Health justiceSample Page
partnership as
a response to
domestic and
family violence
May 2021
S FORELL & MT NAGY
Health justice insights
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
P 2 HEALTH JUSTICE AUSTRALIA | MAY 2021
General practitioners, community health services, hospitals and
other health settings are often sites of trusted help for people –
most commonly women – who are vulnerable to or experiencing
domestic and family violence (DFV). Yet the issues arising for
those experiencing DFV commonly extend far beyond their health.
They include legal issues ranging from the need for violence
protection orders to assistance with family separation, housing
and money problems.
Health justice partnership embeds lawyers in healthcare settings
and teams. It is a strategy to provide accessible, timely legal help
to people experiencing the complex array of issues surrounding
DFV, while supporting health service capability to act as an
effective pathway to support.
This paper describes health justice partnership as an integrated
response to DFV: what partnerships currently look like, where
they are found, who they support, and what they offer partner
agencies, practitioners and their clients. Noting health justice
partnership as an emerging model, there is more to test and
learn about the placement, design and value of health justice
partnerships in different health service settings; and how they
integrate with the broader DFV service landscape. As service
delivery is reassessed in the wake of the Covid19 pandemic, we
identify the opportunity to explore health justice partnership
as a tool to provide accessible, safe, client-centred and holistic
support for those experiencing DFV.
Abstract
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
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• Women experiencing domestc and family violence (DFV) are more vulnerable than
others to a range of legal needs including family law, victm of crime proceedings,
housing, immigraton and money issues.
• Women experiencing DFV more commonly seek help from or are in contact with health
services than legal assistance services. This is in line with health professionals being
commonly identfed as trusted carers and advisors.
• Many health services screen for DFV and yet may not have all the tools required to
respond to the range of issues arising.
• Health justce partnerships (HJPs) bring lawyers into healthcare setngs and teams to
address intersectng health and legal issues facing patents.
• While only one in fve Australian HJPs target DFV, most see clients experiencing DFV. Early
indicatons are that collaboraton through health justce partnership can beneft clients
and the services and practtoners supportng them. Evaluatons of HJPs in maternal and
child health services have indicated:
― streamlined access to legal help for people facing DFV
― legal assistance in a convenient, safe, child-friendly space
― legal assistance at tme and place appropriate to individual client needs
― greater confdence for health practtoners in identfying DFV and capability to
directly link clients with legal help and
― increased use of secondary consultaton and expertse-sharing between practtoners.
• There is, however, more to learn more about the place and potental of HJP in the
broader DFV service landscape – partcularly in light of service changes arising from
Covid19. Questons to explore include:
― the value of HJP in different health setngs, and in supportng health service
screening for DFV
― how HJPs connect with and complement other services, including the specialist DFV
service sector, to support accessible, trusted and effectve pathways to safety for
victm/survivors and their families
― the potental for some more generalist HJPs to help support perpetrators towards
behaviour change.
Most evidence identfed in this paper relates to men’s use of DFV against female
partners, although men can also experience DFV, and DFV occurs in same-sex
relatonships. We refer to women specifcally as the evidence indicates but will also
speak of people and survivors more broadly, partcularly recognising elder abuse as
part of DFV and the impact of DFV on children.
Key observations
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
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Women and children experiencing
domestc and family violence beneft
when services are integrated across
sectors. This is especially true for
women in rural and regional areas,
women with disability, women from
culturally and linguistcally diverse
backgrounds, and Aboriginal and
Torres Strait Islander women, who
all face additonal barriers to
accessing services.
(Australia’s Natonal Research Organisaton for
Women’s Safety 2020 p.2)
Introduction
The experience of domestc and family violence (DFV)
can have a detrimental impact upon many aspects of
a victm/survivor’s life, including their physical health
and safety, mental health, housing, employment and
fnancial stability. These effects are ofen felt amid
already demanding circumstances such as separatng
from a relatonship, protectng the wellbeing of
children or partcipatng in legal proceedings. As issues
intersect and compound, those experiencing DFV can
require support provided by a variety of agencies and
organisatons, but at the same tme, be isolated from
that help. The support needed will vary from person
to person, and for the same person at different points
in tme. Some issues or situatons may require an
immediate crisis response while others may involve
a longer-term strategy. In the face of this complexity,
there is increasing recogniton of the need for
coordinated, integrated policy and service responses
to DFV (Australia’s Natonal Research Organisaton for
Women’s Safety 2020; State of Victoria 2014-2016; Breckenridge, Rees et al. 2016).
