Setting up and running women’s peer support in Wales can be very different to doing this in England. This section considers those differences and how location-specific challenges were overcome by the Welsh projects that took part in Women Side by Side.
Mental health problems are a significant issue in Wales, where between 300 and 350 people die by suicide each year. Many women in Wales experience mild to moderate mental health problems, and yet stigma and shame associated with them remains high. Over 600 Welsh women took part in the Women Side by Side programme, with many facing multiple barriers to accessing basic mental health care.
Peer support in rural isolation
In North Wales in particular, isolation and loneliness are major factors in mental ill health. Some women live in extremely rural areas, which makes it difficult for them to travel to access support. The nearest mental health service might be several hours’ drive away.
In areas where public transport is scarce or unreliable, peer support groups may need to arrange for someone to discretely pick women up from a meeting point or to arrange transport networks in which women who do have cars can offer lifts to those who don’t. This can encourage a sense of empowerment and interdependence.
The importance of Welsh language
While in large cities, such as Cardiff, you will hear English, Welsh, and many other languages spoken on the average street, North Wales is the heartland of the Welsh language. Most education is delivered in Welsh. All official written communication is provided bilingually and the Welsh translation always comes first. North Wales Welsh also is different to South Wales Welsh. If a person is given a document or provided a service in a form of Welsh that is not native to them, they may feel alienated.
This has significant implications for peer support. Some women only feel comfortable communicating in their native tongue but cannot access support that is culturally appropriate. In Wales, language is an emotionally and politically loaded topic and English has a long history of being used as a tool of oppression. It is vital to remember that some families have experienced generational trauma as a result of this. Hearing or writing Welsh or English might have implications for some people’s mental health.
- Jessica had moved to North Wales as a teenager and struggled to learn the language in a Welsh school. Although intelligent, she had been moved to remedial classes and isolated from her peers. She was terrified to attend peer support services, believing they would only be available in Welsh.
- Arwen was chastised by a doctor at her local A and E department who told her that she was being rude when she tried to comfort her poorly daughter in Welsh, the language they spoke at home. Subsequently she was worried that she would be ‘told off’ for speaking Welsh in the peer support group.
Some peer support groups mitigate these difficulties by providing a Welsh language group and an English language group and offering members the choice of which one to attend. However, this can increase a sense of ‘otherness’ and isolation.
A more inclusive solution is to offer all groups bilingually, if at all possible. If group members can act as informal translators, it can give a sense of ownership and inclusion. All printed materials should be provided in both Welsh and English like this toolkit, using the correct regional variation, and placing the Welsh words above the English when possible.
Previous experience of poor treatment or neglect
Previous negative experiences with mental health services can be a huge barrier to accessing peer support. If someone has been brave enough to ask for help but then been mistreated or ignored by those who should have helped them, they will be wary of asking for help again. Although this is a global issue, North Wales has a disproportionate number of underfunded and underperforming health services. Many women find themselves on increasingly long waiting lists or they are offered support that is not appropriate for their needs.
Poverty and discrimination
More than four in ten children are living in poverty in Wales despite one or more of their parents working. People who have grown up in economically deprived areas have lower levels of physical and mental wellbeing. The Welsh Health Survey (2016) found that in the least deprived areas, 8% of adults were being treated for a mental health problem compared to 20% of adults in the most deprived areas.
The 2018 Big Mental Health Survey found that 82% of respondents in Wales reported experiencing discrimination in at least one area of life. North Wales is an area that lacks racial and ethnic diversity. This means that women who come from a black or minority ethnic background find it extremely difficult to access peer support with women who have the same cultural background. As a result, many do not access support at all.