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Health Justice Conversation - Donnella Mills & Tessa Boyd-Caine
- 1. Health Justice Conversation Donnella Mills, Acting Chair, NACCHO Tessa Boyd-Caine, CEO, Health Justice Australia āBecause of them, we mustā NACCHO Membersā Conference Tuesday 6 November, 2019
- 2. Health justice landscape: 2008-2018 2016 First engagement w NACCHO members 2017 First national HJP conference 2013 Other international research translated to Australia 8 new HJPs piloted in Vic; NSW forum examines HJP model 2015 Commitment to establish national centre for health justice partnership 2012 Research on USA model translated to Australia 1 4 5 8 9 14 26 51 65 73 0 10 20 30 40 50 60 70 80 >2008 2008 2009 2012 2013 2014 2015 2016 2017 2018 2017 First national HJP report
- 4. 3 1 8 3 15 All involve Legal Aid NSW, most as part of the Civil Law Service for Aboriginal Communities Health justice services operating in ACCHO settings, 2018
- 5. Health settings Health partners 14 2530 10 1 ACCHOs Community health services (including 2 health districts) Hospital and/or health districts responsible for hospitals Community support services Local councils
- 6. Most common legal issues Top 3 issues identified by each service: ā¢ Family violence (51% of services) ā¢ Family law (43%) ā¢ Fines (31%) ā¢ Housing (31%) ā¢ Care & protection (31%) ā¢ Credit/Debt (29%) Family/domestic violence services ā¢ Family violence ā¢ Family law ā¢ Care and protection Mental health/AOD services ā¢ Housing ā¢ Fines ā¢ Family violence BASE: N= 65 Services with a focus on Aboriginal and Torres Strait Islander people ā¢ Care and protection ā¢ Housing ā¢ Family violence ā¦ though answers were particularly varied for this group of services
- 7. Intersecting needs driving complexity in peopleās lives In four out of five health justice services, the vast majority of clients are facing economic disadvantage
- 8. A cultural model of health LawYarn āThe Aboriginal understanding of health is holistic and includes land, the physical body, the mind, clan, relationships, and lore. Health, in an Aboriginal cultural context, is the social, emotional, cultural and spiritual wellbeing of the whole community, not just the individual.ā NACCHO Annual Report 2015-16
- 9. e healthjustice@healthjustice.org.au @HealthJusticeAU Contact us Tessa Boyd-Caine, CEO Tessa.Boyd-Caine@healthjustice.org.au @tboydcaine @HealthJusticeAU 02 8599 2183 Download at āJoining the dotsā report at healthjustice.org.au
- 10. Range of matters assisted with in services with a focus on Aboriginal and Torres Strait Islander people 13 11 14 14 12 9 9 9 13 11 10 3 12 10 8 7 5 7 3 3 5 8 8 8 3 5 6 11 1 1 3 4 2 Housing/tenancy Family/domestic violence Consumer Credit and debt Social security Child protection Family law Health/mental health Fines Guardianship Crime (victim) Crime (defence) Employment Discrimination Disability (NDIS related) Elder abuse Immigration Assisted Warm-referred (e.g. contacted other organisation on client's behalf) BASE: N= 18 services with a focus on assisting Aboriginal and Torres Strait Islander people (most operating in ACCHO settings). For each category, up to 3 services responded that they did not know whether they had assisted with this type of issue. Though some matters may be more common thanothers, these services are assisting with a broad range of issues
Editor's Notes
- Questions for discussion 1. Donnella to Tessa: How do ACCO models enable this ā in and beyond primary care services. Eg where there are community and other services? What might be the differences? Size and locational differences. 2. Tessa to Donnella: What are the different partnerships and roles in them between ACCO-ACCO and ACCO-mainstream services? What role HJA can play in supporting that? 3. Donnella to Tessa: Is this a one size fits all model/approach? How does it get funded? Who should get the funding? What can we learn about who should be the budget-holder and how to advocate for that to Government? 4. Tessa to Donnella: What can we learn fromĀ the cultural model of health as well as the holistic model of service delivery? How can we both respect and acknowledge the leadership of Aboriginal community controlled organisations in these approaches, while also supporting the translation of those approaches to different communities and contexts, both Indigenous and non-Indigenous? āThe Aboriginal understanding of health is holistic and includes land, the physical body, the mind, clan, relationships, and lore. Health, in an Aboriginal cultural context, is the social, emotional, cultural and spiritual wellbeing of the whole community, not just the individual.ā https://www.naccho.org.au/wp-content/uploads/J2880-NACCHO-Annual-Report_ACCESSIBLE.pdf Ā
- The census indicates a network of 73 services from remote Northern Territory and far North Queensland, to inner-city and suburban areas of Melbourne, Sydney, Canberra, Perth, Adelaide and Brisbane. Health justice services are also found in regional and rural locations in the Eastern states. As in 2017 majority of services on the landscape are in the Eastern States, with 29 services reported in NSW in 2018 and 28 in Victoria (which includes one on the border). We particularly see a rise in NSW from 15 health justice services in 2017 to 29 in 2018 - largely due to more comprehensive reporting by Legal Aid NSW of its wide network of health service-based outreach clinics and HJPs. In Victoria more of the services are HJPs and integrated services. The two service hubs are in NSW. For those of you interested in rural health: 40% of the HJS are outside major cities, 18 (25%) in inner regional areas, 6 (8%) in outer regional, 4 in remote locations and 1 in a very remote location.