Coordinaton and integraton can take many forms and involve a range of combinatons: police, specialist family
violence services, a range of health services, homelessness services, legal services, courts and others (Australia’s
Natonal Research Organisaton for Women’s Safety 2020). This diversity is important as people differ: in their
experiences of violence and how it plays out; in the support they may seek or have access to at different points in
tme; in their comfort or trust of different services; in their opportunites to get help; and in their resultng pathways
to safety from violence.
Health justce partnership is a way that health and legal services work together to support people experiencing DFV.
Through these partnerships, help for issues as diverse as family law, child protecton, housing, fnes and debt can be
integrated into health responses at the tme people are experiencing or partcularly vulnerable to family violence
and in the places that assistance is accessible and tmely. Health justce partnerships support those at partcular risk
of domestc and family violence, including young women and their children, older people, Aboriginal and Torres
Strait Islander peoples, and people in rural and remote areas. While they may provide support at tmes of crises,
they generally address issues to support longer-term change.
As key responders, police are ofen identfed at the centre of integrated approaches (Australia’s Natonal Research
Organisaton for Women’s Safety 2020; Spangaro 2017). However, health services also play a critcal role, as a widely
and routnely accessed and trusted source of support for people facing DFV. Integratng legal help into healthcare
setngs and teams broadens the resources made available to those experiencing DFV at this critcal tme.
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The prevalence of domestic
and family violence
Domestc and family violence
We use the term ‘domestc and family
violence’ (DFV) to describe violence
between family members, such as
between parents and children, siblings,
and current or former intmate partners.
Behaviours include:
• physical violence (hitng, choking,
use of weapons, sexual violence)
• emotonal abuse, also known as
psychological abuse (intmidatng,
humiliatng)
• coercive control (an assault on
autonomy, liberty and equality
using physical and non-physical
tactcs (see Australia’s Natonal
Research Organisaton for Women’s
Safety 2021)
• fnancial abuse (partcularly of
older people)
• child neglect
(Coumarelos 2019; Australian Insttute of Health
and Welfare 2019b; Breckenridge, Rees et al.
2016; O’Reilly and Peters 2018; State of Victoria
2014-2016)
Domestc and family violence touches the lives of
Australians young, old and from all backgrounds.
One in six Australian women and 1 in 16 Australian
men – 2.2 million people in total – have experienced
physical or sexual violence by a current or former
partner. One in four women and one in six men
report experiencing emotonal abuse at the hands of
a current or former partner. However, vulnerability to
DFV varies considerably across the community. Young
women, pregnant and parentng women and their
children, Indigenous Australians, and women living with
restrictve long-term health conditons and/or disability
are among those most vulnerable to DFV (Australian
Bureau of Statstcs 2020; Australian Insttute of Health
and Welfare 2019b; Hegarty, Spangaro et al. 2020). DFV
is also an issue for people facing partcular barriers to
assistance including older people, LGBTQI+ people and
women in rural and remote areas (Australian Insttute
of Health and Welfare 2019b; Lay, Horsley et al. 2017).
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Health and legal impacts of
domestic and family violence
Ensuring safety for women and their children is a critcal
frst consideraton when assistng a person who has
experienced DFV, from the point of disclosure to any
ongoing assistance.
And yet the experience of DFV can also have a detrimental
impact on other aspects of a person’s life such as their
mental health, housing, fnancial stability, relatonships
(intmate, family and otherwise) and their educaton or
employment. It can also profoundly impact the lives of
their dependents/children. The Australian Insttute of
Health and Welfare (2019b p. 13) reports that mental
health issues represent the greatest health impact of
DFV, with depressive disorders making up the greatest
proporton of this disease burden (43%), followed by
anxiety disorders (30%) and suicide and self-inflicted
injuries (19%).
