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How can disparate professions better collaborate in a legal clinic environment to improve the health and wellbeing, legal and social outcomes for patients/clients? In this paper, we explore how an intentional blurring of the boundaries between the health and legal professions in practice—between lawyers, general practitioners and psychologists, in particular—in the context of clinical legal education may result in better patient/client outcomes. We find that direct interdisciplinary professional referrals for patient/clients within a legal clinic environment can promote effective and timely therapeutic interventions for those with complex and interrelated legal and health problems. Drawing upon the literature around cross-disciplinary professional client referrals and two client case studies from a health–justice legal clinic environment in which doctors, psychologists and lawyers personally cross-refer patients with legal and health problems, we recommend some steps to break down the interdisciplinary borders so as to improve access to justice and health outcomes for vulnerable clients.
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No Passport Required: Crossing Interdisciplinary
Borders in an Australian Legal Clinic
Doris Bozin 1, Allison Ballard 1, 2, * , Vicki de Prazer 3and Jenny Weekes 3
1Faculty of Business, Government and Law, University of Canberra, 2617 Canberra, Australia;
2Faculty of Business, Justice and Behavioural Science, Charles Sturt University, 2580 Goulburn, Australia
3Medical and Counselling Centre, University of Canberra, 2167 Canberra, Australia; (V.d.P.); (J.W.)
Received: 14 June 2020; Accepted: 27 July 2020; Published: 29 July 2020
How can disparate professions better collaborate in a legal clinic environment to improve the
health and wellbeing, legal and social outcomes for patients/clients? In this paper, we explore how an
intentional blurring of the boundaries between the health and legal professions in practice—between
lawyers, general practitioners and psychologists, in particular—in the context of clinical legal education
may result in better patient/client outcomes. We find that direct interdisciplinary professional referrals
for patient/clients within a legal clinic environment can promote eective and timely therapeutic
interventions for those with complex and interrelated legal and health problems. Drawing upon
the literature around cross-disciplinary professional client referrals and two client case studies from
a health–justice legal clinic environment in which doctors, psychologists and lawyers personally
cross-refer patients with legal and health problems, we recommend some steps to break down the
interdisciplinary borders so as to improve access to justice and health outcomes for vulnerable clients.
interdisciplinary; professions; law; health; psychology; access to justice; vulnerable clients
1. Introduction
“First, treat no lawyers” is a maxim that might find favour with some physicians and psychologists,
most notably those in North America. Such an idea reflects the deep and pervasive antipathy and
distrust that sometimes exists between health and legal professionals within the United States, though not
necessarily in other nations. A hostile interdisciplinary stance, where it does exist, may have significant
negative consequences for patients and/or clients. Interprofessional rancour and competition may, for
example, manifest in an unhelpful reluctance, or even a refusal, to treat those in need—particularly if
there is some association with medical malpractice lawyers (Jacobson and Bloche 2005). As Jacobson et al.
note, though, this issue of mutual professional distrust does not arise “over dierences in core values
but over dierent approaches for resolving the inevitable conflicts that arise” between the professions
(Jacobson and Bloche 2005). Other factors which may contribute to a mutual aversion between lawyers
and doctors in particular include fundamental misunderstandings of one another’s methods, values
and roles; complex professional goals (such as safeguarding client autonomy and liberty versus patient
care and protection); professional jargon; “arrogant and elitist attitudes”, and preconceived notions of
distrust (Gyorki 2014). While not proposing that inter-professional antipathies, particularly between
doctors and lawyers, is in any way universal or even the norm (and it certainly was not reflective of the
situation experienced by the authors), it is worth considering how professional “ring-fencing” and/or
role-based professional tensions, where they do exist and are unhelpful to achieving optimal outcomes
for patients/clients, can be addressed and resolved through collaboration or other means.
Laws 2020,9, 17; doi:10.3390/laws9030017
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In other words, how might interprofessional barriers be best broken down so that the vulnerable
people served by the health and legal professions can cross interdisciplinary professional borders
with ease?
In considering this question, in this paper, we first address the significant commonalities between
the legal and health professions (with a particular focus on medical practitioners and psychologists)
with a view to highlighting how these shared understandings can be mobilised through clinical legal
education to support better outcomes for patients/clients. We then review a pilot health–justice legal
advice clinic, a type of health–justice partnership, established at the University of Canberra, Australia,
in mid-2017. We describe how the clinic worked in practice and address some of the professional and
practice issues raised by its operation (for example, client confidentiality, consent and the importance
of interprofessional trust) and outline how those concerns were managed. We also consider dierent
approaches to interprofessional referrals and barriers to accessing legal services in Australia, before
focusing on the hybrid referral system used by the health–justice legal advice clinic. Finally, we consider
two client case examples before suggesting areas for future research directed towards ensuring that no
passport is required when “crossing the borders” between a health service and a legal service.
2. Health and Law’s Professional Commonalities: More Open Doors Than Closed Borders
One way of demolishing the interdisciplinary barriers between the health and justice professions
is through creating a reinvigorated interprofessional dialogue which emphasises the professions’
shared core values (e.g., respect for the individual and a commitment to reason-based decision-making,
professional judgment, and experience) and mutual concerns for patient/client safety (Jacobson and
Bloche 2005). Having constructive conversations between professionals about shared aspirations and
professional responsibilities and obligations rather than maintaining a negative focus on professional
divergence and dislike is—intuitively, at least—an approach which is more likely to generate better
patient/client outcomes. While in Australia, the approach of lawyers is typically an adversarial one,
this is not always the case, and, increasingly, alternative approaches to dispute resolution as well as
ideas about therapeutic jurisprudence and restorative justice approaches are becoming more common
across the legal profession, or certainly those parts of it with a greater social justice focus.
