what does the evidence tell us? professor pascoe pleasence faculty of laws, university college...
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What Does the Evidence Tell Us?
Professor Pascoe PleasenceFaculty of Laws, University College London
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“We live in a law-thick world” Gillian Hadfield
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Links between legal problems and morbidity
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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
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• 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
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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
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CSJPS 2010 and 2012
Health impact of legal problems
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The health impact of legal problems
Impacts reported by those experiencing legal problems
(Gramatikov & Verdonschot 2010)
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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)
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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)
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Drilling down
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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)
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A closer look at young people
And comparing users of YIAC services
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Patient centredClient centredCitizen centred
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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.