Facing Double-Stigma, Roma and Traveler Communities Excluded from Drug Treatment Services

Dealing with the double stigma of racially-fuelled exclusion from local services and problematic drug use, Britain’s Gypsy and Traveler communities are among the most marginalized groups when it comes to addressing substance misuse.

Until quite recently drug use was very rare among Gypsy and Traveler communities. In the last 15 years, however, local health workers, community members, and voluntary sector agencies have been anecdotally reporting increasing problematic substance use among primarily the young and unemployed of these groups.

The pattern of this substance misuse is particularly concerning: polydrug use, lack of knowledge about safe injecting and speedy progression to “hard” drugs including crack cocaine and heroin are likely exacerbated by historical disengagement with fulltime education.

A six month research project in Tower Hamlets, London, found that the most common drugs of use were herbal cannabis, crack cocaine and heroin. Worryingly they also discovered that the average age of first drug use was 13 years and that users rarely came into contact with drug services until their use was at a very advanced stage, and then often through Youth Offending Teams or Probation Services.

Britain’s estimated 200,000–300,000 Romani Gypsies and Irish Travelers, as recorded by charity Friends, Families and Travelers (FFT), are among the most disadvantaged minorities in the UK. FFT reports that life expectancy is accepted by the Department of Health to be 20 years less than the general population, infant mortality is three times higher, and children are 20 times more likely than the population as a whole to die before reaching the age of 18.

Poor mental health is a driver of substance misuse. A 2009 report by the Equalities and Human Rights Commission highlights:

"the pervasive and corrosive impact of experiencing racism and discrimination throughout an entire lifespan and in employment, social and public contexts. Existing evidence, including from the consultation, highlights high rates of anxiety, depression and at times self-destructive behaviour."

Gypsies and Travelers are twice as likely to experience depression and three times as likely to have anxiety problems compared to the public as a whole.

Racial discrimination in housing services -- nine of 10 planning applications by Gypsies and Travelers are rejected -- and regular experiences of evictions and precarious housing situations also exacerbate poor mental health in these communities.

Racism feeds into the unwillingness of these communities to engage with schools. A 2014 report found that nine out of 10 Gypsy or Traveler children in Britain have suffered racial discrimination, with nearly two-thirds reporting bullying or physical attacks.

The racism experienced by Gypsies and Travelers on engagement with public services increases unwillingness to seek help for problematic substance use. The Equality and Human Rights Commission reports that community members "were extremely concerned that contacting doctors for advice on substance misuse would lead to social services intervention or police action. Accordingly, very little external help is sought for alcohol or substance misuse, with families preferring to attempt drastic self-help detoxification or merely 'managing' the problem."

Similarly, the Royal College of Physical and Healthcare Practitioners found in a 2013 report that "previous negative experiences with health professionals, complex needs and chaotic lifestyles can make it difficult to access services and navigate the health system."

A quick scan of tabloid headlines related to these communities reveals a familiar blend of benefit-fraud hysteria and dog-whistle racism over theft and property crime. The Daily Mail recently published an article that asserted that "Despite [criminal] trials, many [gypsies] can still be seen openly stealing and aggressive [sic] begging on the streets of Paris every day of the week." Substitute Romani Gypsies for any other ethnic group as the “many” in question and this article would certainly never have been published.

In July this year Conservative MP Gary Streeter alleged that Travelers are richer than most MPs, are not a vulnerable group in need of special treatment and that "when they’re in town there’s a spike in local crime." 

Stoicism and self-reliance are key values for these peoples, long-marginalized and persecuted by majority populations of the societies in which they have found themselves. As such they are often unwilling to discuss intimate matters, including health, with strangers, particularly where these cross-traditional or gender boundaries intersect with moralized health problems like drug or alcohol misuse.

However, the foundational role of community-living and familial support within Gypsy and Traveler culture also offer an opportunity to approach treatment for substance misuse in a more holistic way that integrates individuals’ problematic use with larger community support networks.

Local initiatives in Newham have found that through allowing a local Roma community group -- the Roma Support Group -- to lead a series of meetings between different generations of community members and local health service providers, a public debate could begin that encouraged mutual recognition of barriers to healthcare provision.

Organizers reported that "many older Roma people were able to hear at first-hand how hard some young people were finding the battle against illegal drugs … consultation between drug treatment providers and Roma has really helped demystify some of the problems in providing appropriate substance misuse services."

Addressing the latent racism and nonfactual reporting in public discourse around Gypsies and Travelers is a key element to treating substance misuse in these communities. However any serious attempts to tackle health inequalities within these communities will fail without efforts to adapt services to specificities of a minority determined to preserve their distinctive cultural heritage.