As will be only briefly touched on below, doctors, lawyers and psychologists are all bound by
dierent ethical and professional standards which—in Australia, at least—share many commonalities,
both in values and approach.
The medical profession (anecdotally and assertedly) is obliged to “First, do no harm” (Mehrig 2014).
Those who enter the practice of medicine promise to maintain the highest standards of personal integrity
and competence and to have compassion for those in their care (Leaning 1997). The doctor–patient
relationship is a partnership based on trust, mutual respect and collaboration (Australian Medical
Association 2016). Lawyer–client relationships are analogous. Like doctors, legal practitioners are obliged
to take oaths or affirmations of honour upon admission to professional practice. They must comply
with a range of common law obligations and statutory rules of professional conduct. Fundamentally,
lawyers must be of good fame and character and possess a commitment to integrity and protection of
the public (Dal Pont 2010). Australian psychologists are similarly bound by a professional code of ethics
and obliged to respect patient confidentiality (Australian Psychological Society 2007).
Arguably, then, the medical, legal and psychological professions share significant commonalities
in terms of their professional relationships with those they serve and also the broader community
(including as represented by the courts and/or professional regulatory bodies). All three professions,
for example, have confidentiality obligations to individual patients/clients as part of their ethical
framework (that is, they stand in a position of trust to their patients/clients) and must take responsibility
for the quality of advice/care/interventions/representation/treatment provided to them. Of course,
the professional obligations of these disciplines are not identical, but where tensions do arise on
account of diering responsibilities, an interdisciplinary sharing of information and ongoing education
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about potential areas of conflict would assist in smoothing and navigating the frontiers which separate
these professions.
All doctors, lawyers and psychologists must generally place patient/client interests above their
own and (generally) respect patient/client confidences. At times, however, the duties owed to society
(or to the court, in the case of a lawyer) create potential role conflicts with respect to professional
confidentiality obligations to patients/clients. All three professions may, for example, in the context of
professional privilege/confidentiality, be privy to disclosures of a credible threat to harm another person.
In the case of the lawyer–client relationship, however, the idea of “legal privilege” belongs to the client
and could generally only be waived by them upon instruction, whereas statute law often requires the
mandatory disclosure of certain things by doctors and psychologists but not by lawyers. For example,
doctors, dentists, nurses, police, teachers and certain others (but not lawyers) are mandated reporters
in suspected cases of child abuse or neglect under Section 356 of the Children and Young People Act
2008 (ACT 2008). These diering circumstances clearly raise a potential conflict of interest between
professionals who are working together.
Where lawyers perceive that such a threat is credible, they may disclose confidential information
for the sole purpose of avoiding the probable commission of a “serious criminal oence” and/or disclose
the threat and other relevant confidential details to the client’s doctor, the police and/or the person
threatened (Australian Solicitors Conduct Rules 2015). Similarly, exceptions to the requirement for
doctors to maintain patient confidentiality include where there is a serious risk of immediate harm to
the patient or another person, where required by law, where part of approved research and where there
are overwhelming societal interests (Australian Medical Association 2016). The disclosure obligations
of psychologists in this context are similar to those of doctors (Australian Psychological Society 2007).
At the heart of these confined circumstances of permissible disclosure in breach of patient/client
confidentiality obligations is the public interest—that is, serving public as opposed to private interests.
Public interest embraces “standards of human conduct
. . .
tacitly accepted and acknowledged to be for
the good order of society and for the well-being of its members. The interest is therefore the interest of
the public as distinct from the interest of an individual or individuals
. . .
(Kaye and Ormiston 1991).
An ethos of public service sits at the core of professionalism for both health and legal practitioners.
For some lawyers, providing pro bono legal services to vulnerable people to promote access to justice
reflects their idea of professionalism (Dal Pont 2010)—undertaking pro bono work is “a desirable,
indeed a necessary part, of every solicitor’s practice” (Adams 2000). While the concept of pro
bono service is perhaps not as normalised within the health professions, doctors and psychologists,
like lawyers, regularly deal with those on the margin—the “poor, vulnerable, elderly, addicted, insane,
imprisoned, unemployed, discriminated against, tortured, homeless
. . .
(Nathanson 1997). They know
that these vulnerable people have higher rates of sickness and ill health and that access to the “goods
and freedoms of society plays an important part” in how and whether an individual experiences a given
illness and also whether or not the experience of that illness is particularly severe (Leaning 1997).
The significant commonalities outlined above, including shared ethics of care across the health
and legal professions, underpin, at least in part, the emergence of health–justice partnerships both
within and outside Australia. While still relatively novel in the Australian context, these sorts of
professional interdisciplinary partnerships have become increasingly common (Brown-Irava et al. 2017).
Health–justice legal clinics require health and legal professionals to work together as an interdisciplinary
team, to develop positive working relationships and trust and to put the best interests of patient/clients
ahead of their own. By doing so, the potential benefits for patients/clients (and society) by way of
better health, wellbeing and social outcomes are significant.
Improved patient/client outcomes are possibly one of the best justifications for fostering greater
cross-professional collaboration in a legal clinic context. In any case, professional antagonism in the
context of clinical legal education within the health–justice partnership space would be untenable.
