Let's Talk Health Justice with Harley Dannatt

Hi there and welcome to the latest episode Let's Talk Health Justice – featuring Harley Dannatt, Senior Solicitor and Project Manager at Legal Aid Northern Territory in Katherine.

Harley chats with Health Justice Australia’s Partnerships Manager, Cathy Bucolo, about working across the web of services in Katherine, who collaborate in creative ways to respond to the unique opportunities and challenges affecting their community. They also talk about supporting people to access assistance where, when and how they need it, the importance of recognising and appreciating the small wins and much more. 

For more from Health Justice Australia visit our website, at healthjustice.org.au.

Health Justice Australia acknowledges the Traditional Custodians of the lands and waters where we work, and pays respect to Elders past and present.    

Credits 

Produced by Lizzie Marton, Content Coordinator at Health Justice Australia 

Transcript

Cath: Health Justice Australia acknowledges the Traditional Custodians of the lands on which we work and pays our respect to Elders past and present. We recognise the ongoing harm of colonisation and acknowledge the resilience, knowledge, wisdom and teachings of Aboriginal and Torres Strait Islander Peoples. 

[theme music] 

Welcome to Let's Talk Health Justice, where we explore the intersections of health and justice. We’ll be discussing how these systems can work better together, and what that means for those who rely on health, social and legal services for help. 

For many people, the problems in their lives are not easily broken down into the narrow areas of expertise that our service systems are designed around.  

Think about women and children experiencing family violence, or people navigating mental health challenges. The problems they may face are multi-dimensional, and can require support from a range of people, including doctors, lawyers, social workers, midwives and financial counsellors. 

By working together, health, legal and social services can support people living with complex problems much better than they ever could as a single service. 

Stay tuned as we talk to people working at the intersections to transform the way people access help, including frontline practitioners in health and legal services, researchers who are trying to understand what works and why, and policy makers who shape our service systems. 

This podcast is produced by Health Justice Australia. Health Justice Australia supports the expansion and effectiveness of health justice partnership though research, capability building and strategic advocacy.  

Health justice partnership integrates legal help into services that support people’s health and wellbeing. 

To find out more about health justice partnership and the work of Health Justice Australia, visit our website at healthjustice.org.au 

Lizzie: Hi, I’m Lizzie Marton, a Content Coordinator here at Health Justice Australia. In this episode of Let’s Talk Health Justice, Health Justice Australia’s Partnerships Manager Cathy Bucolo, chats with Harley Dannatt, a Senior Solicitor at Legal Aid Northern Territory. Harley’s a Project Manager in their health justice partnership, the Katherine Individual Support Program – known as KISP.  

Harley has spent the last 12 years or so working in various roles across the web of services in Katherine. Services who connect and work together in response to the unique opportunities and challenges affecting their remote area.  

Listen in to hear Harley speak about developing community solutions to address community need, share some really practical examples about supporting people to access assistance where, when and how they need it, and the importance of recognising and appreciating the small wins. 

[theme music] 

Cath:  So, it's really great to chat with you today. And, just wondering if you could start by telling us a little bit about you and your background and what led you to working in your current role up north in Health Justice Partnership.  

Harley: Thanks, Cath. Yeah, so my name's Harley Dannett. I'm a lawyer in Katherine in the Northern Territory, just about three hours south of Darwin. Originally just came up from, studied in Melbourne, came up from Victoria like a lot of young lawyers and yeah, started working for NAAJA, the North Australian Aboriginal Justice Agency, as a civil lawyer. Yeah, and just loved the place, really. Katherine, yeah, became home pretty quickly. Tried moving down south for a couple of years. But came back to the territory. But it's actually in those couple of years down south that I was first sort of exposed to working within a health justice partnership, working up at the Hume Riverina Legal Service. So those guys up there in Northeast Victoria are really leaders in in HJP work and I was really then fortunate to get an opportunity to come back to Katherine and work in HJP. So that's where we are now. But yeah, I mean, Katherine, as a town, as a region, is a place there's a lot of disadvantage, a lot of really complex social, legal, health issues for our town, but it's also a really, really great place to live and lots of strengths too. So yeah, just love it up here.  

Cath:  And so, is there many staff there, or is it just you in Katherine?   

