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Prevention is better than cure

The emergence of health justice partnerships across Australia in recent years reveals great potential for integrated service system responses to clients’ intertwined legal and health problems.

A health justice partnership (HJP) is a model of service delivery that embeds legal help into health care settings such as a hospital or a community-based medical centre.

At first glance, immersing lawyers within existing health structures may challenge a legal practitioner’s view about the primacy of a person’s legal issue. However research is clear that most people do not recognise that they have a legal problem and are more likely to consult a doctor or health worker instead of a lawyer when things go awry.1

HJPs increase access to justice by reaching vulnerable population groups that would be very unlikely to seek out legal help. There is a growing body of evidence that shows health outcomes improve when a patient’s legal problems are addressed; HJPs are therefore a powerful tool to address health inequities shaped by the social determinants of health.2

HJPs especially support people experiencing family violence, the elderly at risk of elder abuse, people living in poverty, Indigenous peoples and people with culturally and linguistically diverse backgrounds.

HJPs in Australia

Inspired by the medical-legal partnership movement in the United States, HJPs started to appear in the Australian context in the early 2000s. In 2016, a national centre for excellence for health justice partnerships, known as Health Justice Australia, was founded. Its role is to support the expansion and effectiveness of health justice partnerships at a national level through research, mentoring and driving systems change.3

A 2018 census conducted by Health Justice Australia found that Queensland currently has seven HJPs in operation, five in major cities and two in outer regional areas. New South Wales and Victoria dominate the Australian HJP landscape; together these two states operate 58 partnerships in urban and regional settings.4

Across the country, the legal partners connected to HJPs are almost exclusively public legal sector organisations.5 Community legal centres and state-based legal aid commissions are leading efforts to implement and sustain HJPs. Every Queensland-based HJP has a community legal centre as its legal service partner.

Community legal centres are ideally placed to deliver these services because they have a deep knowledge of multidisciplinary service collaboration and a holistic, trauma-informed approach to legal practice.

HJPs in Queensland

A quick summary of HJPs across Queensland demonstrates the diversity of approach:

  • A HJP pioneer, LawRight, currently operates three HJPs throughout Queensland; one at the Mater Hospital (Young Adult Health Centre) in South Brisbane, one in Cairns in partnership with the Wuchopperen Health Service, and one with Footprints in Brisbane Inc., a non-profit community-based health and disability service. LawRight HJPs assist clients with civil law matters including debt, guardianship and administration, mental health law, discrimination and other civil law problems. Wuchopperen is community-controlled Aboriginal and Torres Strait Islander health service and all clients identify as Indigenous. Collaboration between service stakeholders has resulted in the creation of Law Yarn, a unique diagnostic tool to help clients identify legal problems in pictorial form using Indigenous imagery and artwork.
  • The Central Queensland Community Legal Centre (CQCLC) in Rockhampton delivers the Central Highlands Health Justice Partnership with the Emerald Medical Clinic. The HJP lawyer lives in Emerald and is embedded within that local community, reflecting the CQCLC’s commitment to localised support for the Central Queensland region. Patients of the clinic are able to access free and confidential legal advice in most areas of law, with social work support delivered by a CQCLC project officer. Community Legal Centres Queensland will soon launch a new HJP in the Central Queensland region of Blackwater.
  • Women’s Legal Service Queensland partners with Logan Hospital, Redlands Hospital, QEII Jubilee Hospital, Princess Alexandra Hospital (Gold Coast) and the Royal Brisbane and Women’s Hospital. It also services Caboolture and Redcliffe hospitals, and a solicitor regularly visits the Young Mothers for Young Women program run by Micah Projects in partnership with the Mater Mothers Hospital, South Brisbane. The services provide legal advice to women who are victims of domestic violence about family law, DV or child protection matters. The legal appointments are generally coordinated by hospital social workers.
  • Queensland’s newest community legal centre, the Institute for Indigenous Urban Health (IUIH) operates a fully embedded HJP that takes internal referrals from its multidisciplinary primary health clinics throughout south-east Queensland. The service delivers culturally safe legal advice and support in most areas of law with a focus on family law, domestic violence, child protection and civil law matters including housing and tenancy, fines/debt and education.
  • In 2018, Caxton Legal Centre partnered with Metro South Health to co-design and co-deliver the Older Persons Advocacy and Legal Service (OPALS) for the purposes of training health professionals to identify older persons at risk of, or experiencing, elder abuse, and providing those identified with specialised legal and social support services. This multidisciplinary, early intervention service is delivered by a Caxton lawyer based at the Princess Alexandra Hospital working with hospital social workers and a Caxton social worker based in the community.

Looking to the future

Health justice partnerships are relatively new in Queensland and there is still a lot of learning to be gained about ways to optimise service provision. Developing sustainable partnerships necessitates long-term investment in relationships, all of which takes time, energy and resources.

Getting to know the hospital or health service with whom you wish to partner also requires mutual respect for differing professional perspectives. Increasing the legal literacy of health workers is a common feature of many HJPs and often a key to their success. Regular evaluations of the impact of HJPs are important not only for accountability, but to demonstrate service effectiveness.6

Perhaps now more than ever, COVID-19 and the ongoing health impacts of climate change justify the importance of HJPs in addressing the multifaceted health and legal needs of vulnerable Queenslanders.

Resourcing the legal assistance sector in Queensland to continue to deliver HJPs and plan for new services in the future will reveal what we all know to be true; that prevention really is better than cure.

This article appears courtesy of the QLS Access to Justice Pro Bono Committee. Monica Taylor is the Director of the UQ Pro Bono Centre and a member of the committee. This QLS policy committee brings together practitioners working full time in the access to justice sector, and private practitioners who have an interest in access to justice, including pro bono practice, legal aid work and/or innovative models of providing legal services to fill the justice gap. If you are interested in the work of the committee, contact Chair Elizabeth Shearer via elizabeth.shearer@shearerdoyle.com.au.

Footnote:
1Christine Coumarelos et.al, (2012) ‘Legal Australia-Wide Survey: Legal need in Australia.’ Law and Justice Foundation of NSW, Sydney.
2The World Health Organisation defines social determinants of health as, “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.”, WHO, ‘Social Determinants of Health’, who.int/social_determinants/en.
3healthjustice.org.au.
4Suzie Forell and Marie Nagy (2019) Joining the dots: 2018 Census of the Australian Health Justice Landscape, Health Justice Australia, Sydney.
5The one notable private law firm exception is Maurice Blackburn Lawyers in Melbourne, which partners with the Alfred Hospital and the Michael Kirby Centre for Public Health and Human Rights to deliver the HeLP Patient Legal Clinic, mauriceblackburn.com.au/blog/2016/february/01/patients-get-a-helping-hand.
6For example, see the 18-month evaluation of the LawRight Wuchopperen Health Justice Partnership and Law Yarn: lawright.org.au/_dbase_upl/Final_Independent_evaluation_Wuchopperen_HJP_2019.pdf.

This story was originally published in Proctor June 2020.

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