A range of issues surrounding DFV also have legal
elements. With a focus on safety, apprehended violence
orders are an immediate example of this. Criminal
proceedings against the perpetrator may also arise in
the context of DFV, as well as child protecton issues
including the threat of removal. However, legal help
can also address the challenges that can accompany
changed circumstances – such as separaton, child
custody arrangements, immigraton and visa issues,
housing and managing fnancial issues including debt
and maintaining income.
Legal problems in general are widely experienced
in Australia. It is estmated that one in fve people
encounter three or more legal problems in a given year
(see the Legal Australia-Wide (LAW) Survey, Coumarelos,
Macourt et al. 2012). Further analysis of the LAW survey
found that women experiencing DFV are 10 tmes more
likely than other respondents to experience other legal
problems and more severe legal problems (Coumarelos
2019). While 16 tmes more likely than others to
experience family law issues, women experiencing
DFV were also at least three tmes more likely to have
problems related to employment, fnances, government
payments, health, housing, personal injury and rights
issues, and criminal law.
This group was also more likely than others to experience
health and other impacts from these legal problems. In
additon to effects on housing and income, they were
more likely to report their legal problems as leading
to stress-related illness (53% vs 19% of problems) and
physical ill-health (43% vs 18%) (Coumarelos 2019).
Together, health and legal service data highlight the
vulnerability of people experiencing DFV to co-occurring
health and legal need.
Accessible, appropriate and tmely legal assistance has
been identfed as a tool to help address intersectng
legal issues or prevent them from escalatng (Pleasence,
Coumarelos et al. 2014). Legal assistance can take
various forms, from informaton or advice about
optons, to support for a client to act for themselves
(e.g. helping with correspondence or communicaton),
to legal representaton.
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Seeking help for legal problems
While legal problems are common in the general
community, the LAW survey found that many go
unaddressed. People ofen take no acton in relaton to
their legal issues, for reasons including: not identfying
the issue as legal; correct or incorrect beliefs that acton
is not needed (e.g. it would make no difference, it was
trivial or unimportant); and perceptons that legal acton
is inaccessible or risky for personal or systemic reasons
(Coumarelos, Macourt et al. 2012; Forell, McCarron et
al. 2005). This is in additon to issues such as the limited
availability of free and low-cost legal services, relatve
to health services.
Yet additonal issues affect help-seeking for people
who experience DFV. Factors that reduce reportng or
help-seeking for family violence include shame, not
being ready to address the issue, fear of not being
believed, not wantng to get the perpetratng partner
in trouble, fear of child protecton responses, isolaton
and coercive control (Feder, Hutson et al. 2006; Voce
and Boxall 2018; Wendt, Chung et al. 2017).
Though the circumstances may be challenging, the LAW
Survey found that women who experienced DFV were
more likely than others to seek advice for their legal
problems compared to those who did not report a DFV
issue (help sought for 74.6% of problems compared to
50.5%) (Coumarelos 2019 p. 17-18). This may in part
reflect the volume and seriousness of legal issues faced
by this cohort, relatve to other respondents to the LAW
survey. Importantly though, the statstc represents
advice sought from any kind of professional – whether
legal or non-legal.
Analysis by type of professional revealed that advice
for issues directly related to the experience of DFV was
far more commonly sought from a health or welfare
advisor (74.0% of problems) compared to a legal advisor
(44.2% of problems) (Coumarelos 2019 p. 20). More
broadly, help was sought from a lawyer for 51.6% of
legal problems overall (related to DFV and other legal
issues), and from a health or welfare professional for
56.4% of problems.
This tendency to turn to health professionals when
experiencing DFV is reflected in broader literature.