Harley: Yeah, so in the Katherine office, I am the only civil lawyer. NAAJA also has an office here with a number of lawyers and, you know, there's a CLC in town for the women's legal service, KWLS, and also a family violence legal service. But yeah, like at this stage in Katherine, I sort of sit in this unique position working in a HJP, but also as a civil lawyer. So there isn't an established practice of civil lawyer work in Katherine, but part of working this way is sort of changing it and talking to the community about not necessarily always working in the exact same way that legal services have always worked. So, yeah, it's a really interesting part of the role.   

Cath: Yeah, fantastic. That is interesting, and so maybe it's a good point to introduce us to KISP or the Katherine Individual Support Program partnership and tell us a little bit about that? 

Harley: Yeah, sure. So KISP has a really fascinating history that I’ll sort of go through before talking about Legal Aid's partnership. So KISP came about because of a doctor up at the Katherine District Hospital who was the head doctor there, Dr Simon Quilty, he's gone on to do lots of other amazing things. Dr. Quilty and others were looking at the presentations of people in the emergency department and noticing that there were these, this cohort of people who were frequent attenders. And these frequent attenders were also people they realized that had a number of social factors, one of them being homelessness. And really trying to dig down to work out why this group of people were frequently attending emergency and not necessarily able to manage their medical conditions outside of the emergency department. There was a study, that was published in the Medical Journal of Australia, but really, I think a lot of people could quickly come to the realization that that there are these huge social gaps in that, that a lot of people facing really complex disadvantage face. So things like homelessness, things like alcohol and other drugs, addiction and numerous other social factors. The purpose of... so out of that came KISP and this concept of working collaboratively between the hospital and the Aboriginal Health Service, but then also a number of other social services around Katherine to look at a way to triage those frequent attenders, those people who are coming to the hospital multiple times, sometimes multiple times a week, into social support. And those pathways weren't very well developed at that time. And so out of that came KISP with this, really, this intention to work really collaboratively between these services. So what's I guess really the interesting in terms of a HJP is that KISP was already a model that was innovative and was collaborative. Um, so there was sort of in some respects already a framework set up and ready to go in terms of partnering with a legal service. So that I think allowed things to run reasonably smoothly in that respect. But at the same time, KISP was still very much already working on that system level of reform, but that was something for legal services to really, or the Legal Service Legal Aid to sort of fall in line with, which is actually working within these really sort of established systems of how the hospital runs and how other support services operate and how medical services are delivered, and really from the get-go looking at this systems level – why are these people attending here and not there and what are the barriers and what are the breakdowns. So in a way, yeah, Legal Aid sort of fitted in nicely then to really start tackling those, that legal component to this really complex question that a lot of people face.  

Cath: Yeah, you've described that beautifully, Harley, and that history. I think what really jumps out is  that the need and the origin comes from the health service, whereas, lots of HJPs or health justice partnerships in Australia, that movement came from the legal aspect, from the community legal sector. 

Harley: Hmm. 

Cath: You know, after the law survey in 2012 and... that, looking to reach the people who needed legal assistance that the community legal sector weren't reaching. Whereas what you've described in that's happening in your local area is that the need has come from the health side, from the hospital and from Dr. Quilty, yeah, recognising, hey, we need to do – something's not right here, something's going on deeper, broader, why are these people continually being readmitted and showing up here. And then looking for a broad solution and, you know, what we might talk about as the social determinants of health, and then bringing legal into that. 

Harley:  Yeah that's right. Yeah and so, so that work is predominantly done through Wurli-Wurlinjang Aboriginal Health Service. So they run KISP, and you know, over time that's looked differently from year to year. Um, you know, it's sort of the makeup of that team. But essentially, the way it works is that the hospital will record people who attend the emergency department, and if somebody is identified as a frequent attender, somebody who attends three times within six months, that person's given the option, so it's absolutely a consent-based program, they're given the option to participate in KISP. If “yes”, then a referral is made. And what that really does is open up, like you say, looking at that social determinants of health, that assessment takes place to look at, you know, what are those broader areas of need? And more often than not, there are legal issues as we know, you know, there's, there's legal issues here driving, driving health problems constantly and vice versa.   

Cath: Mmm. Could you give us an example of that? 