Clearly, the best interests of the key stakeholders in legal clinic environments—the patients/clients,
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the law students, the health and legal professionals, the clinic academics and the university—would
not be well-served by interdisciplinary professional antagonism.
Doctors, lawyers and psychologists have much in common, including often sharing highly
protective attitudes towards their patients/clients. It is these very commonalities, rather than any
professional dierences, that come to the fore and aid mutual cooperation in the best interests of shared
patients/clients in the health–justice legal clinic setting.
3. Health–Justice Clinics: Interdisciplinary Collaboration Promotes Better Client Outcomes
Health–justice partnerships are diverse in design and come into existence for a range of dierent
reasons. What they commonly recognise and try to remedy, though, is the inequitable access to justice
experienced by vulnerable people. Disability and illness in particular are commonly associated with a
person’s increased vulnerability to significant (often unresolved) legal issues as well as an experience
of disadvantage and social exclusion (Clarke and Forrell 2007). Furthermore, people who experience
a legal problem (if they even recognise it as such) are more likely to consult a health professional
rather than a lawyer (Clarke and Forrell 2007;Gyorki 2014). In about 50 per cent of cases, people
with potential legal problems do not seek any assistance at all and so are at risk of falling through the
cracks. The association between legal problems and chronic illness/disability is also often bi-directional;
for example, “long-term incapacity can cause unemployment, family breakdown and debt problems”
which can, in turn, cause or exacerbate existing psychological and/or physical illness (Clarke and
Forrell 2007).
Given the combined impact of the failure to recognise and/or a reluctance to seek help for legal
problems, a tendency to avoid lawyers and the probability that not addressing legal problems may
cause or escalate health problems (and vice versa), a holistic approach is pragmatic. In other words,
if health and legal practitioners work together to develop an all-inclusive picture of a person’s health,
social and legal problems, they will be better able to develop a comprehensive management plan
for that person. Holistic or “wrap-around” patient/client care/intervention/treatment can be better
facilitated by developing more positive, constructive and trusting interprofessional relationships as
well as an enhanced capacity to cross-refer clients. A more integrated approach in turn oers the
potential to achieve far better health and legal outcomes for vulnerable populations.
A Case Study: the University of Canberra Health–Justice Legal Advice Clinic
With the above issues in mind, in mid-2017, an informal arrangement between law academics
from the University of Canberra School of Law and the University’s Medical and Counselling Service
saw the establishment of a pilot on-campus health–justice legal advice clinic (the Legal Clinic). There
was little by way of preliminary formality, planning or political posturing in respect to the pilot clinic:
the seeds were sown in late 2016/early 2017 over coee conversations and a “handshake” agreement.
While, as will be discussed more below, many other health–justice clinics are planned with great
precision and formal memorandums of understanding, here, the driving force was simply the desire
of two legal academics to provide a genuine opportunity for practical legal experience for credit for
later year law students. This was in response to law student feedback that there were insucient
opportunities for them to obtain practical legal experience.
For their part, the general practitioner head of the Medical & Counselling Service (the Health
Service) and a stapsychologist recognised the need to oer their vulnerable patients a point of referral
to address their legal issues. The parties agreed to establish a collaborative health–justice service to
solve two problems: the anecdotal lack-of-legal-practice-opportunity-for-law-students-problem and
the absence of a reliable (legal) referral point for the Health Service’s patients.
The resulting (pro bono) Legal Clinic was auspiced by a private law firm (owned by one of
the legal academics). The Legal Clinic accepted personal (direct) referrals for legal assistance from
the health professionals at the Health Service. In turn, the Legal Clinic was also able to direct-refer
distressed clients to the Health Service. The Health Service provided, at no cost, a dedicated on-campus
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space (with an oce, computer and single interview room) and private lawyers volunteered their time,
energy and expertise to supervise law students who undertook legal cases and research work for the
referred patients/clients. For the students, their clinical legal experience was also academically credited
towards their law degree studies.
Once the parties agreed to run the pilot Legal Clinic, the law academics developed and conducted
an orientation training session for the health professionals who would be referring patients to the Legal
Clinic. The training covered the rationale for the Legal Clinic, the services it could provide, the way it
would work and information on how to spot a legal issue and how to refer clients to the clinic. The
latter in particular was important. While doctors, psychologists and other healthcare professionals
may understand that their patient has a legal problem, they may not know where to refer the client for
legal help or have any established links to legal service providers (or lawyers). In addition, for some,
this type of referral or “assistance may be, or may be seen to be, beyond their role” (Clarke and Forrell
2007). By advising the health professionals about the type of service the Legal Clinic could provide,
by putting “names to the faces” of the lawyers at the clinic, and, in particular, by having it located
on-campus and geographically proximate to the Health Service, it was logistically (and emotionally)
easier for the health professionals to refer their patients and to understand the benefits of doing so.
Other issues that needed to be addressed prior to the opening of the Legal Clinic included the
appropriate management of patient/client confidentiality and consent issues. To this end, a patient/client
referral form which included provisions for the patient/client’s consent for the referral was developed
by the health and legal professionals. The form was signed by the patient and presented to the Legal
Clinic during the patient/client’s first appointment.
The Legal Clinic operated one day each week, primarily through direct, personal referral from the
health practitioners at the Health Service. It also saw clients on a “drop-in” basis, though this aspect of
the service was not heavily promoted on campus.