- Starting with settings: Around half of all health justice services are located in one or more primary health settings (38), 30 in hospital settings 9 in community support settings, including child and family services, a public housing setting, residential rehabilitation services, support services for people with mental health issues, specialist schools. 17 of which were Aboriginal health or community services 15 of which were Aboriginal community controlled health orgs. 2/3rds operate in one type of setting, the remainder in two or more setting types: e.g. a hospital and a public health setting and/or a community setting. Health partners: 80 health partners in total, reflecting that we are more likely to have multiple partners on the health side. 17.5% were ACCOs. Legal partners: Australia-wide, nearly all legal partners are community legal centres or legal aid commissions. Usually separately but sometimes working together. (CLCs) were partners in two-thirds (66%) of services on the health justice landscape and legal aid commissions in 43%.ā [CR p11] However, differences by state, for instance: VIC, NT, QLD, ACT ā most or all CLC ; NSW ā legal aid commission (LAC) for most The report also provides information about health partners (see report). While they usually reflect the setting ā they may also include administering health districts or authorities. We also have local councils as partners on 1 partnership where services are provided through baby and maternal health nurses.
- For services with a focus on assisting Aboriginal and Torres Strait Islander people (data for 17 out of 18 who were identified as such ā mostly those operating in ACCHO settings): Care and protection ā mentioned by 8 out of 17 as a ātop 3 issueā Housing ā 7 out of 17 Family violence ā 7 out of 17 Family law ā 6 out of 17 (8 mentioned family violence OR family law) Fines ā 6 out of 17 Credit/Debt ā 5 out of 17 (8 mentioned fines OR credit/debt) Here we show what lawyers said were the 3 most common issues that they saw in their practice. Ā In 51% of HJ services - FDV identified a top three issue 43% said Family Law was a top three issue And nearly a third each said Fines/Housing/C&P were most common issues in their practice. Ā The dominance of FDV and Family law across the landscape āto me reflects the fact that people experiencing FDV are being assisted in services beyond those targeting FDV. Ā overall figure, masks variation between different service types. As expect, FDV, family law, child protection dominate in FDV services ā but also immigration -common issue. Ā Services supporting people with MH AOD identify housing and fines as most common issues, together with family violence, credit and debt and health.
- [We are now reporting percentages, which are a percentage of those who answered the question ā rather than the full 73. The base numbers are on each slide. Quite a few respondents missed one or more questions.] This slide speaks to one of the key observations of this census ā which is that health justice services are reaching those experiencing complex need ā whether targeted to particular client groups ā or not.. Noting this is based on estimates by lawyers of the client groups they see ā we find the following. while 1:5 services target family and domestic violence - nearly 9/10 indicated that at least some of their clients were experiencing family and domestic violence, with 32% indicating that most of their clients were facing these issues. Only 3 (5%) services said that none or few of their clients experiencing FDV and the remaining 5 services did not know. [Recent work by LJF indicates people experiencing FDV are 10 times more likely than others to experience a wide range of family, civil and criminal law issues and 16 times more likely than others to experience family law problems ā confirming FDV as a site of complex need Similarly, while around 1 in six services were directed to those living with mental health issues and/or alcohol and other drug issues, and around 82% indicated that at least some clients were experiencing mental health and/or alcohol and other drug (AOD) issues. 28% indicated that most of their clients were experiencing these issues. (7 none/few; 4 DK) Mental health/AOD was the issue most commonly noted by health service respondents as a health issue faced by patients referred to the HJP. Ā In terms of resources to address these issues: All services estimate that at least some of their clients are experiencing economic disadvantage: and 79% of services said that this was most of their clients. So services are reaching those with less resources to employ their own lawyer.
- Replace to link to the key findings