This is the edited text of Tessa Boyd-Caine’s comments as part of a panel entitled ‘Home truths from disruptors’ at the Mental Health Funder Forum convened by Future Generation on 14 April 2021.
I was so pleased to have the chance to explore these questions as a member of a panel of mental health ‘outsiders’, each working through new ways to improve mental health across Australia. Convened by Future Generation and supported by EY, we were there to share home truths about disruption, innovation and the role funders can play in enabling change.
My starting point is the many people experiencing problems that affect their health, but which can’t be solved by the health system alone. Frequently, legal problems fall into that basket.
Unmet legal needs in housing
Evictions without fair warning from public or rental housing are a good example here. A lawyer can challenge a lack of due process around an eviction. But if the reason someone keeps being evicted is because they are experiencing the acute anxiety or stress of a mental health problem, then the legal response will be far more effective if it is sequenced around the support of a health service. The point of getting legal help is not just to see a lawyer, but to get a problem fixed. Why stop at challenging a dodgy eviction if this legal help can lead to sustained housing for someone?
Often, people will not think about a lawyer as someone who can help them with their housing (or financial, or employment or safety) problems, but they do raise these non-medical problems in the health services they know and trust. Health justice partnerships are a collaborative service approach that responds to this evidence by embedding legal assistance into healthcare teams and settings, to help people with the legal problems in their lives that effect their health.
Working at the intersection of health and justice is tricky.
Most of the budgets for services, and the programs and policies that sit behind them, operate in siloed approaches that ignore (or make it difficult to identify) any connection between health and justice. This is administratively convenient, but it means our policy and funding processes are removed from the way people experience multiple, intersecting health and legal problems in their lives. And that is a problem, both for the relevance of policy and funding approaches; and for their effectiveness in responding to people’s needs.
The best funding conversation I have had in relation to Health Justice Australia’s work was when a foundation said, ‘We love the concept you’re working with, but we don’t really understand it, so we’re going to fund you to develop the evidence base.’ The most frustrating conversations I have are at the other end of the spectrum, when we can’t get beyond siloed approaches. I’m often asked why someone should put their health funding towards a legal service or vice versa. My answer is that there are plenty of programs that provide single service approaches for single problems, and they may well be effective. But in our work, day after day we see the failure of services to respond to multiple, intersecting health, legal and social problems that people often experience at the same time. We need different solutions to tackle complex problems of this kind. We also need to ensure that the service systems we design to help people are not themselves part of the problem, failing to help people at the times and in the places when they ask for help.
The challenge of siloed responses is interesting in terms of our impact on mental health. Health justice partnership was not intended as a response to mental health. Only 16% of health justice partnerships target mental health in their approach, for instance by bringing legal help into a specialist mental health or alcohol and other drugs service. But over 80% of these collaborations are responding to mental health issues in their work, across a diverse range of health settings from public hospitals to Aboriginal community-controlled health organisations to child and maternal health clinics.
This tells us that people are going to walk through the doorways they know and trust and ask for help in the places they feel comfortable, no matter how hard we try to design specific services and pathways to them.
It also tells us that we need to build the capability of those trusted people to identify and respond appropriately when they are asked for help. This means building the capability of mainstream practitioners in health and legal services to identify and respond appropriately to the range of problems that might be effecting someone’s health or wellbeing, through relationships with other colleagues and services to bring new expertise and approaches to the table. In mental health, this might mean drawing on specialist mental health expertise to do this, while accepting that people won’t always walk through the special doors we have built for them.
What funders need to know
My top tip for funders is the same thing we often say to the services we work with: value learning as much as you value success. This means being willing to fund activities where you might not know what they will achieve, but because you want to learn something you don’t already know. It means being open about, and willing to learn from, failure.
Valuing learning also means taking a much more intentional approach to measurement of outcomes. People often approach evaluation as a means to demonstrate ‘success’. But the purpose of evaluation is to learn; and we can learn as much from what doesn’t work as from what does. That willingness to learn is all the more critical in an area like mental health, where problems persist and needs grow despite decades of investment in services and research. Learning what works and what doesn’t is critical if we want to make progress on the continuing challenges we face in improving mental health, as in tackling disadvantage more generally.