What is Health Justice Partnership?
Mary is a 70 year old women who lives independently at home, despite requiring dialysis for her diabetes and experiencing some mobility issues. She was visited by an occupational therapist to assess her home because she had difficulty climbing her stairs. The assessment recommended to her landlord, the state housing authority, that a handrail be installed. The housing authority took no action and Mary was subsequently admitted to hospital after a fall at home.
Luckily for Mary, the hospital she was admitted to has a health justice partnership with a local community legal centre, meaning a community lawyer works in the hospital to help patients with legal needs. The lawyer wrote immediately to the housing authority making them aware of their legal obligations for minor modifications in homes. Four days later the handrail was installed and Mary was able to be discharged to return to living independently at home.
Health justice partnerships are a response to several problems undermining good health, justice and wellbeing. Firstly, despite the high level of demand on community legal assistance services already, there are many more people who need those services but never seek them out. In fact, as the national LAW study showed, many people with legal needs will never go to a lawyer; but they will mention those needs to a trusted healthcare professional, like a GP, community nurse or social worker.
Secondly, unmet legal need has an impact on health outcomes: unmet legal needs can exacerbate or contribute to poor health; and health outcomes can be undermined by legal need. As Mary’s story shows, it took a legal intervention to ensure her home was safe enough for her to live healthily and independently. This makes legal need one of the social determinants of health, what the World Health Organisation calls the ‘the circumstances in which people are born, grow, live, work, and age’.
Good health shouldn’t be determined by what you earn, where you live or who your parents are. Yet there’s growing evidence in Australia that people on low incomes experience poorer health outcomes than others: for example having to choose between paying bills and filling prescriptions; or being so stressed by debt that it harms someone’s mental health. These are the kinds of experiences that health justice partnerships around the country are working to resolve, by providing access to legal services in trusted health settings like community health services and hospitals.
Are health justice partnerships (HJP) any different to co-location or outreach services?
Firstly, HJP focus on early identification of unmet legal need among people who will not otherwise come into contact with lawyers. By including a lawyer as part of the healthcare team, these partnerships support healthcare professionals to recognise legal problems; and then to provide a holistic service response to patients.
Secondly, HJP are transformative: while individual outcomes are key, health justice partnerships also work to change professional practice to be more responsive to community needs. For example, ‘secondary consultations’ between lawyers and health workers might mean that patients never need to see a lawyer at all, but can access legal information and guidance directly from their doctor or other health worker.
Thirdly, health justice partnerships have a strong commitment to systemic advocacy as a way to address broadly the range of legal needs that affect people’s lives. Domestic and family violence; elder abuse; safe, secure and healthy housing; credit and debt; and employment or workcover issues are all issues being addressed positively by health justice partnerships. But these are all issues with structural elements as well as individual experience: from women seeking to leave violent situations at home facing bills for property damage caused by their violence partners; through to the vulnerability of older people when their families are both carers and have powers of attorney over their assets.
Thomas suffered several workplace injuries which left him unable to work. He also has literacy issues. He was pursuing a WorkCover claim and had entered into and complied with several hardship arrangements with the bank on this basis, enabling him to make reduced repayments on his mortgage. He was still waiting for an outcome on his personal injury claim as the most recent hardship arrangement was coming to an end and he was afraid of losing his home. Thomas sought assistance from a health justice partnership (HJP). His community health service had a health justice partnership with a community legal centre, which assisted him to make another application for hardship, this time on the basis that there was a court date set in the not too distant future and therefore there were higher prospects of an outcome and improvement in his financial circumstances.
Unfortunately, the bank refused his hardship application. Not only this but the bank continued to contact Thomas for payment of the arrears, despite his having a lawyer acting on his behalf. The HJP lawyer assisted Thomas to complain to the Financial Ombudsman Service about both the bank’s refusal of hardship and their continued and unwanted contact. In settlement of the claim, the bank awarded Thomas an amount of compensation and agreed to enter into another reduced repayment arrangement on the basis of his current hardship.
By integrating legal services into health settings, we improve access to justice and better address social determinants of health. Far from adding to the already busy jobs of health workers, many report relief at being able to respond more comprehensively to issues in their patients’ lives that, until now, they’ve recognised but not been able to do anything about. This was one finding that motivated the AMA to get on board with health justice partnership, developing a domestic violence toolkit for GPs for its members, based on a resource developed by Women’s Legal Service NSW.
Health justice partnerships are an innovative development in how legal services are delivered to vulnerable people at times of real crisis in their lives. There are over 20 health justice partnerships across the country, including 9 that were funded by the Victorian Legal Services Board; and 4 being established through Commonwealth funding as part of the 2015 Women’s Safety Package. There is also considerable interest from Legal Aid offices around the country.
 Some personal details have been changed to protect individual privacy.
 Adapted from Redfern Legal Centre (2016) Aboriginal Health Justice Partnership Evaluation of First Six Months of Operation, December 2015.