Let's Talk Health Justice with Dr Liz Curran

In this special episode, we're lucky enough to hear Peter Noble in conversation with Dr Liz Curran.  

Peter is the Executive Director – Regions and Service Delivery at Victoria Legal Aid and a board member of Health Justice Australia. 

Dr Liz Curran is Associate Professor of Clinical Legal Education and Research Impact Lead at Nottingham Law School, Nottingham Trent University, UK.

Dr Curran has been researching, writing about, and advocating for health justice partnership for over 20 years. In this episode, Dr Curran speaks about her vast experience and the changes she has observed across the HJP landscape. She also speaks to the importance of collective and individual reflective practice, creating space for empowerment and client voice in partnership, and much more. 

We know you’ll enjoy this episode and take away valuable insights from Dr Curran's thoughts and perspectives!  

For more from Health Justice Australia visit 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. 

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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 

[theme music] 

Hi, I’m Cathy Bucolo, Manager, Capability at Health Justice Australia. Welcome to Let's Talk Health Justice, a portrait of the people and practice at the intersection of health, justice and partnership.   

In this special episode we're lucky enough to hear from Peter Noble interviewing Dr Liz Curran.  

Peter is the Executive Director – Regions and Service Delivery, at Victoria Legal Aid and is also on the board of Health Justice Australia. 

 Dr Liz Curran is the Associate Professor of Clinical Legal Education and Research Impact Lead, Nottingham Law School, at Nottingham Trent University, UK. 

Dr Curran has been researching, writing about, and advocating for health justice partnership for over 20 years.  

Dr Curran speaks about her vast experience and the changes she has observed across the HJP landscape, the importance of collective and individual reflective practice, creating space for empowerment and client voice in partnership and much more. 

We know you’ll enjoy this episode and learn so much from Dr Curran!  

Peter Noble: I'd like to begin by welcoming our special guest, Dr Liz Curran, and acknowledging that our conversation is taking place in Naarm Melbourne, Australia on the unceded lands of the Wurundjeri people of the Kulin Nations, to whom we pay our respects.  

Hello and welcome, Dr Curran.  

Dr Liz Curran: Hello. I'd like to also acknowledge the Wurundjeri people of the Kulin Nations. Their Elders past, present and emerging, and acknowledge that land has never been ceded. Thank you. 

Peter Noble: It's a true pleasure to be speaking with you today, Dr Curran. Can you tell us a bit about what led you to be interested in health justice partnerships, or the intersection of legal and health and wellbeing issues more generally? 

Dr Liz Curran: Yes, I've been reflecting on this recently, actually. I first encountered the importance of health and justice when I was a junior lawyer in Warrnambool, on Gunditjmara land, and I was working as a young lawyer in a private law firm. And we used to do some work at the Brierley Hospital, and that was a hospital for people experiencing poor mental health. I used to go up there and talk to the mental health nurse and the client, who might have a matter before the mental health tribunal. And I think it was every fortnight I go up there for a full afternoon and I'd sit down with the client with a file and often the mental health nurse would come in later. And I found that often, more often than not, it was being adversarialised and it was being put before a tribunal when all that the person might have wanted was an adjustment to their medication. Because I mean, really being crude, because they had constipation or something. And so what I would do is, to see the role of an advocate, not a court advocate, because I didn't really want that for the actual client. What I saw was the role as an advocate to say, “This is the client’s story. This is actually all they're asking for. Why is everybody investing all the energy in going before a tribunal and adversarialising it, when it seems to me that it could be just a simple adjustment?” And the health staff and the mental health nurse actually started to appreciate the value of that. So that was, I guess, the first inkling, and that was in the early ‘90s.  

And then I had the privilege of being employed at La Trobe University in 2001, and I was the Clinical Supervising Solicitor working four days a week at the West Heidelberg Community Legal Service. And it was a community legal service that had been set up co-located with what originally was called West Heidelberg Community Health Service. And I was seeing psychologists, doctors, councillors, youth workers and I was working side-by-side with them and also doing some professional development training and doing – what wasn't called then secondary consultations – which is when a health professional or allied health professional comes and knocks on your door and says “Liz, I've got a client. I don't know what to do. I don't know if it's something that you could help with.” So what I realised when I started working is most of the health professionals were suspicious of lawyers, even though that service had been running since effectively the 1970s. They saw lawyers as people involved in the criminal system, family law, care and protection. And they didn't really understand. And because it was a student clinic, we did a lot of consumer law, a lot of, started to bring in the sort of thing about preventing eviction, ensuring proper process for debt collection. So I worked very closely also with the financial counsellors, and of course debts and fines cause incredible high levels of anxiety and stress and lack of hope and suicidal ideation. So all very, very critical. And so what I realised when I was working side-by-side with the health professionals was that if they could knock on my door and have even two or three minutes, they would be far more empowered to actually be able to support their clients. And given a lot of their clients were suspicious of lawyers, it was an indirect way of getting the message through to the clients and getting them help that they needed, if they weren't ready to see a lawyer or solicitor. And what I found happened was over time with those conversations, it not only built the trust of the health professionals and allied health professionals, but they keep referring to all that “Oh that’s from Liz, Liz suggests this, Liz suggests that,” and then overtime I would end up seeing the client themselves. So that idea of borrowed trust, hence the term that's being used now, trusted intermediaries. So, the person or the support service that the client trusts or the patient trusts. And then there's a sort of borrowed trust between the two, which is a theme that will probably come up later in this discussion. So that was my first taste of the health justice partnership and watching and observing very, very closely the shift and change in the health and mental health and wellbeing of my own clients, but also those of the health service. And also what I want to also say is there was a lot of reciprocity. So if I had a client and they were experiencing financial problems, I could then link them with a financial counsellor. If they were experiencing grief or trauma, I could link them into the excellent psychologists that I worked side-by-side with. I learned a lot. I also learned about... it's really poorly described in legal because client care often means managing risk, and in my view client care, it's the public health, health promotion notion of client care where it's the client that's the centre and we're all working together in a holistic way. To take eggs out of their basket, so to speak, so they could get on and resolve all the other issues in their lives, often cascading, intersecting, elevating at different times. And if we can empower them and solve some of their problems, then they can get on and heal. So that's the first encounter. 

