The Partnership between Health and Law to Ensure Human Rights
If human rights are to meaningfully alleviate poverty, we must factor in the day to day need for legal advice services. Even where there is no court or tribunal case involved, access to legal advice can be critical. It can save mistakes being made, help people understand their rights and responsibilities, and lead to early intervention and often prevention of problems or their escalation. With recent cuts to legal services, Health Justice Partnerships (HJP) are not only innovative ways to access to justice, but also have positive outcomes on the social determinants of health (SDH).
The UK and Australian research reveals that disadvantaged individuals with legal problems only consult lawyers about 13 – 16% of the time. This means that around 84% of disadvantaged individuals who most need help are not getting it. There are a range of reasons for this, including barriers, many of which are systemic. A key access point for lawyers to reach out to disadvantaged individuals is through the health and allied professions. HJP sees lawyers working alongside health and allied health professionals to reach clients with a range of legal problems, such as debt, family violence, poor housing, consumer issues, care and protection, and access to public services.
HJP is not medical defence work. This is a common misconception. Rather HJP is about lawyers going to places where the people who need help are likely to be, such as their health and allied health services, to help with a range of legal problems. Rather than waiting for referrals or for clients to make an appointment, the HJP model sees lawyers working alongside other professions to support clients so they can have information and advice to help them navigate a complex legal system.
In a study in Bendigo, Victoria, it was shown that, as a result of HJPs, clients’ knowledge and confidence in engaging with public services increased by 90.9%. Prior to HJPs, 40% of clients interviewed were deterred from seeking legal help due to poor experiences with lawyers or the legal system. Clients who have multiple and complex problems reported that they were previously anxious and frightened, as they did not know their rights. This impacted on their SDH. The intervention of the Bendigo HJP is reported as having a positive impact on clients’ SDH and offering ‘hope’, as they now have someone to negotiate on their behalf, who knows their legal position. This allows clients to ‘know where they stand’.
There were also positive responses from health staff. Levels of trust between health professionals and patients, responsiveness, and engagement all increased by 87.5%. Clients in HJP are getting ‘better help’ and there is a ‘positive impact’: for example, no drug relapse, reduced stress, and reductions in suicidal ideation have been reported.
There is complexity of clients and need for responsiveness. Appointments were problematic: time and place can be critical and services need to be ‘opportunistic’. The HJP doesn’t rely on clients to work out if their problem is legal. Trained intermediaries create trust in the person who makes their pathway clearer, as the professionals have been trained in identifying legal issues, such as debt, social welfare, housing, family violence, discrimination, fines, child protection, and human rights under the Charter.
The many findings include the importance of relationships with a non-hierarchical, non-judgemental, ‘down to earth’ lawyer in professional and client engagement, and secondary consultations with a lawyer which were of ‘huge value’ (81% strongly agreeing and 9% agreeing) to health and allied health staff, even if they were quick and short conversations. Timeliness and opportunistic availability of a lawyer on site at a health centre were seen as critical.
In conclusion, HJPs are reaching those people otherwise excluded. Empirical research has shown that trust and confidence in legal services is critical for the success of HJPs, in view of a lack of legal knowledge in the community and poor experiences or perceptions of lawyers and/or the legal system. These act as additional barriers to people seeking help. HJP seem to overcome these barriers through professionals working together with a focus on holistic client care.
HJPs are not about saving money (although through earlier intervention and prevention of problem escalation they do save money downstream for courts and the health system), nor are they about austerity. Most Australian HJPs are not government funded. Funding is often from limited philanthropy arising from the need to address social justice, fundamental human rights, and social determinants of health. If HJPs are effective, they result in better client reach and client care to make a difference in lives, enable human rights protection and adherence, increase engagement with those who are excluded and disadvantaged, and facilitate respect, capacity, collaboration and empowerment (including systemic work to stop problems at the core).
This article is based on a Seminar delivered by the author for the Oxford Human Rights Hub, Law Faculty, Oxford University delivered on 1 November 2016 by Dr Liz Curran. A short video of the Victorian Legal Services Board explains HJP in the words of clients and partners.