Harley: Sure. So a classic example, you know, is a person who is attending at the hospital, really struggling to maintain their health condition, struggling to hold on to their medication or maintain their hygiene. And the reason for that is that they might be sleeping rough. Okay, so how, why is that person sleeping rough? Why aren't they in housing? We contact housing and we find out that that person actually was taken off the wait list. So that appeal, that question and as to why that person's not on the housing list, that's a legal question. That's something that legal services can work with. At the same time, we have people who have legal problems that are really being driven by health. So of course, there's things like AOD addiction, but even just the circumstances in which people do drink alcohol are really exacerbated by those social settings, by being homeless, and those things lead to, often, criminal legal trouble. And how can we help people in that domain? How can we help people in the mental health domain from keeping out of a legal system? Those answers are, yeah, are often how to engage with health services. Sometimes those health services aren't there, sometimes they are. Of course, Centrelink and access to Social Security, those are legal issues that are, you know, deeply entwined with access to medical information and assessment. Um and in context of Katherine, making sure that that medical assessment, you know, is culturally appropriate, is in language, getting that medical information to be able to advance a Centrelink or NDIS application is really crucial. So this really entwined overlap. I work really closely with a social support worker at Legal Aid who works in primarily in the criminal setting, and her work is, you know, really day to day trying to get this health information of those clients, or often my clients as well, get that getting that health information into the courts in in a way that the courts can then make decisions accordingly. So it's this constant nexus between your health information and legal services, and then there's this constant driver of legal problems, be it housing, social security, access to basic government services like license, getting ID, getting access to your banking, not being scammed, all of these financial things, you know, really directly impacting on people's ability to stay healthy. 

Cath:  Hmm. Fantastic. Great example. Thank you. Do you mind, I’ve actually got some detailed questions about that, that I’m curious about, one is, so are you actually embedded in any of those health services a certain amount of days a week?  

Harley: Yeah, so not actually within the health service. So the KISP team itself attends the hospital. I should probably flag as well. Katherine's quite a small place. So I'll talk about my outreach. But we do travel around quite a bit, working in and out of each other's offices. So the KISP team are frequently at the hospital. And I'll talk about collaborative case management in a moment. The other big piece of this, of the program in Katherine is the role that our Doorways drop-in centre. So that's the Katherine Doorways Hub. It's run by the Salvation Army. So that's a service that runs Monday to Friday. It's a multi-purpose space. It's a homelessness drop-in centre that I guess its primary objective is a safe and inclusive place in Katherine but it also provides access to health hardware, and it also is a space where services can engage with people who are experiencing at risk of homelessness or any other sort of vulnerability. So that service, I guess every  town has its own little history.  

Cath: [laughs] 

Harley: and its own little timeline of different, you know, funding that's popped up along the way. So, so that service actually ran, it was funded around the same time that KISP was initially funded through two different streams,  and the two services quickly realised that they need to work together, and they do. 

Harley: So the Salvos provide this physical space and it's a physical space that is that  a large section of that KISP cohort also attend. So my outreach is to the Salvos, so I'mover there every day, yeah, in this kind of, in this space that is set up to be... It's not a service space. It's not a health clinic. It's not a clinical setting. There are appropriate spaces to see clients, but it's predominantly a semi-public space for people to access and access help. So that's where I physically locate myself to do a lot of this work. And KISP and the Hub work very closely. So it's almost like a bit of a, it's almost a triangle. The hospital, not so much, the hospital absolutely still work with KISP. And yeah, if you start to draw the web of connections around the town, it starts to become a bit of a complex web, but we like it that way because I think that's, yeah, that that's how we overcome the fact that no, there is no one type of client. You know, there is no one way that a person presents. So I make referrals to the Hub. The Hub makes referrals to Wurli. Wurli makes referrals to me. It's all very complicated, but yeah. 

Cath: But it works. 

Harley: Yeah. And it's a small group of people that are essentially working together across a number of services. 

Cath: Yeah, yeah. I can imagine it now. And I think that picturing that triangle is really a good way to think of it. And also, thinking about the range of challenges and unique challenges of working in Katherine and like you know and have described those challenges that affect community. And as one example, we know the homelessness rate is 31 times the national average. Did you want to talk about any more about that triangle and that the different partnerships and how you respond to a stat like that, and you know, the reality of what that's like – that's more than a statistic, how that plays out in your community?  