The 2016 Personal Safety Survey found that health
professionals were among those most likely to be
approached for assistance afer partner violence. Of
women who had experienced a physical assault by a
current or former male partner, 20.4% said they sought
advice or support from a general practtoner about
the last incident and 13.1% said they had approached
another type of health professional (with respondents
able to report more than one advisor). In comparison,
19.1% had sought advice or support from a counsellor
or support worker, 16.5% from the police and just 7.2%
from a legal service. The only category of advisor more
common than a general practtoner was a friend or
family member (consulted by 43.1%). Signifcantly, over
a third (34.6%) did not seek advice or support from
anyone (Australian Bureau of Statstcs 2020).
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Health services as a pathway
to help
For instance, Victorian studies have identfed between
14.2% and 17% of pregnant women or frst-tme mothers
reportng partner violence during pregnancy or in the
frst 12 months following the birth of a child (Gartland,
Hemphill et al. 2011; Hegarty, Spangaro et al. 2020).
With maternal and child health (MCH) services in Victoria
providing more than 95% of all postpartum care to recent
mothers (Hegarty, Tarzia et al. 2016), these women are
likely being seen by MCH services, even when they are
not actvity seeking DFV support from these sources.
Similarly, older people who may be vulnerable to elder
abuse are very high users of GP services (Australian
Insttute of Health and Welfare 2018). As isolaton and
coercive control can be key features of DFV, routnely
accessed health services can provide a rare opportunity
for disclosure (Spangaro 2017).
Emergency rooms and hospital wards are also sites of
family violence disclosure following injury or ongoing
abuse, partcularly for some groups vulnerable to DFV.
While in 2016–17 there were 6,300 hospitalisatons
of adults aged 15 and over for assault injuries due to
domestc and family violence, people in remote and very
remote areas were 24 tmes as likely to be hospitalised for
domestc violence as people in major cites. Indigenous
adults were 32 tmes more likely to be hospitalised for
domestc violence compared to non-Indigenous adults
(Australian Insttute of Health and Welfare 2019a).
Finally, Aboriginal Community Controlled Health
Services are also key access points, providing holistc
and culturally appropriate care to Aboriginal and Torres
Strait Islander people, partcularly in rural and remote
communites (Natonal Aboriginal Community Controlled
Health Organisaton 2019; Australian Insttute of Health
and Welfare 2016).
The degree to which women experiencing DFV turn to health professionals highlights the critcal role of health services
not only in addressing the signifcant burden of disease arising from DFV but as a key access point to support (World
Health Organizaton 2016; State of Victoria 2014-2016; Hegarty, McKibbin et al. 2020; Spangaro 2017).
Even when those affected do not actvely seek help for DFV, general practtoners, antenatal, maternal and child health
services, mental health, and alcohol and other drug services are all accessed by people at the same tme they may be
vulnerable to or experiencing DFV (Hegarty, McKibbin et al. 2020; Campo 2015; NSW Ministry of Health 2019; O’Reilly
and Peters 2018; State of Victoria 2017; Hegarty, Spangaro et al. 2020; Parentng Research Centre 2017).
General practce, antenatal clinics,
community child health and
emergency departments are key
places for interventon for DVA
[domestc violence and abuse], as
health practtoners are the major
professional group to whom patents
want to disclose.
(Hegarty, McKibbin et al. 2020 p.2, citng Feder,
Hutson et al. 2006)
Some victms of family violence will
not contemplate engaging with a
specialist family violence service but
will interact with health professionals
at tmes of heightened risk for family
violence – for example, during
pregnancy or following childbirth – or
seek treatment for injuries or medical
conditons arising from violence they
have experienced.
(State of Victoria, 2014-2016 p.28)
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The capability of health services
to respond to DFV
As well as being highly utlised by people experiencing
or vulnerable to violence, health services can provide
a safe, trusted source of advice and support (Spangaro
2017). The vital importance of trust is stressed in the
literature around health services as a pathway to
respond to DFV (e.g. Feder, Hutson et al. 2006) and trust
has long been explored as an element of healthcare
relatonships more generally.
The recogniton of health services as an opportunity
to connect people experiencing DFV with support has
seen the routne screening or risk assessment for DFV
become a common domestc violence interventon for
certain cohorts in health services and systems (Spangaro
2017; Hegarty, Spangaro et al. 2020). Hegarty, Spangaro
et al. (2020 p. 12) found women using antenatal services
were open to being asked by health professionals about
whether they had experienced abuse or not. They were
less likely to disclose if not invited to.