Throughout all of this, possibly the most important aspect of the Legal Clinic was the relationship
of trust and goodwill between the legal academics, the lawyers and the health professionals. Together
they envisaged the possibility of running an on-campus health–justice legal advice clinic on a shoestring
and through ongoing interdisciplinary collaboration, they made it work. The trust and goodwill
between the health and legal professionals was present at the outset but it, and the partners’ personal
and professional commitment to the service, also grew over time as positive outcomes were achieved
for the referred patients/clients through eective team-work. Clear lines of communication and trust
are two of the key components of successful health–justice partnerships (Ewais and Banks 2018;
Curran 2016) and they featured strongly in the Legal Clinic.
4. Patient/Client Referrals: A Patchwork Quilt of Warm and Cold Spots
Perhaps one of the most important aspects of the collaboration between legal and health
professionals in the context of clinical legal education through health–justice partnerships is having
a good referral system. Legal (or law) clinics, including health–justice clinics or partnerships, are
typically cooperative ventures between dierent service providers and stakeholders including law
faculties, health services, legal aid/community legal service providers, private lawyers and/or firms
and law students, so having pre-determined and productive ways of referring patients/clients is
clearly a crucial element in the success of such ventures. Sometimes legal clinics operate within an
existing medical or health service (for example, the Health Advocacy Clinic at the Mater Young Adult
Health Centre in Brisbane, Queensland, and the Loddon Campaspe Community Legal Centre–Bendigo
Community Health Service partnership in Bendigo, Victoria). In such cases, referrals would be internal
to the organisation and so perhaps more straightforward. Ideally, in all cases, though, even those
referred within an organisation, patients/clients would be direct-referred within or between services
so as to provide holistic wrap-around client services in the hope of achieving better client outcomes.
Clients may, for example, be referred to legal clinics by health and medical practitioners for information,
support, advice and a for a range of legal services, including mediation and dispute resolution. Clients
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may also be referred (or referred back) to medical practitioners and psychologists by law clinics.
Regardless of the direction of referral, the aim of referring clients is to “deliver high-quality, timely,
safe and ethical services” to the client (Australian Attorney-General’s Department n.d.). As Gyorki
suggests, integrating legal services into a healthcare setting not only provides a direct referral pathway
for health professionals who treat patients with legal needs to refer patients to on-site legal services;
it might also serve to bolster patients’ attainment of better health outcomes (Gyorki 2014).
Establishing clear and effective referral pathways to the legal service, including on-site legal clinics, is
critical. This may mean assuming responsibility for making appointments with the other service provider
and also clarifying whether clients can book their own legal assistance appointments (Gyorki 2014).
It may also require determining (ideally in consultation with the patient/client) the amount of their
private information that may be shared with the other service as well, of course, as obtaining the
patient/client’s consent to the sharing of that information. Referral processes should be determined by
client needs, service arrangements and the capacity of the referring and receiving services (Australian
Attorney-General’s Department n.d.). As seen in Table 1below, each of the dierent types of client
referrals has advantages and disadvantages. Patient/client referrals can occur by telephone, letter, email,
website or other forms of written communication or via face-to-face handovers, or some combination of
these or other approaches. Referrals may be active and warm or facilitated and cold, or some amalgam
of these approaches (Australian Attorney-General’s Department n.d.). Where feasible, facilitated,
warm and/or active referral processes are preferable in light of the aim of creating holistic wrap-around
services, particularly for those clients who are likely to experience any diculties in accessing the other
service without overt assistance.
Table 1below is adapted from the table in the Australian Attorney-General’s Department (n.d.)
referral guidelines for the Family Relationship Centre and the Family Relationship Advice Line and
incorporates referral information gleaned from the “Breaking down the silos: Overcoming the Practical
and Ethical Barriers of Integrating Legal Assistance into a Healthcare Setting” report (Gyorki 2014).
Table 1. Advantages and Disadvantages of Dierent Types of Referral.
Possible Term Characteristics Possible
Advantages/Disadvantages Referral Pathways
Passive Referral
The client is given
contact information for
appropriate service(s)
and is left to make
her/his own contact at a
time that best suits the
This process gives
responsibility to the client to
take action on their own
behalf. However, there is a
greater likelihood that the
referral will not be taken up.
Patient/client contacts
legal service provider by
phone call, fax, email or
by drop-in to make an
Facilitated Referral
The client is helped to
access the other service;
for example, the
referring organisation
makes an appointment
with the other service on
the client’s behalf, asks
the other service to make
contact with the client/s
or a caller is transferred
to the other service.
The other service is made
aware of the client, and the
client is helped to access that
other service. The client may
need to wait for a response
from the other service.
With the patient/client’s
consent, the medical
service provider contacts
the legal service provider
by phone call, fax, email
or by dropping-in to
make an appointment for
the patient/client.
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Table 1. Cont.
Possible Term Characteristics Possible
Advantages/Disadvantages Referral Pathways
Active Referral
The referring
organisation, with the
client’s consent, provides
the organisation to which
it is referring the client
with information that it
has collected about the
client or with its
professional assessment
of the client’s needs.
The client does not need to
repeat all of their story and
the agency to which the
client is referred has relevant
information about the client.
However, there is a risk that
the information is
communicated out of context
and therefore misinterpreted
by the service which is
receiving the referral,
especially if not done as a
“warm” referral (see below).
With the patient/client’s
consent, the medical
service provider contacts
the legal service provider
by phone call, fax, email
or by dropping-in to
make an appointment for
the patient/client.
