Patient advocates

As the social and economic impacts of the COVID-19 pandemic ripple across the country, doctors are seeing patients who are experiencing increasingly complex circumstances. Factors such as financial uncertainty, housing instability and family upheaval can interact with mental health issues to create multidimensional problems that extend beyond the expertise of health services. While much attention has been focused on how these problems are being exacerbated by the pandemic, there has been less discussion about how services can respond.

One approach is for health services to include legal help in their teams. Known as health justice partnerships, these collaborations between health and legal services have become increasingly common across Australia and are a response to the way socioeconomic adversity and health can interact.

Take Sashi as an example. She was dealing with health issues but was also facing a range of other challenges. She was sleeping on friends’ couches, had struggled to find secure employment after being made redundant twice and had accumulated significant debt. Fortunately, the Royal Melbourne Hospital where she was receiving treatment had a health justice partnership with Inner Melbourne Community Legal. The partnership’s lawyers helped her to have most of the debts waived and to negotiate payment plans for the others. They also connected her to assistance by submitting a disability claim to her superannuation insurer. Dealing with these financial issues was a key step in helping Sashi regain a sense of control over her life. She said,

“[Without this service] I would have just gotten into more and more debt…My mental health had a lot to do with it…the debts were impacting my ability to think straight and my ability to cope.

“Now I am actually able to breathe I can fully focus on my therapy… You have given me a new life… I can plan for my future.”

Sashi’s experience highlights the profound effect that help with practical problems can have on a patient’s wellbeing and for some, on their ability to engage with healthcare. Many issues in areas such as credit, debt, fines, housing, social security, employment and family violence have legal elements and help from a lawyer can be invaluable in resolving them. Although legal problems are widespread, the reality is that many go unmanaged, leaving them to impact other areas of a person’s life, such as their health, and opening the door to escalation. Even when people do seek help, often this is sought from a non-legal adviser, such as a doctor or social worker. For those facing mental health challenges, barriers to legal assistance can be compounded by factors such as: difficulty keeping appointments and following up on referrals; communication and behaviours that make it difficult to receive help; mistrust of lawyers or legal services and problems having a mental illness recognised.

Embedding legal help in healthcare settings helps connect patients with the help they need, when they need it. When legal practitioners are co-located with health practitioners, health and legal services can work closely together, building capability and effective referral processes. For health practitioners, the option of connecting patients to legal assistance provides an avenue to address some of the problems that affect wellbeing, but do not have medical solutions.

Thinking about mental health support in the wake of COVID-19 provides an opportunity to consider more holistic responses to intersecting life issues. Broadening the range of expertise in a healthcare team to include legal help supports patients to gain control of underlying stressors that can impact mental health. As we all find our way through unprecedented circumstances, new ways of working may help get us closer to the solutions we need.

To read more about the intersection of health and legal assistance in a mental health context, go to Health Justice Australia’s “Legal help as mental healthcare”.

Contributed by Marie Nagy, Researcher, Health Justice Australia