However, the implementaton and results of DFV
screening have been variable. In NSW, where screening
is more routne than other states, screening rates vary
from 88% in maternity services, to 46% in child and family
services, 87% in alcohol and other drug services and
60% in mental health services. This variaton is even
greater when the fgures for each service type are
examined by local health district (NSW Ministry of
Health 2019; see also Hooker, Nicholson et al. 2020).
While screening in general does appear to increase the
detecton of DFV, studies indicate that detecton does
not necessarily lead to a referral, acceptance of the
referral and an improved outcome (O’Doherty, Taf et
al. 2014; Hegarty, Gleeson et al. 2020).
The lack of a strong link between screening and positve
outcomes in the overall literature may be due in part to
varied factors at the service level. A number of studies
and reviews point to the challenges health personnel
face in identfying and responding to violence when
they see it, even with routne screening (O’Reilly and
Peters 2018; NSW Ministry of Health 2019; State of
Victoria 2014-2016). In additon to practcal issues
such as tme and privacy, key barriers to health
practtoners routnely screening for DFV include lack
of training to appropriately identfy and respond to
violence and a lack of connectons/referral pathways
if violence is identfed (Hooker, Nicholson et al. 2020;
see O’Reilly and Peters 2018). An evidence review of
DFV interventons in health identfed the importance
of linking screening with interventons to address the
issues arising (Spangaro 2017).
Perspectves from healthcare professionals about
the support they need for this work align with what is
important to patents. A meta-analysis of studies reported
the views of women exposed to intmate partner violence
that use health services. Women wanted responses
which were non-judgemental, non-directve, individually
tailored and with an appreciaton of the complexity of
partner violence. Women also identfed the need for
services to know about and be actve in linking women
to appropriate resources. They valued coordinated
mult-disciplinary approaches, and training to improve
practtoner awareness of DFV and their ability to raise
and discuss it (Feder, Hutson et al. 2006, p.22, 34).
Holistc assessment, looking not just
at the details of physical abuse, but all
the other factors that play into family
violence like fnancial issues, health
issues, social isolaton and all of that,
and trying to address family violence
in a holistc way.
(Respondent, Hegarty, Spangaro et al.
2020, p.75)
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However, given the breadth of issues implicated in family violence, the appropriate resources that health staff could
need to be aware of and confdent to connect their patents with stretch far beyond the medical. The challenge is
not for health services to know everything but to have accessible, trusted and safe pathways to other expertse.
Most critcal is assistance to address immediate safety concerns. But support to enable and sustain safe change is also
vital. This includes help for issues as diverse as family law around separaton, parentng and fnancial arrangements,
social security, housing, employment, immigraton and child protecton related issues. Understandably, health
professionals, like many others, may not be aware of which services, including legal services, can assist with this
range of issues, nor how to access and engage with legal help appropriate to their patents’ contexts and needs
(Forsdike, Humphreys et al. 2018; ACT Government Family Safety Hub 2020; see also Pleasence, Coumarelos et
al. 2014; Cohl, Lassonde et al. 2018). More broadly Australia’s Natonal Research Organisaton for Women’s Safety
(2020) observed that ‘victms/survivors ofen have complex and diverse needs that cannot be met by a single service’
(p.1) and that the foundaton to improved service delivery is connecton and coordinaton across services and silos.
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Health justice partnership as
a response to domestic and
family violence
At the same tme, partnerships build the capability of
the partner services, and health practtoners, to identfy
health-harming legal issues affectng their clients.
Similarly, they build the capability of legal services to
understand intertwined health and legal need and to
support clients appropriately. Common features of health
justce partnership include:
• relatonship building, cross-disciplinary training and
the exchange of expertse and trust between health
and legal practtoners to develop the capability of:
― health practtoners to more confdently and
effectvely identfy and refer patents to their
legal partners
― legal partners to take account of the health and
family issues affectng their clients
• streamlined and warm referral processes to an
accessible (usually onsite1) lawyer
• the opportunity for health and legal professionals
to consult about problems their clients are
experiencing and coordinate their responses
(secondary consultaton, case conferencing) (Forell
and Boyd-Caine 2018).
