Liz Curran, Nottingham Law School
Around the world, colonised communities are still significantly impacted in terms of their life outcomes and ability to advance the sustainable development goals (SDGs), due to the impacts of colonisation on various minoritized populations. This includes ongoing poverty, inequality, poor mortality rates and negative health and well-being. The growing body of international research cannot be ignored.
This research and impact evaluation over 3-4 years reports on and examines the effectiveness of this Health Justice Partnership (Hume Riverina Legal Service & Albury Wodonga Aboriginal Health Service) which aims to improve justice and social determinant of health outcomes for Aboriginal community members experiencing poor mental health and well-being.
This co-designed, participatory, reflexive action research builds on a previous seven- year longitudinal study with two of the same partners enhanced by using the same tools adapted for cultural safety and using trauma informed practice within a framing by Culturally Responsive and Equitable Research and Evaluation. Curran’s research is already improving Access to Justice evidencing how outcomes are improved in social determinants of health by uptake of justice options (housing, safety, income etc). This impact research:
- Documents how (by harnessing law) entrenched inequality is being addressed.
- Focuses on the poor, disadvantaged/vulnerable.
- Provides practical solutions and effective change for practice.
Evidence:
- fills data vacuums e.g., lived experience implications and in-place solutions.
- impact of multidisciplinary/integrated practice (e.g., Health Justice Partnerships (HJP) with frontline services ‘trusted intermediaries’ (TI) in reaching disadvantaged and improved outcomes.
- how legal empowerment and changes in practice for TI and community via collaboration with civil legal aid services has/is changing practice so services/decision-makers are:
- responsive
- tailored
- accountable in decision-making and service funding.
This paper will explain the methodology, why it is used and look at the inroads made over time and lessons learned emerging from the empirical data that might be used internationally. What makes a difference in peoples lived through justice interventions, how, when, and why?
Lynne Haultain, Victoria Law Foundation
Findings from the Public Understanding of Law Survey (PULS), a state-wide, representative legal need and legal capability survey conducted in Victoria, Australia again underscores the nexus between health and legal problems.
The PULS demonstrates that people with a long-term health condition, those not working due to health or disability, and those experiencing moderate of severe mental distress reported higher overall problem prevalence, higher numbers of problems, and higher prevalence of most legal problem types.
Consistent with previous findings, stress was the most common adverse consequence of legal problems, being reported through the PULS for more than 70% of problems. Ill-health or injury was also common, being reported for more than 20% of problems.
Health also featured prominently in PULS findings concerning what people do about legal problems, how long they last, and whether associated legal needs are met. Notably elevated rates of unmet legal need were reported by people with long-term illness or disability, those not working due to health or disability, and those experiencing higher levels of mental distress.
The PULS findings again point to the bi-directional relationship between legal problems and health. Poor health increases vulnerability to legal problems, and legal problems often negatively affect health.
Using the new PULS data and findings, this paper updates the known links between health and the experience of legal problems, with the addition of the intersection between health and legal capability at a population level. The evidence provides a sound base for the reconsideration of
legal service in many settings, and reinforces the critical importance of integrated and/or wrap around services for many groups.
Michele Leering, Independent scholar, CALC ED Emerita
Health justice partnerships provide fertile ground for seeding cross-disciplinary collaboration, early intervention approaches, client-centred and holistic problem-solving, and systemic advocacy to resolve and advance legal entitlements and human rights aligned with the social determinants and drivers of health. Based on a study released in 2024 that researched how this approach has evolved in four countries, I review the spectrum of health justice approaches, and summarize the impact of these partnerships from eight systematic and scoping reviews, and explore how we might scale up this multidisciplinary intervention considering current developments in Ontario, Canada, and the importance of undertaking evaluation research.
Amy Slotek, Legal Aid Ontario
Tess Sheldon, Faculty of Law, University of Windsor
Jayda Goldhar & Diya Parikh, Mental Health Justice Clinic, Law Students, Faculty of Law, University of Windsor
Injustice interferes with our communities' health, particularly our communities' mental health. Here, we introduce a critical patient-centred model where persons with lived and living experience of the psychiatric system not only participate in but lead the development and implementation of Mental Health Justice Partnerships (MHJPs). This approach departs from traditional service models by emphasizing meaningful engagement and program ownership, in stark contrast to the superficial inclusion and tokenism often seen in psychiatry and mental health contexts. MHJPs address the unmet and intersecting legal needs of persons with mental health and addiction disabilities. MHJPs are based on the value of community-embedded legal services, placing lawyers in locations where people are already accessing health and social
supports. Access to justice is most meaningful when legal services are offered on-site within community settings. MHJPs exemplify the cross-sector collaboration necessary to address social problems that no single sector can solve alone. They also depend on the understanding of access to justice as a social determinant of mental health. Some health
problems may be more effectively treated with legal remedies than with medical ones.