Cold Referral
The client is transferred
to another service,
without any immediate
communication between
the Centre or Advice
Line and the other
services—for example,
by putting the client into
a call centre queue.
The other service may be
unaware of the nature of the
call or of any information or
services that have already
been provided. The client
may be frustrated that they
have to re-tell their story or
may not communicate their
needs in a way that allows
the other service to see why
the client has been referred.
Medical service provider
transfers the potential
patient and/or client
calling in to another
Warm Referral
A “live” three-way
conversation in the
presence of the client
(whether face to face or
by telephone) in which
the referring
organisation introduces
the client, explains what
has already been done to
assist the client and why
the client is being
This provides an open and
transparent process in which
information can be
exchanged between the
Centre, the client and the
other service. Issues can be
clarified immediately. The
client does not need to
repeat all of their story. The
process relies on someone
being available at the other
service at the time the client
is to be referred.
Medical service provider
contacts the legal service
provider by phone call,
fax or email while with
the patient/client, or by
dropping-in with the
patient/client to the legal
service provider to either
make an appointment for
the patient/client or to sit
in on the interview with
the patient/client’s
4.1. What We Did
Using the framework provided in Table 1above, the referral approach adopted by the Legal
Clinic was an amalgam of the warm, facilitated and active referral approaches. Referrals were
patient-centred and individualised to the client in question, acknowledging that there is really no
one-size-fits-all approach.
The patient/client’s individual diagnoses, the type(s) of legal problem(s) and the seriousness
(or not) of the client’s matter/circumstances were key influencers in deciding which referral type
was appropriate in a given case. Typically, though, after a health practitioner obtained patient
consent for a referral to the Legal Clinic, they would either make an appointment by telephone or
in person or, alternatively, if it was a clinic day, accompany the person to the Legal Clinic and do a
face-to-face hand-over.
Sometimes, the client would ask the health practitioner to also act as a support person during the
legal interview. Occasionally, too, the lawyers would refer clients to, or “back to”, to the Health Service,
particularly if the lawyer was concerned about the client’s mental health and well-being. In general,
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this sort of tactic is not uncommon in Australian legal practice—Australian employment and personal
injury lawyers may advise their clients to establish a dedicated professional relationship with a general
practitioner and may also suggest that the client obtain a doctor’s referral for a government-funded
“mental health plan”. This strategy is particularly useful for sexual harassment and discrimination
matters, employment disputes and worker’s compensation claims where clients may be traumatised
and in significant emotional distress. As observed by prominent Australian employment lawyer,
Josh Bornstein, in 2018, in response to a question from ABC presenter Virginia Trioli, about a (sexual)
harassment case (emphasis added):
By the time a woman comes to see me about me a sexual harassment case, the first thing I’m
always prepared for is that her health will be severely compromised and in fact this is an issue for people
who have traumatic experiences at work and there are a hell of a lot of them. We spend more time at
work than we do at home and so the whole gamut of human experience and drama occurs at work,
but a woman who has suered sexual harassment who’s got to the point of booking to see me will be
very, very distressed and traumatised. It’s only a matter of degree so I spend ten minutes giving medical
advice even though I’m a lawyer, and making sure that if they haven’t already got a GP and a least a referral
to a psychologist [they get one]. The other thing about the journey is, the journey can be over in three
months and usually no one knows about it. It’s on under the radar. If I have someone coming to see me
about sexual harassment in a law firm and I press send on a letter of demand, for example in the legal
industry, I can then set the clock and I will be like lightning. And cases like that are over reasonably
quickly and with confidentiality. So, in one sense that’s a good thing for women and women in that
situation often want confidentiality, so it’s very complex. My first duty is to advance what they want.
On the other hand, this is going on all the time and no one knows about it and this doesn’t assist the broader
policy issues (ABC Television 2018).
Every client and every patient is dierent. Consequently, an individualised and flexible approach
to client care by both health and legal professionals is likely to achieve better outcomes. The health
professionals involved in the pilot Legal Clinic reported that their engagement with the lawyers and
the services that they provided had improved their own ability to further assist their patients. In their
patients, they observed both a positive shift in thinking and added insights into their problems from
a legal perspective. These positive changes in the patient, in turn, assisted the health professionals
working with them to better compartmentalise and address the patient’s various health, legal and
other issues (Weekes 2019).
4.2. Barriers to Accessing Legal Services in Australia
Clients may experience a range of barriers in accessing dierent services, including legal advice
and assistance services. Obstacles to service access may include things like a lack of information
about available services, a lack of services generally (e.g., interpreter services), a lack of anonymity
(this is particularly problematic in rural and regional areas where there are fewer lawyers), a lack of
capacity/interest in taking up the referral, a lack of access to childcare arrangements (when visiting a
lawyer), no or reduced access to transport (particularly for elderly or disabled clients), long waiting
lists, costs, cultural and/or language barriers, diculties in contacting clients (e.g., lack of phone
services) and family relationships (Australian Attorney-General’s Department n.d.).
In particular, many women who have experienced family or domestic violence do not follow
through with general practitioner referrals to other services. However, where a patient does accept
a referral, factors that make it easier for them to access the other service include oering to make or
making the appointment, providing written information about the appointment (including the time,
location and directions to the appointment and the name of the person to be seen) and also telling the
client about referral pathways to safety and healing, the specialised service to which they are being
referred and what might be expected from it (Royal Australian College of General Practitioners 2014).
