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The Case for Multi-Disciplinary Models

A growing number of initiatives in the healthcare sector in Canada and in other jurisdictions facilitate access to care beyond what might be considered a medical intervention. The Social Medicine Supportive Housing Project at Toronto’s University Health Network (UHN) stands out as a prominent example in the Canadian context. In 2019, UHN launched a housing project to build homes on its lands with a view to prescribing housing to dozens of patients for whom chronic homelessness and housing precarity translate into thousands of emergency room visits every year. A 2023 article in Maclean’s Magazine discusses the UHN project, which was then a few months from welcoming its first residents. The rationale behind the initiative appears straightforward: effective problem resolution is holistic problem resolution.

A stable, safe living environment is critical for good health.[1] Additionally, experiences of social adversity – such as persistent problems securing good and affordable housing – often correlate with other health, legal, economic, and social problems.[2] The Supportive Housing project contemplates access to a range of community supports, including from medical professionals, social workers, therapists, counsellors and others. Commendably, the UHN is tapping its own resources to address the consequences as well as the root cause of this category of medical health-presenting problems. In so doing, they are working across disciplines to facilitate access to holistic, longer-term problem resolution. With much of the population still living with challenges spurred by the COVID-19 pandemic, and in the face of concurrent housing and cost-of-living crises, access to solutions which identify and address the various facets of complex “life” problems may prove to be a lifeline for some of the most vulnerable populations.[3]

What are Multi-disciplinary Models and Why do they Matter?

Clinicians are among several professional groups for whom the nature of their interactions with the public readily lends itself to spotting problems beyond their specific area of expertise. Put differently, clinicians are well-positioned to both assist patients with their medical needs and to act as intermediaries, connecting patients to non-medical supports. Medical-legal partnerships based in healthcare settings are generally centered on this idea.[4] Clinicians’ access to patients and potential to learn about intersecting medical and non-medical problems is often a starting point for screening and referral in these models. As in the UHN Supportive Housing project, the overarching goal is holistic, durable problem resolution.

Contemporary scholarship on the access to justice problem presents a strong case for medical-legal partnerships and other multi-disciplinary models. Across civil legal problem types, the legal dimensions of serious problems are not always recognized as such, or else they may not be considered serious enough to merit legal intervention. In some cases where the problem is understood as engaging questions of law and fairness, concerns about the costs of legal assistance (monetary, temporal, etc.) or where to access effective and affordable legal assistance may act as barriers to pursuing formal dispute resolution. In each of these scenarios, the potential to be directed to relevant avenues for legal information and assistance can be a critical step towards life-altering problem resolution.[5]

How people understand a problem, and the resources available to them, will generally shape what they do about the problem. There are several ways to view this. Consider as an example a landlord who does not uphold her responsibility to ensure that a rental unit meets a reasonable standard for a safe, healthy home. Viewed as a case of bad luck (the misfortune of renting a unit owned by a problematic landlord) the tenant may try to mitigate the issues they can (through DIY solutions, for e.g.) and live with what may be harder to address. Absent restrictive cost barriers, the tenant could view moving as the best recourse. (Though in the current economy, it is likely a safe assumption that the tenant would not be looking for a new home in Toronto’s or Greater Vancouver’s housing markets). Conversely, the medical health impacts of the housing problem may be such that those impacts are prioritized over the housing conditions that caused them. Viewed primarily as a medical health problem, a tenant with access to healthcare may choose to address the problem with help from a medical health professional. The tenant could also pursue some combination of these or other options.[6] To the extent that the non-lawyer public often initially views their everyday legal problem through the lens of the problem’s non-legal aspects, the solution(s) they initially pursue likely will also be non-legal.[7]

This is what makes multi-disciplinary models such an important part of the conversation on access to justice. Multi-disciplinary models such as medical-legal partnerships offer entry points to the legal system that consider the non-legal aspects of serious problems, as people experiencing the problem may view them.[8] Depending on the multi-disciplinary model, people seeking help for a given aspect of their problem may be referred to professionals with the specific expertise to address one or more other aspects of the problem. A medical health professional working in a multi-disciplinary team may refer the patient who discloses information about their unhealthy living environment to the lawyer and the social worker who are part of their multi-disciplinary team. In this way, this process circumvents several barriers to accessible, meaningful justice, including: (i) legal consciousness – in this case, the tenant not recognizing the legal dimensions of the problem; (ii) early problem resolution – the tenant potentially not addressing the legal aspect of the problem during its earlier stages, when it may be less complex, time-consuming, and costly; (iii) unmet legal need – the potential for the aspects of the tenant’s problem that could merit a legal resolution to go unresolved;[9] and, (iv) holistic problem resolution – the resolution of the various legal and non-legal aspects of the problem, potentially leading to longer-term social or other change in the life of the tenant. The benefits the tenant might gain in this example could also apply to experiences of other civil legal problem types resolved through medical-legal partnerships or other multi-disciplinary models.

Medical-legal partnerships are among the most established multi-disciplinary models for legal and non-legal problem resolution,[10] though there are various other models. Lawyers and law school students may work in networks with social workers, mental health professionals, counsellors, family services professionals, and other professionals to facilitate access to dispute resolution, assistance, and care for a range of complex life problems. At the local level, there are also examples of initiatives that draw on community-based resources and connections to identify and provide legal and non-legal supports.[11] A recent Canadian Bar Association podcast explores several types of multi-disciplinary service models and discusses their benefits for the public, lawyers, and access to justice more generally.

