European Commission releases initiative on mental health: What’s in it for Europe’s Roma?

On 7 June 2023, the European Commission put forward a Communication laying out a comprehensive approach to mental health, aimed at helping Member States and stakeholders take swift action to deal with mental health challenges. The Communication features 20 European flagships and identifies financing opportunities worth EUR 1.23 billion.

ERGO Network’s research report Roma access to healthcare and long-term care (2022) includes a dedicated chapter on Roma mental health. Our findings show that the Roma experience a higher risk of being in poor mental health, however, most of them cannot access much-need care and support due to unavailability of services in communities, high costs of consultations, antigypsyism and stigma, and lack of trust in the healthcare system overall. See below for a summary of our analysis of the EC Communication from this perspective.

  • Read our full response to the Communication here!

We warmly welcome that the Roma are explicitly mentioned in the Communication, with statements closely aligned with our own findings. We also particularly appreciate the social determinants of health perspective, looking at poverty, discrimination, and poor access to quality housing, education, and employment. The text also features clear links with the EU Roma Strategic Framework for Equality, Inclusion and Participation, which is mentioned twice, as well as with the Council Recommendation on Roma Equality, Participation and Inclusion. We are equally happy to see that the Communication mentions ethnic minorities, underlining that inequalities based on ethnicity have an important impact both on mental health as well as on access to adequate care. Last but not least, discrimination is comprehensively mentioned throughout the document, including explicit references to the discrimination faced by the Roma.

However, antigypsyism as such is not mentioned, nor is there any reference to racism or the EU Anti-Racism Action Plan. While comprehensive efforts and funds are dedicated to combatting the stigma and discrimination associated with mental health, which is very welcome, no similar efforts are foreseen to combat discrimination on other grounds (such as ethnic or racial background), despite it being acknowledged as a determinant of poor mental health. The sections on the prevention of psycho-social risks at work and on reinforcing mental health systems and improving access to treatment and care fail to mention discrimination in the workplace, or when seeking support services. It is a missed opportunity to not have included requirements for anti-bias training for mental health professionals and for Member States to promote the hiring of minority mental health workers and mental health mediators.

An encouraging flagship initiative is aimed at improving data collection through the European Health Interview Survey (EHIS), where we hope that data will also be broken down by ethnic background, to have a complete picture of the state of Roma mental health and of their access to and take-up of corresponding support services. Part of the EUR 28 million that the European Commission pledges in order to provide psychological first aid to people fleeing the war in Ukraine and their children must be dedicated to combatting racism and antigypsyism, given overwhelming evidence from the ground that Roma families escaping the war have been severely discriminated in host countries, often being turned away, not believed, denied help, or persecuted because of their ethnicity.

Overall, we broadly welcome the European Commission’s comprehensive approach to mental health, as a very important first step in improving mental health in Europe. However, the Communication falls short of being a strategy with targets and monitored objectives, and many of the initiatives and funds are not new. Disappointingly, the main social and material determinants of mental health – poverty and discrimination – are correctly identified, but not sufficiently addressed. Lastly, stakeholders (including civil society) are only mentioned once in a general sentence, while nothing is said about giving ownership to the affected communities and individuals themselves, as they should be closely associated to the design, implementation, and monitoring of policies affecting their lives and wellbeing.

ERGO Network hopes that the gaps identified above will be remedied through implementation and through subsequent EU policy measures, and we stand ready to support these efforts at both EU and national level.

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For more information about our work on Roma mental health, please contact Amana Ferro (a.ferro@ergonetwork.org), Senior Policy Adviser in the ERGO Network staff

Briefing on Discrimination and Social Exclusion of Roma with Disabilities

BRIEFING ON DISCRIMINATION AND SOCIAL EXCLUSION OF ROMA WITH DISABILITIES

This briefing is prepared jointly by the European Disability Forum and ERGO Network

Studies from 2016 show that at least 15% of Roma people have a disability, amounting to over 1.6 million people between the European Union, the Western Balkans and Turkey. The available data highlights a high prevalence of disabilities among Roma communities, also due to the health inequality gap and poorer health condition of the Roma population. However, the information on Roma with disabilities is very limited.

To gain a better understanding of the discrimination and social exclusion that Roma with disabilities face in Europe, together with the European Disability Forum, we have conducted a research study based on the data collected by the EU Agency on Fundamental Rights (FRA) and our own research. The outcomes and analysis are published in a joint EDF-ERGO Network briefing on discrimination and social exclusion of Roma with disabilities.

The briefing highlights a comparatively high risk of intersectional and multiple discrimination for Roma with disabilities, with the disability marginalisation adding to the systemic racial discrimination and antigypsyism that keeps them at the margins of society. Discrimination affects their access to basic services such as inclusive education, healthcare and long-term care, their integration into the job market and, in turn, their overall socio-economic condition.

Findings

Available data clearly show that Roma with disabilities encounter more obstacles than the average to complete quality education, 81% of them dropping out of education early. Early school abandonment and inequalities in educational outcomes are partly encouraged by the bullying and harassment that young Roma people with disabilities endure in school settings and that, according to the FRA, affect 27% of them, as well as by a general trend to falsely diagnose Roma children with developmental and learning disabilities, leading them to be placed in segregated schools with reduced curricula.

As a result of the low average educational attainment, young Roma with disabilities encounter numerous issues entering the labour market. Within the age bracket 16-24, 63% of Roma with disabilities is neither in education, employment or training – with the percentage raising to 84% for the people of the same age with high support needs. The situation is further worsened by discrimination during job search and on the workplace: many respondents claimed to have felt discriminated against when looking for a job, largely because of being Roma.