The presentation will showcase two MHJPs in Toronto that exemplify this transformative approach. We will explore how these models can operate effectively within existing funding frameworks and the constraints of the broader neoliberal context. By comparing these models with others that fail to avoid tokenism, we offer clear, actionable strategies that emphasize the profound impact of true program ownership, despite its potentially higher costs and deeper commitments required. Given the persistent barriers that reflect a societal tendency to erase disabled people, equal access to justice demands innovative approaches and genuine engagement.
Jennifer Stone, Neighbourhood Legal Services
Rami Shoucri, St. Michael’s Academic Family Health Team
The Health Justice Program (HJP) is a unique partnership in a large urban Family Health Team in Toronto. Launched in late 2014, it is the first health & justice partnership in Canada to adopt a social justice lens through its collaboration with community-governed legal aid clinics. St. Michael's Hospital’s Academic Family Health Team (SMHAFHT) and Neighbourhood Legal Services work together to provide embedded legal help to low- income patients in an effort to stabilize key social determinants of health. Aboriginal Legal Services, ARCH Disability Law Centre, and the HIV and AIDS Legal Clinic Ontario, other collaborating clinics, also lend their complementary expertise working with vulnerable populations. We believe this model has enormous potential for breaking down silos and encouraging inter-professional problem solving for marginalized and low-income people.
After 10 years of the Health Justice Program, we wish to present some key takeaways that we believe highlight the potential for this model of service to improve access to justice:
- HJP referrals have become a greater proportion of NLS cases over time. This was particularly important through the acute phase of the pandemic when the SMHAFHT remained open when many other offices went remote, but the trend has persisted to this day due to increased knowledge and relationship- building over time.
- Referral patterns are largely consistent with the literature organizing most common health harming legal needs into the “I-HELP”2F3 factors. While these are mostly consistent with the baseline distribution of issues that general legal aid clinics address, they also highlight several important gaps in Ontario’s legal aid-funded system that health & justice partnerships can identify and address, such as advance care planning and family violence.
- A unique aspect of this HJP is the SMHAFHT as a teaching site. This provides unique opportunities for practical knowledge acquisition for budding primary care providers. We also welcome law student learners who benefit from the academic mandate. Our goal is to offer practical hands-on teaching for the next generation of physicians and lawyers about access to justice and how to overcome barriers thereto.
- The collective perspectives and resources of the partnership also allow for the identification and management of otherwise intractable and complex legal issues for the most vulnerable in our society. These cases are highlighted in our annual reports and often involve intersectional issues and high levels of disability accommodation or other human rights issues.
By sharing our HJPs experience and several key case examples, we hope to demonstrate the significant potential that these types of partnerships, led by community legal clinics, have to improve access to justice in our communities.
Patricia Vagg, The Australian Centre for Agriculture and Law (The AgLaw Centre) & University of New England, Australia
The Australian state of New South Wales (NSW) touches the east coast, and extends into the interior of the continent. The western part of the state, a land area known as the Western Division, is characterised by widely-separated settlements, extreme climate and landscape, very limited public transport and unreliable internet access. With a land area of 325,000 square kilometres, the Western Division is nearly as large as Malaysia or Germany. It has a population of about 50,000 people, and it is estimated there are fewer than 20 practising lawyers – precise details are unclear. The region’s largest town, Broken Hill, has a population of only 17,000 people. Many residents of the western region access services by travelling hundreds of kilometres to larger towns, either east within NSW, south to Victoria, west to South Australia, or north to Queensland. Not everyone is able to travel, and these people may be unable to access justice and legal services. The scarcity of services, and the presence of barriers that can make it difficult to access existing services, may mean that people living in the Western Division are disproportionately exposed to risk and to the cumulative effects of other sources of potential disadvantage.
In western NSW and in other places, rural and remote services, and residents’ use of those services, have been explored in relation to health and education, and to some extent in relation to interpersonal violence, but less so in relation to legal services more generally. Services need not only to exist, but also to be accessible. Existing literature in education and in health indicates that access to services requires knowledge and action from two sides - from residents seeking services, and also from the organisations and systems that design and provide services. A deeper understanding of people’s experiences can help inform the configuration of legal and justice services so that they are useful to the people who most need them.
Data collected during semi-structured conversational interviews will be analysed against a conceptualisation of access which is well-recognised in health but has not yet been applied in law. This analysis will contribute to a deeper and more precise understanding of the legal needs and preferences of residents of remote NSW. Residents and lawyers will be able to share their experiences of what can be difficult, and also what things have been easy or have worked well, when people need legal help. This knowledge could contribute to an evidence base for researchers and service providers to improve access to legal and justice services to better meet the needs of people in western NSW.
The NSW Western Division is not Australia’s only remote or very remote region. Other states and territories in Australia have areas that are similarly remote or even more remote, as do other countries in the world. Different places may have similar barriers preventing provision of and access to services, and may also be able to learn about and implement legal and justice innovations that could be successfully applied in other places. The results of this research could inform policy and practice in NSW, in Australia and in other jurisdictions.