So, while there may be many “practical and ethical barriers” to client referral, to integrating
legal assistance into a healthcare setting and to including lawyers on the “care team”, these can, as
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discussed below, be addressed through proper planning. Clearly, where a health practitioner is able
to contribute to providing a wrap-around service for a client by referring directly to a legal service,
and/or by accompanying the client to the legal service, systemic barriers may be broken down. In such
a context, the client is likely to feel more supported and to have more faith in the legal practitioner.
This is likely to be, at least in part, because they trust the health professional who has facilitated the
interaction and who has, by implication, therefore also demonstrated some degree of trust in the lawyer
(Allinson and Chaar 2016).
4.3. The Benefits of Building “a Circle of Trust”
The factors that promote trust between patients and health professionals include competence,
social/communication skills, honesty, confidentiality, caring and demonstrating respect for the patient
(Allinson and Chaar 2016). As mentioned above, direct referrals by a trusted health professional to
a lawyer may sow the seed of establishing a similar confidence in the lawyer or practice to whom a
patient is referred. Clearly, the skills and attitudes of key staare also crucial to eective client referrals.
Successful referrals require empathy, respect for the client, cultural sensitivity, comprehension of levels
of client distress and non-judgmental attitudes. Referring staalso need to possess the knowledge,
capacity and skills to support their clients to access other services, including being able to negotiate
ways to overcome any possible barriers to service access (Australian Attorney-General’s Department
5. Confidentiality and Protocols
As Gyorki notes, providing direct referral pathways from health professionals to on-site legal
services such as the Legal Clinic has the capacity to significantly improve health outcomes for
disenfranchised individuals (Gyorki 2014). However, moving away from traditional legal service
models in a lawyer’s oce and integrating legal services within a healthcare setting where lawyers
are part of the healthcare team also presents a number of practical professional and ethical diculties
(Gyorki 2014).
As Benfer notes, both lawyers and law students working in health–justice partnerships must be
particularly cognisant of client confidentiality and ethical obligations as well as the need to protect
lawyer–client privilege and privileged work product (Benfer 2014). Both the legal and health partners
must also be aware of their dierent professional reporting, information-sharing, privacy, insurance
and statutory obligations and take deliberate steps to comply with what is required so as to avoid
liability and breach (Benfer 2014).
Consequently, it is necessary to develop clear protocols between the referring and receiving
service providers. These could be in the form of “memoranda of agreement” or other forms of
formal agreement, which outline the relationships and delineate the roles and responsibilities of
the collaborating partners (Australian Attorney-General’s Department n.d.). In addition, arranging
education for the dierent partners on rules and ethical policies, preparing agreements on emergency
care in the event of injury, having information-sharing policies and holding current professional and
regulatory accreditation and approvals are necessary (Benfer 2014). Where confidential information
is to be shared between health service and legal service providers, formal agreements are essential
and any policies, arrangements and/or agreements made between the parties should be periodically
reviewed and modified as appropriate (Benfer 2014).
What We Did
The legal and health professionals and the students involved in the Legal Clinic worked
collaboratively to ensure that the best interests of the client were the paramount concern. The overall
aim of the clinic was to work collaboratively to achieve better health, wellbeing, legal and social
outcomes for the patients/clients. As alluded to above, the arrangements between the health and
Laws 2020,9, 17 10 of 13
legal professionals consisted of a range of formal and informal processes, which included establishing
proper and ethical referral protocols and procedures.
If a client agreed to a referral to the Legal Clinic, for example, they were asked to sign a confidential
consent form (which was able to be individualised and adapted). It included details such as their
personal particulars (name, address, contact details), an overview of the patient/client’s concerns,
the details of the treating/referring health practitioner and patient/client name, signature and date block.
The arrangements between the legal and health professionals were premised on the following:
Each professional’s understanding of their ethical obligations to individual patients/clients in line
with their own discipline’s ethical framework and the appropriate sharing of these obligations
with the other discipline professions as required (as discussed during the preliminary training
The professionals working together as an interdisciplinary team to develop and maintain positive
working relationships and open channels of communication with each other and to put the
patient/client’s best interests ahead of their own;
Establishing and continuously building inter-professional trust and respect through regular formal
and informal meetings to provide feedback and resolve any problems arising;
Being committed to providing a holistic wrap-around patient/client service directed towards
achieving better patient/client outcomes. Regardless of the direction of referral, the aim of referring
clients is to “deliver high-quality, timely, safe and ethical services” to the client.
Administratively, the Health Service was responsible for the following:
Obtaining the patient’s consent to be referred to the Legal Clinic;
Making an appointment with the Legal Clinic for the patient by telephone or in person, and/or
alternatively, on occasion, escorting the patient to the Legal Clinic and (at times) attending the
interview with them in a support capacity;
Providing (where possible) a personal hand-over of the patient/client to the Legal Clinic.
In addition to consulting the client and providing legal advice and assistance and forward referral
if necessary, the Legal Clinic was responsible for drafting ethical referral protocols and procedures,
including basic client consent forms (which were individualised and adapted in light of a client’s
personal characteristics, vulnerabilities and diagnoses). The Legal Clinic was also responsible for
maintaining client records on behalf of the auspicing law firm.
6. Case Studies from the Legal Clinic
The following two client case studies highlight the benefits of providing a holistic wrap-around
client service in the Legal Clinic.