The integraton of legal help into a healthcare team is
itself a service system change – providing a more holistc
response to the ofen complex and intersectng range of
issues that DFV involves. The lessons that emerge from
this movement can help inform a broader conversaton
about how we enable, support and value client-focused
service systems that are responsive to intersectng need.
Having the legal service has been
amazing. Women can come for an
appointment and no-one knows she’s
coming in to see a lawyer as well.
She’s just coming in for a maternity
appointment.
(Respondent, Hegarty, Spangaro et al. 2020 p.83)
We know there’s somewhere for them
to go, not like it used to be when they
were calling and no one answers,
[and] the clients couldn’t get in to
see anyone. Clients need one point
[of contact] and someone to support
them rather than sending them off
somewhere else.
(Health care professional, Evaluaton of HJP,
ACT Government Family Safety Hub 2020 p.13)
Health justce partnership is one form of collaboraton to integrate legal help into healthcare setngs or teams, to
support people experiencing intersectng health and justce issues. In responding to DFV, health justce partnership
lawyers provide safe, discreet and tmely assistance to health service users, in trusted and supportve setngs which
they already access. Through the relatonship built between health and legal services and practtoners, health
justce partnership enables coordinaton of support for the range of intersectng issues affectng the health, safety
and wellbeing of people experiencing DFV.
1 Pre-Covid19. During Covid19 lockdowns many HJP lawyers had to work remotely and the delivery of services remains dynamic as the
pandemic contnues.
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Domestic and family violence on the
Australian health justice landscape
Across Australia, health and justce services come
together in a range of ways to provide legal help in
healthcare setngs. A 2018 census identfed 78 such
services (Forell and Nagy 2019) and that fgure in early
2021 is over 100.²
Health justce partnerships are found in primary health
setngs including Aboriginal community-controlled
health organisatons, hospitals and community support
setngs (e.g. family and child services). The health
practtoners involved vary from setng to setng but
include hospital social workers, nurses, midwives,
doctors, maternal and child health practtoners, mental
health and community health professionals. Legal help
is most commonly provided by community legal centres
and legal aid commissions.
A 2018 census of the health justce landscape
highlighted that one in fve partnerships specifcally
targeted DFV (e.g. in antenatal, maternal and child
health services and specialist elder abuse partnerships).
However, beyond these targeted approaches, people at
risk of or experiencing family violence are seen in nearly
90% of all services on the landscape. These include
generalist health justce partnerships, partnerships
in mental health and addicton services, partnerships
supportng young people and partnerships supportng
Aboriginal and Torres Strait Islander people (Forell and
Nagy 2019). The broad identfcaton of DFV reflects
the pervasive nature of DFV within people’s lives and
across the community. It also highlights the role of
generalist health services as an access point for people
experiencing DFV.
Domestc and family violence and/or family law were
among the most common legal issues being dealt with
in health justce services (a ‘top three’ issue for 62% of
65 respondents). Other common legal issues included
housing, money issues and for some, immigraton
(Forell and Nagy 2019).
While more research is needed, early evaluatons of
health justce partnerships addressing domestc and
family violence suggest a range of outcomes for clients
and for service capability. These include:
• improved self-reported health provider knowledge,
skills and confdence to identfy and respond, and
refer women experiencing DFV, and increased
referrals (Hegarty, Humphreys et al. 2014)
• more tmely, streamlined access to legal help for
women facing violence
• assistance in a convenient, safe, child-friendly space
• assistance at a pace and place that is safe and
appropriate to individual client needs
• greater confdence of health practtoners to
identfy DFV, and capability to directly link patents
with legal help
• increased use of secondary consultaton with legal
professionals, either formally or informally, about
problems clients are experiencing
• greater confdence that referrals made are safe
and appropriate (ACT Government Family Safety
Hub 2020; Eastern Community Legal Centre 2018).
