates of suicide. From 1988 to 1992 the Irish rate for suicide and undetermined deaths was 53 per cent in excess of the native-born rate (at an age-standardised mortality of 17.4 per 100,000). [37] There is little indication that these figures have changed over the years. A London study of the period 1991-1993 found a significant mis-classification of immigrant suicides, with a strong tendency for the official figures to underestimate Irish suicides. The authors of this report calculated the Irish rate as being higher, by a factor of 2.2 (for men) and 2.9 (for women) than the rate for native-born people. [38]

In the UK, suicide is the second most common cause of death, after road traffic accidents, for those aged 15–35 years, in Ireland suicide is the principle cause of death in young people.

Studies have also shown that Irish-born people are over-represented in admission figures for attempted suicide and self-poisoning [39].

Diagnosis and assessment of mental ill-health

Psychiatrists, the police and Approved Social Workers (ASWs) all have statutory responsibilities under the Mental Health Act 1983 with respect to the recognition of mental health problems. There is concern, particularly in relation to people from Black and Minority Ethnic communities, that these professionals do not have the awareness of cultural values and norms necessary to do this task effectively.

Of the three professions with responsibilities for assessment under the Mental Health Act, only ASWs have a statutory requirement to show an understanding of working in a multi-racial society. There is no requirement during the training of doctors, nurses, police and social workers to demonstrate cultural sensitivity.

GPs and psychiatrists make diagnoses as well as deciding upon the type of care to be offered. Psychiatrists currently diagnose serious mental health problems in people from Black and Minority Ethnic communities at much higher levels than amongst the white community. [40] There is concern that lack of training in, and lack of awareness of different cultures may lead to incorrect diagnosis.

Alcohol mis-use by some Irish migrants may be a response to being homesick or to discrimination. When this problem is compounded with poverty, discrimination, unemployment or homelessness it can inflict huge psychological distress on an Irish person’s well being.

Diagnosis may be based on prejudice, lack of cultural understanding and stereotypical assumptions such as “mad Irishman” and “alcoholic” making them questionable. There is anecdotal evidence from Irish voluntary sector agencies that alcohol is also used by some Irish-born people as a form of self-medication when the symptoms of depression or schizophrenia make life difficult. This can result in a diagnosis of alcoholism with the underlying disorder being neglected. As in the case of the African Caribbean person, who is likely to have a secondary diagnosis of cannabis psychosis, the Irish person is likely to have a secondary diagnosis of alcoholism. [41]

As with some other communities religious devotion is often misinterpreted by practitioners, who do not understand the significance of prayer and religious rituals for some Irish clients. There is also a tendency to blame mental illness on “Irish catholic guilt” thus making the assumption that all Irish people are of the same faith. It also and neglects both the reality of exclusion and disadvantage and the importance of faith and prayer to people in distress.

Although Irish-born people speak English, the language is sometimes used differently and can be misconstrued by professionals assessing the client. Despite legislation to deter racist abuse, it is still common for accents or colloquialisms to be ridiculed. This may evoke an angry response, and thereby confirm the negative stereotype assumptions that the perpetrator believes. [42]

Approved Social Workers (ASWs) are involved in the assessment of people in a “mental health emergency”. They receive specific training for the purposes of this assessment and it is their role to decide the best course of action. This could involve a decision to detain an individual in hospital under a section of the Mental Health Act.

GPs play an important role for people from the Irish community because they are frequently their first point of contact with the psychiatric system.  As with psychiatrists, the Police, ASWs and indeed all health professionals, better training is needed for GPs to increase their awareness of Irish-born people and hence to provide an improved service. There is little research or information about GPs in relation to the Irish communities.

Treatment/services

There is evidence that Irish-born people are reluctant to access health care, which may mean that problems are never discussed, get out of hand and require crisis intervention, or may lead to suicide. Despite the high incidence of mental distress, Irish people appear to be less likely to access counselling and psychotherapy services. It has been suggested that the main reason why the Irish are reluctant to seek help is because of the cultural tendency not to admit to problems. The Director of the Immigrant Counselling and Psychotherapy Centre has stated that “It is much easier to cloak our problems with alcohol and religion”. [43] While there is some truth in that assertion it is more likely that like other people from minority ethnic groups that talking therapies are not offered to Irish people. The success of ICAP and other Irish organisations testifies to the fact that Irish people will happily access services that are culturally sensitive. A significant number of Irish-born people are marginalised and can only be identified and treated by appropriate outreach services. As in other communities, insensitivity, hostility and stigma prevent people accessing help early enough.

Often treatment and services for the Irish community are not relevant to their needs or of a high enough quality. Services need to be appropriate to the culture of clients in order to be effective. For example, a recent report of the views of Irish mental health service users in Brent found that there were no Irish-specific social workers or outreach workers employed in the mental health field in Brent. There were no Irish psychiatrists practising in any of the borough’s hospitals. In addition, there were no Irish-specific mental health resources similar to those provided for other ethnic communities who, like the Irish, suffer dis-proportionate levels of mental illness compared to the host community. [44]

Mary Tilki argues that “current models of good practice need to include joint provision between a local NHS trust and the Irish voluntary sector. An example of good practice could be outreach services, which would be jointly funded by the voluntary and the statutory sector. Its support services could, for example, include alcohol counselling/advice work and an elderly project.”

Ethnic monitoring of hospital in-patients has only been mandatory since April 1995; hence there is at present, a dearth of statistics on the different treatments received by people from different ethnic groups. The 2001 census categories require the Irish to be monitored as a separate group, and service providers are now required to do this. Pressure must be put on PCGs PCTs to ensure that the GP who is the first line of treatment and prevention for the majority of clients be obliged to keep ethnic monitoring records.

