Holistic approach to healing patients

The Health Justice Partnership addresses the legal dimension to patient health and wellbeing.

In May 2015, Sydney Local Health District (SLHD) and Redfern Legal Centre partnered to become the first hospital-based Health Justice Partnership (HJP) in NSW. This innovative service allows health professionals and solicitors to work together within the health setting,to reduce and alleviate some of the health issues in people’s lives that can be assisted by legal interventions.

HJPs have been in the USA for many years, with over 150 in existence. In Australia, they are in their infancy, but rapidly expanding to many hospitals and
other health settings.

Why, and how, is a legal service integrated within the health setting?

The detrimental impacts that the social determinants of health have on many populations, especially those with social disadvantage, can at times, be remedied, or at least minimised by legal intervention. The social determinants of health, such as where we live, whom we live with and how we live can be translated across to legal assistance.

Where we live

Vulnerable patients, who often live in social housing, often have health issues that are directly related to their housing. These include a state of disrepair in older houses, a lack of essential services or severe mould that impacts directly on the respiratory health of patients and their children.

Many patients are also living in unstable and temporary accommodation, sometimes due to fleeing domestic violence and ending up with a debt to their public or community housing providers, and need assistance to get back into stable secure housing. When they are leaving hospital with a new baby these are urgent issues that community lawyers can assist with.

The detrimental impacts that the social determinants of health have on many populations, especially those with social disadvantage, can at times, be remedied, or at least minimised by legal intervention.

Who we live with

We know that domestic violence, or intimate partner violence (IPV), is prevalent in all communities and disproportionately affects women and their children, who
experience physical violence, emotional control and the ongoing stress and anxiety that results from living in such environments. These not only cause short-term health issues, but the longer-term impact, especially on children, is starting to become evident.

Solicitors can assist by providing legal advice about reporting violence to the police, the Apprehended Domestic Violence Order court proceedings, and direct referrals to the Women’s Domestic Violence Court Advocacy Service. Many women will divulge domestic violence to their health professionals, as this is a safe and trusted relationship, but will often be fearful of reporting to the police. Additionally, women can seek advice without the other party knowing, as they are seen within the health setting.

For many women, leaving a violent relationship can be overwhelming with many other factors involved such as debt, family law issues and housing. Being integrated within the local community legal centre, the HJP solicitor can work together with solicitors that specialise in all of these areas. For the SLHD and RLC HJP, over 50% of clients had been victims of domestic violence at some time.

How we live

Another social determinant of health is living with increased amounts of debt, which is becoming a significant issue in many patients’ lives. The accessibility of short-term loans and increase in irresponsible lending practices is causing many vulnerable people to be coerced into debts they are not able to service. On top of the stress and anxiety this creates for many patients, high interest rates make it difficult to even make minimum repayments, impacting on their ability to even afford basic items for their family such as food and clothing.

A solicitor can assist with debt in many ways. Initially they can stop debt collectors contacting the patients, and then assess if the credit was given within responsible lending practices and seek remedies and debt waivers if not.

Sue-Ellen Hills, (left) solicitor at Redfern Legal Centre and Elaine Doherty, NUM Drug Health, RPA

Redfern Legal Centre and Sydney Local Health District HJP

The SLHD service is located at Royal Prince Alfred Hospital, with the solicitor, Sue-Ellen Hills, provided with an office and administrative support through the Drug Health Service. Ms Hills is at RPA two days per week and sees patients at Drug Health as a drop in, through booked appointments, and also goes to see patients on the ward. Ms Hills is well integrated within the hospital setting, which has been essential for the success of the service. She receives referrals from social work staff, registered nurses, doctors and other allied health professionals.

An additional advantage to hospitals of this service is that it allows health professionals to focus on a patient’s health issues, and then have the solicitor deal with the legal issues in their lives, creating clarity for the patient as to who can assist them with these issues.

To enable health professionals to know how the solicitor can assist, over 250 staff at RPA have had training in identifying health harming legal issues. These training sessions focussed on health professionals being able to identify when an issue a patient comments on may have a legal remedy.

A core role of community legal centres is providing access to justice and to assist clients in knowing that the issues that they have in their lives, can have a legal remedy. This can be done through community education, but also through outreach services such as a HJP, which provides two methods of increasing access to justice. Firstly, they use health professionals’ knowledge to identify legal issues and provide referrals, and secondly, many clients will not seek out assistance at legal services, however, they are comfortable in a health setting, will take a referral from the hospital, and be seen within the health setting.

Since its inception, the HJP has seen over 200 patients in matters such as domestic violence, tenancy, debt, dealing with government and many other areas. In an evaluation conducted after the first 6 months, it was found that over 80% of patients would not have sought legal assistance if it were not for the HJP. Health professionals overwhelmingly found that having a solicitor on site led to improvement in their patient’s lives.

It seems to be an unusual partnership between a solicitor and a hospital, however, after remarkable changes in patient’s lives in their health and social circumstances it is clear that this is an effective way for community lawyers to reach and assist vulnerable people.

Article originally published by The NSW Doctor May/June 2017.