Harley: Yeah. Yeah it's really interesting, that statistic. It's a statistic that we use quite a bit in our advocacy  and it is very powerful. And without a doubt homelessness and I guess associated poverty, you know, really undercuts a lot of our work, particularly where homelessness is, you know, one of the key drivers to both health and legal and and many other difficulties that people face. And what essentially that means in reality is that, you know, we might quickly identify that housing is the need, but the grim reality for people is that there aren't a lot of stable, suitable, affordable housing options for people. So in a way it sometimes does mean that whilst that is often a goal that we work towards – and sometimes there's legal barriers to that, sometimes there's other barriers to that, and sometimes we do have success in, you know, helping people find that housing. It does undercut so so much of our work in a lot of different ways because it just continues to be a barrier and a difficulty for people. So from a medical point of view, you know, when you talk about people sleeping rough, you know, managing medications, managing heat, clean belongings and access to hygiene. Those, those things are really difficult from a medical point of view, of course. And then, it flows on through. I guess the other thing, though, as well as that stat, I mean I think that stat is really important. The other thing we have to always do, though, with the conversation around homelessness is is unpack that it is also a – there's a range of different experiences that that people have. And within Katherine there's often a generalization, and I think the answer is that there's many different experiences. There are within the Aboriginal communities in the Northern Territory and a lot of people do move around, they move between communities and towns. Katherine is like a service hub for a really large area, many Aboriginal communities. It's also a health hub, so people coming in maybe to get access to medical treatment and then finding themselves stuck in Katherine, not able to get home, not able to afford to get home or know that they can't manage their health at home. So for example, access to renal clinics is a massive driver of homelessness. So that's sort of one iteration but then also there are people who do long-term live in bush camps around Katherine and that's, that's a different situation as well. So sometimes that's how we respond as a network of services. But ah, not everyone is always in the same crisis. Of course, we have domestic family sexual violence driving an immediate need for crisis accommodation and much of these other crises that you see across the country. I guess something that we do is try and break down what are the particular needs. And sometimes it is a case that a person will be on a housing waitlist for eight to 10 years. And as services, we have to think about how we support those people living either in overcrowded family houses or in bush camps. And adapt. I guess that's the key thing, is then how do we adapt? 

Cath: Yes, yes.   

Harley: How do we make sure that we're not relying on the post, for example, for people to get our forms? Or you know. “Make sure you give me your phone number,” well, people living in bush camps really struggle to hold onto a phone. You know, relying on those systems, putting in other systems. And that's, and that's I guess, where the hub really comes in, you know like the classic legal service, you know, you're taking down people's details, you know, “What's your name, your date of birth, your phone number.” But then making arrangements to say, well, look, I'll be at that place every day. If I'm not there, just say, where's Harley? And they'll give me a call and I'll come over. And that's, that's our contact. And that can be a bit unnerving, I think, from a legal service point of view. But that's reality, like that's just the reality we have to adapt to with helping this cohort.  

Cath: Yeah. And that's what, that's what it sounds like. Really practical, also, even just that term or word homeless, like what you've described is that everybody, anyone that's experiencing homelessness is not a homogenous group. And so, KISP and the hub and your work, you're really looking at, each individual that's in front of you and what's right for them. And then those, beautiful practical examples of supporting people to access assistance in the way that they need it, when and where they need it, and really understanding the local community that you're working in.  

Harley: Yeah, that's the aim, yeah.  

Cath: Yeah, yeah, it sounds sounds like you're doing a great job, Harley, doing that. 

Harley: Thanks. No, well, I mean, yeah, we try our best. I guess the other point, and that getting back to that stat and just how how grim that is, and how those lot those lofty goals of getting somebody, supporting somebody to access housing is... When you say doing a good job, I think the other thing that this work really teaches you is acknowledging small wins. People are up against it. We really need to acknowledge sometimes that periods of financial security is a win. You might not be employed and financially secure forever. You might not have housing forever. Your health may overall not have a great profile, but if you're supported for a period of months, that's more than potentially what you otherwise might not have experienced. 

Cath: Small wins. 

Harley: Small wins. 

Cath: Yeah, absolutely. That's a really good reminder, I think, because as a lawyer, your job isn't to build a house. So yeah, like it's sort of, yeah, yeah, did it yeah.  

Harley: I wish, yeah, it'd be great, yeah. 

Cath: I think exactly as you said that, the legal assistance can contribute, but it's not going to be the only solution in these huge social problems that people are experiencing. 

Harley: Hmm. Hmm. 

Cath: I guess on that – it's really obvious that no one service or one person or one organization is going to be able to do this work alone. People are just living with such complex problems in their lives, so partnership is the way to address that.  

Harley:  I think a lot of the time with HJPs, you are playing a triaging role.  I undertake casework as well, but, within the legal, within the civil legal or generalist legal setting, you know, there is, there's so many specialisations, and it's the same in the medical world as well. I think what we bring as far as expertise is around identifying issues and making sure that people get the specialist help. And particularly in Katherine, I think that's something that we're working on more and I'd like to see develop, which is links, better links back to the legal resources that are available sort of nationwide. There always so much interest in in wanting to help people in, you know, in the top end, in remote Australia, how to channel or access those resources and get those resources up here. It really, you know, requires people to be able to meet face to face, but then there's such a breadth of legal issues that we really need those broader resources, but much in the same way as health, yeah. 