2 In additon to health justce partnerships, the health justce landscape includes legal outreach clinics (co-locaton with less integraton),
integrated services (where the lawyer is employed by the health service) and service hubs (where a range of service types co-locate in
one setng).
Promising practice and outcomes
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
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The impact of health justce partnership on screening
rates, referrals or uptake of referrals across a range of
health services is an area for further exploraton.
Beyond co-locaton, studies identfy that effectve
partnership requires the investment of tme and
resources to build relatonships between the health
and legal team, and the capacity to build trust and work
collaboratvely with the client (Forell and Boyd-Caine
2018; ACT Government Family Safety Hub 2020; Eastern
Community Legal Centre 2018).
MABELS changes the way maternal
and child health nurses refer clients for
family violence and legal support from
a stressful process involving two ‘cold’
referrals, with extended waitng tmes
and ofen unknown outcomes for the
client, to one streamlined referral,
which is accepted promptly and with
guaranteed informaton and feedback.
The referral process is strengthened
by direct professional relatonships
between maternal and child health
nurses and the MABELS team, clear
protocols governing the process,
optons for secondary consultaton
and even more tmely responses for
emergency cases.
(Keatng, 2018 p.5)
The MABELS model works for a
range of reasons, not the least that
it has been assiduously built on a
range of best-practce features, such
as a commited partnership
characterised by strong leadership
support and involvement, strong
governance structures, strong trust
and relatonships across the
partnership, a strong focus on
planning, monitoring and contnuous
improvement, training and preparaton
provided for all staff, the quality,
integrity and commitment of staff
members and the complementary
combinaton of partner expertse.
(Keatng, 2018 p.9)
Health justice partnership on the DFV
service landscape
Health justce partnerships commenced as a practtoner led movement to more effectvely reach and support
people experiencing intersectng health and health-harming legal issues. Health justce partnership enables legal
services to reach clients with unmet need who would otherwise not access their help. It provides health services
with a greater range of tools to address social issues that affect the health of their patents. As the practce has
grown, DFV has surfaced as a key area of work for HJPs. Some HJPs were established to specifcally address DFV.
However, as noted above, DFV also arises in generalist HJPs, HJPs supportng people living with mental health issues
and HJPs supportng Aboriginal and Torres Strait Islander communites.
Health justce partnerships have evolved to join a complex landscape of specialist and generalist services responding
to DFV (see Australia’s Natonal Research Organisaton for Women’s Safety 2020). While all HJPs link health and legal
services, the way they intersect with other services, including specialist DFV services, varies from partnership to
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
P 14 HEALTH JUSTICE AUSTRALIA | MAY 2021
partnership. Some are directly linked to Family Violence
Units run by legal services, to Domestc Violence Court
Assistance Schemes through their legal partners, or to
other services through their health partners and/or
local networks. However, there is more to learn about
how HJPs best connect with other services that support
people with the range of issues arising from DFV. There
will be tmes when legal help is not the most pressing
need and the capacity of HJPs to step back and link to
others is as critcal as their capacity to step forward.
Thinking more broadly, while a number of HJPs focus
specifcally on the needs of women, others engage with
men in health setngs (e.g. alcohol and other drug,
mental health and generalist health setngs). Among
these men will be perpetrators of DFV (Chung, UptonDavis et al. 2020). Chung, Upton-Davis et al. (2020) have
suggested that there is much opportunity for human
services agencies (which includes health services) to
play a role in identfying and responding to perpetrators
of violence, and guiding men towards changing their
violent behaviours, their violence-supportve attudes
and their use of coercive control. The potental for HJP
in this role also warrants further exploraton.
At the same tme, access to face-to-face support for
people experiencing DFV was constrained as services
moved online, partcularly during lockdowns (Pftzner,
Fitz-Gibbon et al. 2020b; Health Justce Australia
2020). Lawyers in health justce partnerships reported
the challenge of staying connected with their health
partners during the acute phase of Covid19, and with
clients they would usually reach through the health
service. This was due to having to cease onsite service
provision, and to the shif in focus of health services
to responding to the pandemic. However, some
observed how the strength of pre-existng relatonships
between partner services was able to support ongoing
collaboratve practce through the pandemic. Where
the relatonship was less strong, this was more difcult
(Health Justce Australia 2020).
