Social welfare issues, such as welfare benefits, debt, and housing problems, are growing, and have significant and negative impacts on health. ARC North Thames researcher Sarah Beardon explores how legal advice services can partner with the NHS to support patients with welfare issues and address health inequalities.
If you became ill (physically or mentally), how would this affect your life? Would you lose your job? What would your employer’s obligations be towards you? Or what would happen if you were self-employed? Would you be eligible for income support? What if you fell behind on your rent or mortgage payments or needed specially adapted housing due to disability?
These are some of the most immediate worries people have when diagnosed with a serious or long-term condition, but they cannot be solved by a healthcare professional. You would need a legal advisor. Under the law, we all have rights to support if we experience hardship or are treated unfairly in our personal and working lives.
Yet many of us don’t know what our rights are, or where to seek help with navigating the complex processes of the welfare system. This means that significant numbers of people do not get their legal problems resolved and live without the support they are entitled to, a situation we refer to as a ‘legal need’.
The heath impact of legal problems
Let’s think about legal needs from another angle. How would you feel if you lost your income, or had to survive on £7 per day? Would you feel anxious? Could you keep yourself fed and warm? What if you got into debt and could see no way out? What if you became homeless, how would your physical health fare on the streets?
Social welfare legal problems can have significant impacts on a person's health. Mental health can be particularly affected due to the immediate and severe psychological distress these issues can cause, and the subsequent social isolation and exclusion. Physical health can also be affected by the poor living conditions, poor nutrition and unhealthy behaviours resulting from welfare problems.
Supporting systems and communities with health-justice partnerships
My research has been exploring how we assist patients in these circumstances and aims to support our health systems to respond effectively to the complex needs of communities and address the underlying causes of poor health (instead of just the symptoms). The law is a powerful tool for change that can be used to enforce people’s rights and ensure a decent standard of living, assisting patients with their recovery and with their health and wellbeing in the longer term.
‘Health-justice partnerships’ exist across the world, including across the United Kingdom, United States and Australia. The service models are diverse: they exist in a wide variety of health settings, address different legal needs, and involve different approaches to linking up health and legal services. Essentially, they provide welfare rights advice for patients through their healthcare provider. As part of my PhD, I reviewed the international evidence on the impacts of these partnerships.
My research paper shows consistent evidence that health-justice partnerships improve access to justice, improve social and economic circumstances for individuals, and improve mental health and wellbeing. A wide range of other positive outcomes were reported, including benefits for patient and staff experience, more responsive and personalised care, and action being taken on systemic discrimination and community-level health risks.
Turning learning into action
However, the majority of my work has focused on another question: if we want to implement these partnerships, how do we do so successfully? While they exist across England, they seem relatively unstable, both starting up and disappearing again at a rapid rate. The people working to implement these partnerships have experienced significant difficulties in designing integrated systems and getting meaningful collaboration between health and legal teams.
In response, I have been working with health-justice partnerships across England to understand the challenges they face and what has helped them to be successful. The results of the study provide practical information and recommendations to inform the design and delivery of health-justice partnerships. Explore my findings in the video here and below.
Tackling the cycle of inequality
There has never been a more important time to take action in supporting patients with social welfare issues. The economic effects of the COVID-19 pandemic, on top of a decade of austerity, have led to rising levels of poverty, debt and homelessness. The largest impacts have been felt by people on the lowest incomes, and people living with disabilities and mental health conditions. If these problems remain unaddressed, they can lead to a vicious cycle of legal need and health inequality.
To improve health, and to ensure equitable access to justice, our health and legal systems must work together to coordinate support for people who are experiencing these interconnected issues. Developing health-justice partnerships is something very tangible we can do locally and is a significant step forward in taking action to address health inequalities.
This blog is written by Sarah Beardon, a PhD researcher within the Department of Applied Health research at University College London (UCL). The findings discussed are from her research paper International Evidence on the Impact of Health-Justice Partnerships: A Systematic Scoping Review.
This research is part of Sarah's NIHR CLAHRC/ARC North Thames-funded PhD research project Integrated legal advice and health services.