What Does the Evidence Tell Us?

Professor Pascoe PleasenceFaculty of Laws, University College London

“We live in a law-thick world” Gillian Hadfield

Links between legal problems and morbidity

A Medical-Legal Vicious Cycle (adapted from Tobin Tyler et al 2011, p.236)

Homelessness Health problems

Inability to work / disruption of work

Eviction Loss of income / welfare needs

Non-payment of rent

• Over the past two decades, at least 33 large-scale national surveys of citizens’ ‘legal needs’ in upwards of16 separate jurisdictions.

• Around 100 publications associated with the surveys

• A substantial evidence base, providing a remarkably consistent picture

National citizen surveys Sub-national citizen surveys

Health impact of legal problems

CSJPS 2010 and 2012

51.3% reported to have one or more adverse consequence

24.7% reported to have led to stress-related illness

4.0% reported to have led to another mental health problem

8.8% reported to have led to physical ill-health/injury

More than 15 million legal problems each year

CSJPS 2010 and 2012

Health impact of legal problems

The health impact of legal problems

Impacts reported by those experiencing legal problems

(Gramatikov & Verdonschot 2010)

Legal problems and morbidity: a strong association

Problem prevalence by age and illness/disability status

(English and Welsh Civil and Social Justice Survey – Pleasence and Balmer 2009)

Legal problems and morbidity: a strong association

Problem prevalence by age and illness/disability status

15-24 25-34 35-44 45-54 55-64 65+0

25

50

75

100

No illness/disability Physical only Mental only Physical and mental

Age

Prob

lem

pre

vale

nce

(%)

(Australian LAW Survey – Coumarelos and Pleasence 2013)

Drilling down

A closer look at young people

Legal Problems, Age and Disadvantage as Determinants of Mental Health

No problem Problem0%

10%

20%

30%

40%

50%

16-24 NEET Isolated 16-24 NEET Not Isolated 16-24 EET Isolated 16-24 EET Not Isolated 25-59

Group

% w

ith m

enta

l hea

lth p

robl

em (M

CS <

45)

A closer look at young people

And comparing users of YIAC services

Patient centredClient centredCitizen centred

Health and legal problems: and public services

Increasing co-ordination of health and legal services

292 Medical-Legal Partnerships in hospitals in 36 U.S. states.

Inspired the Health-Justice Partnership between Bendigo Community Health Services and Loddon Campaspe CLC.

Building on other initiatives in Australia, such as West Heidelberg CLS’s long-term integration with Banyule Community Health, the NSW Cancer Council Legal Referral Service, Baker & McKenzie Cancer Patients’ Legal Clinic at Peter MacCallum Cancer Institute.

Similar initiatives in England, such as Macmillan Welfare Benefits Service.

Around 40% of CABx outreach is in health settings.