Prior to 2020, people experiencing or at risk of DFV
already faced multple, intersectng health and legal
issues. As jurisdictons move out of lockdown to a
‘new normal’ post Covid19, longer term impacts will
contnue, including additonal economic stress and
mental health issues.
Previous research showing increases in DFV following
natural disasters would indicate that DFV may also
Health justice partnership in the context of Covid19
Research has identfed an increased vulnerability to DFV through the Covid19 pandemic due to factors including
economic stress, disaster related instability, increased exposure to exploitatve relatonships and coercive control,
isolaton, reduced optons for family support, increased alcohol consumpton and people in already volatle
relatonships being restricted to their homes (Usher, Bhullar et al. 2020; Pftzner, Fitz-Gibbon et al. 2020a; Pftzner,
Fitz-Gibbon et al. 2020b). The complexity of issues facing women has also increased (Pftzner, Fitz-Gibbon et al.
2020a; Pftzner, Fitz-Gibbon et al. 2020b).
Reports show that COVID19 is used as
a coercive control mechanism whereby
perpetrators exert further control in an
abusive relatonship, specifcally in the
use of containment, fear, and threat of
contagion as a mechanism of abuse.
(Usher, Bhullar et al. 2020 p.550)
HEALTH JUSTICE PARTNERSHIP AS A RESPONSE TO DOMESTIC AND FAMILY VIOLENCE
P 15 HEALTH JUSTICE AUSTRALIA | MAY 2021
remain elevated (Parkinson and Zara 2013; Parkinson 2017). Further, as crises including bushfres and floods will
contnue to occur, we can assume circumstances like this will contnue to exacerbate situatons that are already at
or near crisis point in people’s lives.
In the face of this new reality, health services remain at the front line, with this complexity of issues coming through
their doors. Health justce partnership is one approach to this challenge and early indicatons are that this collaboratve
model has benefts for clients and for the services and practtoners supportng them. However, Covid19 has also
changed how people access services and how services connect with each other and to their clients. Moving forward
we need to explore collaboraton and connecton beyond co-locaton, both in the physical space and the digital. We
seek to learn more about the impact of health justce partnership, partcularly in support of current health strategies
to respond to DFV; and about how health justce partnerships, as part of a broader service environment, most
effectvely contribute to seamless, safe and effectve pathways for victm/survivors towards safety.
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About Health Justice Australia
Health Justice Australia is a national charity and centre of excellence for
health justice partnership. Health Justice Australia supports the expansion
and effectiveness of health justice partnerships and works to change service
systems to improve health and justice outcomes through:
Research: Developing and translating knowledge that is valued by
practitioners, researchers, policy-makers and funders
Practice: Building the capability of health, legal and other practitioners to
work collaboratively, including through brokering, mentoring and facilitating
partnerships
Policy advocacy: Working to reform policy settings, service design and
funding, informed by the experience of people coming through health justice
partnerships, and their practitioners.
+61 2 8599 2183
[email protected]
www.healthjustce.org.au
© Health Justce Australia, May 2021. This publicaton is copyright. It may be reproduced in part or in whole for
educatonal purposes as long as proper credit is given to Health Justce Australia.
Health Justce Australia is a charity registered with the Australian Charites and Not-for-profts Commission. Health
Justce Australia is endorsed as a public benevolent insttuton and has deductble gif recipient status (generally,
donatons of $2 or more are tax deductble, depending on your taxaton circumstances).
Health Justce Australia ABN 55 613 990 186
Acknowledgment
While any errors are ours, we thank and greatly value the input of Helen Sowey and Annete Michaux who peer
reviewed this paper.
Suggested citaton
Forell, S and Nagy, M. (2021) Health justce insights: Health justce partnership as a response to domestc and family
violence, Health Justce Australia, Sydney