As with other initiatives in the justice sector for which the return on investment is primarily generated through economic, social, and individual public gains rather than financial profit, a significant challenge for multi-disciplinary models appears to be funding, particularly beyond the pilot project phase. There are also other challenges for launching and maintaining multi-disciplinary models, such as the availability of physical space for collocated models, administrative staff resources, challenges around professional boundaries, and other considerations. Notwithstanding, the benefits of these models for meaningful access to justice and holistic problem resolution are significant. Research suggests that there is an interest and willingness among legal professionals to collaborate through these types of models.[12] It may be that, like the UHN model, some resourcefulness may be required to make multi-disciplinary models for legal and non-legal problem resolution more broadly available across Canada and a prominent way to address the access to justice problem.

 

Lisa Moore, Director
Canadian Forum on Civil Justice

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[1] Research from the Canadian Forum on Civil Justice also suggests that access to justice is important for good health. Survey data reveals that a significant percentage of Canadians report experiencing physical and/or mental health problems as a direct result of their everyday legal problem experience. Lisa Moore, Everyday Legal Problems and the Cost of Justice in Canada: Cost of Justice Survey Data (Toronto: Canadian Forum on Civil Justice, 2018) at 211-216, online: CFCJ <https://cfcj-fcjc.org/wp-content/uploads/Everyday-Legal-Problems-and-the-Cost-of-Justice-in-Canada-Cost-of-Justice-Survey-Data.pdf>.

[2] For a discussion on the intersection of everyday legal problems and experiences of social and economic adversity, see Ab Currie and Lisa Moore, Social and Economic Adversity Experienced by Canadians and Everyday Legal Problem (Toronto: Canadian Forum on Civil Justice, 2018), online: CFCJ <https://cfcj-fcjc.org/wp-content/uploads/Social-and-Economic-Adversity-Experienced-by-Canadians-and-Everyday-Legal-Problems-Ab-Currie-Lisa-Moore.pdf>.

[3] Experiences of serious everyday problems often begin through the normal course of life and are often considered life problems.

[4] Medical-legal partnerships are also referred to as health-justice partnerships. For a general discussion see Lisa Moore, Crossing Boundaries: Exploring Multi-Disciplinary Models for Legal Problem Resolution (Toronto: Canadian Forum on Civil Justice, March 2022) at 15, online: CFCJ: https://cfcj-fcjc.org/wp-content/uploads/Crossing-Boundaries-Exploring-Multi-Disciplinary-Models-for-Legal-Problem-Resolution-by-Lisa-Moore.pdf>.

[5] Some multi-disciplinary models offer services broadly, irrespective of a community member’s ability to pay for one or more aspects of the service. Other models are designed to serve the needs of a given population or community and may restrict their services accordingly. How the model is funded, and the scope of the model will generally determine its accessibility.

[6] For people experiencing between one and as many as seven everyday legal problems in a given 3-year period, an estimated 74.3% report taking two or more actions to resolve the problem. Lisa Moore, Everyday Legal Problems and the Cost of Justice in Canada: Cost of Justice Survey Data (Toronto: Canadian Forum on Civil Justice, 2018) at 108, online: CFCJ <https://cfcj-fcjc.org/wp-content/uploads/Everyday-Legal-Problems-and-the-Cost-of-Justice-in-Canada-Cost-of-Justice-Survey-Data.pdf>.

[7] For more on how the public generally understands their legal problems, see Rebecca L. Sandefur, “Access to What?” (Winter 2019) 148:1 Dædalus 49.

[8] The consideration and design of systems from the perspective of users is a central tenet of people-centered justice. Further, people-centered justice is critical for improving access to justice.

[9] Data from the 2021 Canadian Legal Problems Survey suggests that almost 80% of people with legal problems do not receive legal assistance from a lawyer. This includes 24% of cases where people contact a lawyer for help with a legal problem and do not receive help from the lawyer. Sarah A. Sutherland, “Are 80% of Legal Problems in Canada Really Going Unmet?” CBA National Magazine (4 April 2023), online: <https://nationalmagazine.ca/en-ca/articles/law/access-to-justice/2023/are-80-of-legal-problems-in-canada-really-going-unmet>.

[10] As an example of their popularity, consider that medical-legal partnerships are present in 49 U.S. states and the District of Columbia. See National Centre for Medical Legal Partnership, “The Partnerships”, online:

<https://medical-legalpartnership.org/partnerships/#HRSA-HC>.

[11] CFCJ’s Dr. Ab Currie has done a lot of work in this area in Ontario. See generally, Ab Currie, The Communities Being Served are the Resources that are Needed: Innovations in Community-Based Justice in Ontario, an Anthology of Canadian Research (Toronto: Canadian Forum on Civil Justice, March 2022), online: CFCJ <https://cfcj-fcjc.org/wp-content/uploads/The-Communities-Being-Served-are-the-Resources-that-are-Needed-Innovations-in-Community-Based-Justice-Anthology-by-Ab-Currie.pdf>.

[12] See Lisa Moore, Multi-Disciplinary Legal Problem Resolution: Survey Responses and Analysis (Toronto: Canadian Forum on Civil Justice, January 2022), online: CFCJ <https://cfcj-fcjc.org/wp-content/uploads/Multi-Disciplinary-Legal-Problem-Resolution-Survey-Responses-and-Analysis-by-Lisa-Moore.pdf>. The annual Justice Development Goals report produced by the national Action Committee on Access to Justice in Civil and Family Matters also regularly features insights on collaborative efforts by justice stakeholders in the justice sector and across disciplines.

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