Good practice

The effectiveness of Irish service providers, operating with few resources, has been highlighted and documented. There is a need to invest in capacity building to expand the ability of the Irish voluntary sector to meet the needs of Irish people in Britain.

An appropriate service development for people from Irish communities, as with other Black and minority ethnic communities, requires their involvement in planning and implementation from the outset, rather than services, which are not tailored to meet their needs. “Having an awareness of culture and the needs of people from different cultural backgrounds, for example, would work against a tendency to slot people into cubby-holes for diagnosis; it would mitigate against blanket diagnoses for particular groups, and it would engender working with clients and carers in the planning as well as implementation of appropriate treatment.” (Melba Wilson, Mind Race Advisor, 1998). [45]

This means that Black and minority ethnic organisations can provide valuable input to mainstream, statutory agencies regarding diagnosis, assessment and treatments. Where this occurs the notion of ‘mainstream’ can appropriately be redefined and good quality services can be established.

Written by Carole Reid-Galloway, last updated by George Stewart, Mind Information Unit November 2001

Useful Agencies

There are Irish community organisations or centres in many parts of Great Britain. Details are available from various national bodies with links around the country. Some of these include:

Further Reading

Articles

'A Race Apart', Gearoid O’Meachair, Social Work Today, 30 January 1992

'Access Refused', Rachel Downey, Community Care, 10-16 July 1997

'Breaking the Silence', Paul Gribben, The Irish Post, 1 February 1992

'Ethnicity and variations in the nation’s health', Health Trends, 27, 114-119

'Forgotten figure: mental health and the Irish in Britain', Richard Butler, Openmind, Aug/Sept. 1994, 70

'Generations of an invisible minority', Institute of Irish Studies, Occasional Paper No.2, Liverpool Institute of Irish Studies

'Irish Missed', Audrey Thompson, Community Care, 16-22 January, 1997

'Mental Health and ethnicity: an Irish dimension', Patrick J. Bracken, Liam Greenslade, Barney Griffen and Marcelino Smyth

'Mental Health and the Irish Community', An Pobal Eirithe No. 2

'Mental hospital admission rates of immigrants to England and comparison of 1971and 1981', Social Psychiatry and Psychiatric Epidemiology, 24 2-11

'Migration and schizophrenia: an examination of five hypotheses', Social Psychiatry, 221, 181-191

'Mortality among second generation Irish in England and Wales', J. Haskey, British Medical Journal, 1 June 1996

'Suicide levels and trends among immigrants in England and Wales', Health Trends, 24, 91-94

'The Health of the Irish in Britain', M. Tilki, Federation of Irish Societies Bulletin, 9 May 1996

'The incidence and prevalence of schizophrenia in the Republic of Ireland', Social and Psychiatric Epidemiology, 25, 210-215

'The Irish in Britain, Socio-Economic and Demographic Conditions', Occasional Papers in Irish Studies No.3 Liverpool Institute of Irish Studies

'The Irish: Britain’s forgotten immigrants', Social Work Today, 19, 18–19

Books

The Irish Experience of Mental Ill-health in London, Brent Irish Mental Health Group, 1986

Aliens and Alienists, Roland Littlewood and Maurice Lipsedge, Routledge, 1997

Health, ‘Race’ and Ethnicity: Making Sense of the Evidence, C. Smaje, King’s Fund, 1995

Mental Health, Race and Culture, Suman Fernando, Macmillan/Mind, 1991

Race, Culture and Mental Disorder, Philip Rack, Tavistock, 1982

'Racism and Transcultural Psychiatry', Kobena Mercer, In: The Power of Psychiatry, Peter Miller and Nickels Rose (eds.), Polity Press, 1986

Reports

Age and Race: Double Discrimination. Life in Britain Today for Ethnic Minority Elders, Commission for Racial Equality/Age Concern, March 1995

Discrimination and the Irish in Community in Britain, Commission for Racial Equality, 1997

Meeting Diverse Needs, Ute Kowarzik, Action Group for Irish Youth and Federation of Irish Societies, 1997

Race relations – code of practice for the elimination of racial discrimination and the promotion of equal opportunity in the provision of mental health services, The Commission for Racial Equality, 1992

Researching Irish Mental Health: Issues and Evidence – A study of the mental health of the Irish community, A Muintearas Report, Paddy Walls 1996

The Hidden Minority – Mental Health and the Irish Experience in Brent, Elizabeth Farrell, 1996

The Irish in Britain in the 1990’s, A preliminary report on the 1991 Census. Census Reports No. 1, Liverpool Institute of Irish Studies, Liam Greenslade

Other Information

Diverse Minds
Mind’s Black and Minority Ethnic Initiative, Granta House, 15-19 Broadway, Stratford, London, E15 4BQ
tel. 020 8519 2122 ext. 218/222

MindinfoLine

0845 7660 163
Language Line – telephone interpreting service available

or write to:
Mind
PO Box 277
Manchester
M60 3XN

Mind Mail Order
15-19 Broadway, Stratford E15 4BQ
tel. 020 8221 9666.

Mind’s Policy on Black and Minority Ethnic People and Mental Health, Daphne Wood, Mind, 1993

Mental Health Statistics 3, Race, Culture and Mental Health, Mind Information Unit

Cultural Identity and Racism Video Directory , a comprehensive list of videos for sale or hire in the UK, Mental Health Media Council, 1993

References