The limited access to education, lower access to employment, and unequal access to social protection make so that Roma with disabilities stand an exponentially higher chance of living below the poverty line: 82% of persons with disabilities with moderate support needs, and 90% with high support needs, are at risk of poverty. The marginalisation of Roma with disabilities also reflects on their access to the housing market: inability to pay rent and anti-Roma discrimination when looking for housing are part of the reason why 55% of Roma with disabilities experience housing deprivation and 75% live in overcrowded housing.

The Roma experience an overall poorer state of health than the majority of the population, with a higher prevalence of chronic illnesses and a lower life expectancy. Deterring them from accessing healthcare and long-term care are not only the high cost of treatments and the lack of information, but also discriminatory attitudes informed by antigypsyism.

The ethnic discrimination intensifies for those with some form of disability: 18% of Roma with disabilities with moderate support needs and 17% of Roma with disabilities with high support needs felt discriminated against in accessing healthcare, compared to 12% of Roma without disabilities. It is also important to note that the inaccessibility of healthcare system and healthcare services create another discriminatory barrier for Roma with disabilities.

Read the full Briefing here

Conclusions

While some of the issues highlighted in our briefing could be addressed by separate Roma and disability policies, the current legal framework adopted by the EU does not offer a comprehensive protection for people facing intersectional and multiple discrimination, e.g. on grounds of ethnic discrimination and disability. Because of this, Roma with disabilities are left with limited protection of their rights and limited legal remedies to respond to their marginalisation.

We therefore, together with European Disability Forum, recommend the EU and Member States to adopt targeted actions, in particular:

  • Increase the visibility of Roma with disabilities and address policy gaps at the European and national levels
  • Adopt a comprehensive EU equality law to prohibit intersectional and multiple forms of discrimination
  • Collect equality disaggregated data on people living in institutions in the EU;
  • Invest in housing first initiatives and targeted outreach measures to improve access to healthcare and long-term care services for Roma with disabilities;
  • Involve Roma with disabilities and their representative organisations in designing, implementing and monitoring policies that affect them.

For more information about ERGO Network’s work on Roma health and related fields, please contact Senior Policy Officer Isabela Mihalache and our Senior Policy Adviser Amana Ferro.

Research report: Roma access to healthcare and long-term care

ERGO Network launches its research report on Roma access to healthcare and long-term care

The European Roma Grassroots Organisations (ERGO) Network held its annual Policy Conference on 23 November, entitled “Implementing the EU Roma Strategic Framework. Roma access to healthcare and long-term care.” A significant health inequality gap exists between the Roma and the majority population, persisting across every area of physical and mental health and wellbeing, including rates of suicide, disability, life expectancy, and infant mortality. The Covid-19 pandemic laid bare and worsened the pre-existing dire situation of Roma health in Europe.

The EU Roma Strategic Framework for Equality, Inclusion, and Participation 2020 – 2030 includes as one of its four sectoral objectives “Improve Roma health and increase effective equal access to quality healthcare and social services”, while the Council Recommendation on Roma Equality, Inclusion and Participation features a comprehensive section on “Health and access to quality healthcare and social services”, calling on Member States to “ensure equal access without barriers to quality healthcare and social services, especially for those groups that are most at risk or those living in marginalised or remote localities.” Ensuring access to health and long-term care is also extensively covered by the European Pillar of Social Rights, the compass for Europe’s recovery, while it is also supported by Goal 3 of the Sustainable Development Goals of the United Nations.

During 2022, ERGO Network conducted in-depth national case studies in six countries (Bulgaria, the Czech Republic, Hungary, Romania, Slovakia, and Spain), looking at the main determinants of Roma health as well as at the key barriers the Roma face when trying to access healthcare and long-term care services in these countries. The main findings and recommendations were brought together in an EU synthesis report, launched today in the framework of the above-mentioned event.

Key messages:

1. In all 6 countries, social determinants greatly influence a poor Roma state of health.

Tackle unsanitary dwellings and living conditions, exposure to environmental hazards, lack of adequate nutrition, dire poverty and material deprivation, and unhealthy working conditions.

2. High costs of healthcare and long-term care and gaps in health insurance coverage are significant deterrents for the Roma to seek care.

Support access to universal health insurance for all including the Roma and make healthcare and long-term care free or affordable at the point of use, including specialist care.

3. Limited healthcare and long-term care infrastructure and staff shortages are prevalent in rural and remote Roma communities.

Invest in an adequate supply of medical and care facilities, as well as qualified personnel, making healthcare and long-term care available to people where they live.

4. Roma health mediators play a key positive role which deserves better support.

Health mediators must be Roma themselves, anchored in the communities they serve but formally employed by the national health system with adequate pay, ongoing training, and due recognition.

5. The Roma continue to face widespread antigypsyism in healthcare and long-term care.

Combat prejudices and stereotypes within medical services and care facilities, ending segregation and ensuring anti-bias training and compliance with anti-discrimination legislation.

6. Roma communities and their civil society organisations must be involved in a bid to build trust and improve take-up.

Policy-makers, as well as healthcare and long-term care professionals, must cooperate closely with Roma stakeholders and their representatives, to ensure evidence-based solutions.

With this research, we aim to kick-start a debate with policy makers on how to improve the availability, accessibility, affordability, quality, inclusiveness, and take-up of healthcare and long-term care services by Europe’s Roma, including in the framework of the European Pillar of Social Rights Action Plan, the European Care Strategy, and the announced European initiative on Mental Health in 2023, among others.

For more information about ERGO Network’s work on Roma access to healthcare and long-term care, as well as on the European Care Strategy and related fields, please contact Senior Policy Adviser Amana Ferro.

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Health publications – ERGO Network

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