6.1. Case Example One
A patient/client with significant mental health issues was facing a number of criminal charges
interstate. On account of those issues, the patient/client had been unable to attend court interstate for
over a year, but a further court date was pending. The Health Service “warm- referred” the client to
the Legal Clinic. On initial consultation, the client was reluctant to do anything to address the criminal
charges issue. With the consent of the patient/client, the lawyer asked the health professional to attend
the next interview as a support person. The lawyer then explained to both the possible consequences
of not dealing appropriately with the criminal charges and the upcoming court attendance. Ultimately,
the patient/client, after encouragement from the health professional, gave instructions to the lawyer to
address the criminal charges. After significant work by the lawyers and the law students, the Court
agreed to dismiss the charges against the client. The health professional subsequently advised the
lawyers that the patient/client “was in a much better place psychologically as a result of the criminal
charges being dismissed”.
Laws 2020,9, 17 11 of 13
6.2. Case Example Two
A patient with significant work-related spinal injuries, psychological distress, constant pain and
a lack of financial resources was warm-referred to the Legal Clinic by the Health Service. Although
the client had already retained a private lawyer in relation to a negligence claim against the client’s
employer, there had, from the client’s perspective, been a significant delay in resolving the dispute and
there were, on the face of it, a number of outstanding legal issues that the law firm had not addressed.
These included the question of outstanding monies owed by the employer, a possible victim of crime
application and housing issues. There are a number of possible explanations for these “omissions” by
the retained lawyer including that lawyers may have been “siloed” by specialising in certain areas of
law, such as personal injury or negligence, rather than considering a broader spectrum of social justice
issues such as helping the client to secure government housing. In this case, for example, the low level of
prescribed fees for making a victim of crime application in the relevant jurisdiction, as per Section 12(2)
of the Australian Capital Territory’s Victims of Crime (Financial Assistance) Regulation 2016 (ACT 2016),
oered little financial incentive for the retained private lawyers to undertake the work. The (pro bono)
clinic lawyer, with the assistance of the health professional, identified all the relevant issues that were
negatively impacting the client’s ability to fully recover their health and to become financially and
physically independent. After consulting the retained lawyer and requesting that they “accelerate”
their assistance to the client, the Legal Clinic assisted the patient/client to recover the monies owed
and to ensure access to disability-appropriate accommodation. The health professionals anecdotally
reported to the lawyers that there had been an improvement in the client’s health and psychological
status after the Legal Clinic’s intervention.
7. Conclusions: Lessons Learned—The Way Forward
While there is clearly more work to be done to optimise the scope and practice of legal clinics,
such as the one described in this article, as well as to define the types of services that such clinics oer
to clients, the pilot clinic’s reported patient/client outcomes, as exemplified by the two case studies
above, were positive. Two of the key components in this particular legal clinic’s success were, firstly,
in the view of the authors, the referral system adopted by the health and legal professionals. Secondly,
the shared aspirations and the ongoing mutual relationships of trust, confidence and friendship fostered
by all parties were pivotal. However, as the reported positive outcomes largely rely on informal
feedback from the participating lawyers and health professionals and a brief on-line survey of the law
students who worked in the clinic, a more formal mechanism of assessing patient/client outcomes,
determining the appropriateness of the referral systems used in such environments and assessing the
real benefits to law students is needed. This oers significant scope for future research.
In addition, as the pilot clinic was operated by an informal agreement between the legal academics,
the auspicing law firm and the Health Service, the authors agreed that more attention needed to
be given to this issue in future iterations of the clinic. The informal agreement underpinning the
operation of the pilot clinic was a “handshake” deal based on a shared goal of improving outcomes
for patients/clients while also providing practical legal experience for law students. Despite this
informality, arrangements were nevertheless put in place to safely share patient/client information and
to include, as necessary, and with the client’s consent, the referring health professional as a “support
person” in the Legal Clinic’s client interviews. The rationale for having health professionals attend the
Legal Clinic patient/client interviews was to ensure that they gained a better understanding of the
legal parameters and complexities of their patient’s situation. This arrangement also avoided the need
for the health professional to take their own notes of the interview, therefore avoiding their inclusion
of these records in any subpoenas of patient records. To facilitate this arrangement, as well as the
referral itself, prior to being referred, patient/clients were asked to sign a confidential consent form
which allowed the lawyers and health professionals to share any patient/client information that was
relevant for legal purposes. While all patients/clients did sign the consent form, it was also made clear
Laws 2020,9, 17 12 of 13
to them that should they not wish to sign the consent form, they would still be able to access the Legal
Clinic and its free legal services.
In moving forward, the authors considered that formalising the original “handshake” arrangement
with a comprehensive written memorandum of understanding around the objectives, roles,
responsibilities and records management obligations of the dierent parties and professional disciplines
participating in the clinic was important. Commentary on these developments and what was done as
the pilot Legal Clinic entered the next stage of its genesis are, however, outside the scope of this article,
which focuses on the establishment and operation of the pilot clinic.
While the pilot clinic ran successfully on a shoestring and without any funding from the university
(apart from the provision of an on-campus space in which to house the clinic and interview clients),
securing ongoing funding for the clinic and also ensuring its continuing independence moving forward
were both considered to be imperative (and beneficial) attributes. The legal and health professionals
who designed, established and operated the clinic contributed their ideas and labour on a voluntary
and pro bono basis and brought significant goodwill to their eorts on the clinic’s behalf. This approach
of course reflects a volunteer and public service ethos that is also very much part of the Australian
community and the professions. However, in order to promote sustainability, to provide a dedicated
workspace and to oer greater numbers of law students the opportunity to obtain on-campus legal
practice experience, some degree of funding would likely be necessary.