Cath: Yeah, yeah, that's right. Which is where we started off – you can't do that alone. And so you need to refer on for different reasons. 

 Harley: Yeah. 

 Cath: Yeah. And really understanding, yeah, who that is. What are the backup plans and warm referrals that you can do to other services? 

Harley: Mm. Yeah and then facilitate that engagement. I mean, yeah, the word engagement gets used a lot, but understanding what that means in a Katherine context, and really making it happen, because it's all good and well to have services out there, but there are practical or cultural or you know other reasons why those, why sometimes that engagement doesn't happen. So just being a linker, but not just any old linker like “Here's a form,” but like ongoing and checking in and “How did you go with those people that you spoke to?” 

 Cath: No, that's right. “Here’s the brochure.” 

 Harley: Um, “Oh, you didn't actually have a phone in the end”, here, or like, “Well, let’s call them now on my phone” - or whatever. You know, making sure those things happen is, yeah, all part of the work. 

Cath: Yeah, another term I've heard recently is navigator. And then also talking to someone from an Aboriginal legal service, that idea of... you need to say yes for quite a while. It sounds like that's the case. That's what you're saying for Katherine as well, that people living in Katherine... So you say, “yes, yes, I can help you.” And it might be, you might be triaging and then referring them and checking up and doing all those things that you've said. It sounds like what wouldn't work is to have very clear, very strict boundaries and scope and that this is my department and this is what I do. But that that kind of attitude and practice is not going to work. 

Harley: Yeah. Look, that's exactly right. I mean, I think there's an inherent problem with this idea that all of your clients are going to understand exactly what civil legal topics are. 

Harley: And if you just say, I'm here to do civil law, and you can say a list of words that people understand how their, that their problems might fit in this box or not in that box. And you know, I'll see this service for that one and that service for that. It just – it reflects a siloed approach to how we've developed our service system and then it reflects how, you know, how government funds programs, you know, that service gets domestic violence funding and that service gets housing funding and that one's from the state and that one's from the territory, that one's from the Commonwealth. It just doesn't reflect reality and that's where that collaborative case management comes in to really try and bust that apart. So we can just have a genuine conversation about what's going on for somebody and even after you do that, it's not necessarily, "OK, now we've segmented out all the issues.” Because the issues are still, they're still intertwined, we can't – I'm not a nurse. I can't do the medical stuff. You know, there's limits on what we can do in terms of silo breaking, but what we can do is, you know, provide our specializations and work with each other. 

Cath: Yeah. Well, Harley, I think we're going to finish up. We're asking this question to all our guests. And so we know working in partnership isn't easy, and there's no one way to go about it. So I was just wondering for you, what drives you to work in partnership and what keeps you motivated and passionate? 

Harley:  I think there's two sides to this question as well.  

Cath: Mmhmm. 

Harley: There's like an aspirational side that, all those things we've talked about today about breaking down silos and getting better outcomes and... I think once you've cast that critical eye on silos and said, well, why do we have this system these systems in this way?  And why do we see these, why do we see the justice system preventing people from getting stronger in the health world and vice versa? I think aspirationaly what drives me is to try and work in partnership to break down those silos and to build a better way of doing things through established practice, just sort of one relationship at a time. That's the aspirational answer. The hard truth answer is there's actually no other way. It's not sort of actually an option. 

 Cath: Ah, yes, yes.  

Harley: You know, at a bare minimum, you really have to be doing it anyway. So you can't be a complete island, particularly not in remote regional contexts, you have to be working with your partners, whether you like it or not. I don't know which answer, you can pick, Cath. 

Cath: [laughs] No, I like them both. I think they're both true. 

Harley: Yep. 

Cath: Yeah. Oh, thank you so much. That's, a great way to end, on the aspirational and then the reality as well. 

Harley: Yep. 

Cath: Thanks so much for your time today, Harley. It's been a really great conversation. 

Harley: Thanks, Cath.  

Thanks for listening to this episode of the Let's talk health justice podcast. You can read the study Harley mentioned in our show notes. And a big thank you to Harley for taking the time to share your insights and sense of humour with us!  

For more from Health Justice Australia visit our website, at healthjustice.org.au.