Although this pilot Legal Clinic focused on a particular alliance between legal and health
professionals, many other professional alliances are possible and could oer many potential benefits,
including by “future-proofing” the students of a range of dierent disciplines. For example,
work-integrated learning and working agreements/alliances between lawyers and accountants, lawyers
and economists, lawyers and engineers and engineers and architects, to name just a few, could capitalize
on the similar skills needed by each, as well as exploring the value of the dierent insights to practice to
be gained from working more closely across professional disciplines. This area is ripe for both creative
practical applications and future research.
The success of the pilot Legal Clinic suggests that achieving positive client outcomes in respect
legal, health and social concerns will be facilitated through providing supportive, professional and
compliant interdisciplinary referrals. Integral to this is developing and maintaining the relationship of
trust and respect between the dierent professions. Where this works well, as it did with the pilot
health–justice legal advice clinic, no passport is required to cross the border from one professional
disciplinary practice to the next.
Author Contributions:
Conceptualization, D.B. and A.B.; Project administration, V.d.P. and J.W.; Resources, V.d.P.
and J.W.; Writing—original draft, D.B. and A.B.; Writing—review & editing, D.B. and A.B. All authors have read
and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.
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(CC BY) license (
... Collapsing disciplinary silos in the educational context provides students with early opportunities for "interprofessional dialogue which emphasizes the professions' shared core values (e.g., respect for the individual and a commitment to reason-based decision-making, professional judgment, and experience) and mutual concerns for patient/client safety." 58 Interprofessional contact during training provides an early opportunity to foster awareness, interest, and capabilities for future work in HJPs. ...
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This article traces the development and growth of health justice partnerships (HJPs) in three countries: the United States, Australia and the United Kingdom.
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This bulletin draws on Law and Justice Foundation research to explore the prevalence of non-legal services as the first port of call for socially or economically disadvantaged people with legal problems. It looks at why disadvantaged people with legal problems seek help from non-legal services and explores how these services respond to the legal needs of their clients. It also identifies challenges non-legal services face in assisting clients with legal problems and suggests strategies to facilitate non-legal services as effective pathways to legal assistance.
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The Universal Declaration of Human Rights enters its 50th anniversary year in 1998. Around the world efforts are under way to celebrate this event and accelerate efforts to disseminate the contents of the declaration. These efforts are undertaken in recognition that progress has been at best uneven since that early morning of 10 December 1948 when the United Nations General Assembly formally adopted this document and thereby sought to enshrine in world consciousness a commitment to secure basic human rights around the world. In 1948 there were 58 member nations of the UN; there are now 185. For this world community the declaration has acquired the status of international law and all governments can be held to its principles. Many other international treaties and charters have incorporated the language of the declaration or referred to it; and many national governments have included its language and principles in their constitutions.1 The declaration encompasses civil and political rights of individuals (in the first 21 articles); economic and social rights, including to health care (articles 22-27); and reciprocal obligations and constraints conferred by participation in a community (articles 28-30) (see p 1455). There are several histories of this document which are relevant to those interested in the struggle to persuade human beings to find common ground and push off to higher reaches from it. Yet for the medical community in general, and for the subset who are medical students, the history is less crucial than is the fact of what this document now has become, 50 years from its making. With astonishing durability it has withstood the test of time and has become the minimum consensus statement …
Background Issues of health and law are closely connected in people with chronic illness but as yet there is little emphasis in current health services funding and planning on establishing formal links between these two important areas. Context The Mater Young Adult Health Centre and Health Advocacy Legal Clinic partnership offers an example of an innovative and effective health–justice and multidisciplinary practice. Health and legal services are co-located in a purpose-built tertiary hospital for adolescents and young adults with complex health needs, which facilitates close collaboration between health and legal professionals and interdisciplinary work. Aim and objectives In this paper, we explore young people’s health and well-being in a contemporary context of holistic care provided within a health–justice partnership in a tertiary hospital for young adults with chronic illness. Methods Using illustrative examples, we describe the collaborative treatment model involving health and law professionals working in an interdisciplinary clinic. Findings While we touch on the role of students in the clinic and the educational benefits for the them, our primary focus is on describing the integration of law and health as a model of care and the importance of growth and shift in the understandings of professionals. We provide examples of treatment, coordinated actions and successful outcomes in the well-being of three complex young people, their families and the community. Conclusion We conclude by offering future visions of service expansion, both in terms of availability on-site as well as increased support.
During the past 30 years, there have been 3 separate medical liability crises. In the first 2 crises, which occurred in the 1970s and the 1980s, either physicians experienced increasingly unaffordable insurance premiums or many specialists were unable to purchase insurance at any price. The current crisis has elements of both, especially for high-risk specialties. Cumulatively, the recurrent crises have exposed the rawness of physician antipathy toward attorneys and the legal system. That antipathy appears to be deeper and more pervasive than ever before,1 making it hard to imagine that relations between attorneys and physicians can get much worse.
Q&A Special: #MeToo. ABC TelevisionAustralia
ABC Television. 2018. Q&A Special: #MeToo. ABC TelevisionAustralia. Available online: qanda/qa-metoo-special/10649600 (accessed on 14 June 2020).
Goldsmith v Villaneuva
  • Justice Adams
Adams, Justice. 2000. Goldsmith v Villaneuva, [2000] NSWSC 1181 at [17] per Adams J.