Peter Noble: Dr Curran, they are fascinating reflections on your own personal journey and thanks for bringing your professional experience into that. Now clearly, you've got a strong background not only as a community lawyer, but as an educator and an accomplished researcher. I'm interested in your work as a researcher and your, I guess, broad visibility of a range of health justice related practice and I'm interested in the reflections you've got about either changes on the landscape or any innovations you might have observed, over that time. 

Dr Liz Curran: Most of my research, when I get the opportunity, is co-designed and participatory. I was on the advisory of a number of what we call interdisciplinary student clinics where the law students were working alongside medical and social. And I'm working, for instance, with physiotherapists and podiatrists, and so then, long story short, I was presenting on the Bendigo programme at a national conference of community legal centres and the now Director of the Hume Riverina Legal Service, at the time, was the Managing Solicitor, Sarah Rogers – an amazing woman. She approached me and said we're really interested in starting a multidisciplinary, but a health justice partnership, in the Hume Riverina area with four partners. So Hume Riverina Legal Service, NESAY, North-East Support and Action for Youth, and also the Flexible Learning Centre which is a school for young people who've disengaged from traditional school, and they had a higher proportional of Aboriginal students, and also the Albury Wodonga Aboriginal Health Service was the fourth partner in that. I did the longitudinal evaluation of that – emerging from that was the current project and that's Bagaraybang bagaraybang mayinygalang, which is a programme called Alleviating and Empowering, and it's basically situated in an Aboriginal organisation, Albury Wodonga Aboriginal Health Service. And again, fabulous leadership with David Noonan, who's the CEO and a fantastic Aboriginal board and they situate the lawyer and the Community Engagement Officer embedded in the actual health service, so instead of being, they're not really, it's not a co-location arrangement. They become part of the fabric of the service and it's really critical because for Aboriginal people, trust and cultural safety is key and it's become now the third, third iteration. But of course, with that Invisible Hurdles Project that sits behind it, building the relationships of trust and a lot of the workers at what we call AWAHS – Albury Wodonga Aboriginal Health Service. And by the way, that programme came about with our help with the funding submission and it was co-designed with Aboriginal people and the health service Elders and staff at the health service. And I took that to Hume Riverina Legal Service, and they said “If that's what they think, if that's what you think will work, let's put that funding application in” and we got that funding. So it was co-designed, it was participatory. And as I said to the manager of the social wellbeing team last week, “no surprise that when a programme is co-designed, and participatory, it's effective.” So it's really significant because I think if we want to close the gap, it's a significant learning from that project. 

The other thing I should say, which was pivotal, and I forgot to mention it, was the Victorian Legal Services Board and Commissioner had originally a family violence theme, but they also then developed a theme on health justice partnerships. And I think that was the fillip to get health justice partnerships up and running. And you had just come back, I think, from the States and other places doing a Clayton Utz fellowship on this, and I was hired by the amazing Sue Ball at the Legal Services Board, Head of Grants, to run quarterly, sometimes day long, mostly day long sessions for those programmes that were funded under the programme. It was about capability and it was about building confidence, assisting and supporting them in how to evaluate in an effective and efficient way so that they could build their skills in-house if they didn't have the proper funding for evaluation and doing, you know, simple ABC, I guess, of how to do it. And I think that significant funding led to, and that capability session. So all the funded programmes, not just the justice arm but the health arm. I said “I'm, you know, I want the health in the room” and I would run sessions around language, common understandings, how to build collaboration. And then in those sessions people be very honest, like "We’ve been set up for six months and we haven't got any referrals,” and I'd say, “Well if you haven't got any referrals, that's understandable. Are you doing professional development? Are you doing secondary consultations? Because people aren't just gonna trust you if you sit in an office and shut the door and don't go to the lunchroom, don't converse, don't share things, don't have corridor conversations.” So there's a real need for people to actually become approachable. Forget about being a lawyer and just become a problem solver. Non-hierarchical, non-judgmental, relaxed, respectful, listening to people, hearing people – active listening is critical and reflective practice. 

Peter Noble: I'm going to jump in there because I'm delighted that you've touched on this point of reflective practice. What you've really described is an extraordinary accumulation of learnings and insights, in fact, over many decades. But you've got experience at leading and educating on reflective practice more particularly, including as a strategy in evaluation. So can you tell us a bit about a bit about that? Your collective and individual kind of reflective practice and how I think you've said before, that it's not indulgent navelgazing, but it's actually really essential. 

Dr Liz Curran: It's quite confronting, reflective practice. It's not a descriptive thing. You don't just describe what you did, how you did it. It's not activity based, which a lot of evaluation can tend to be. So it's actually really asking you to really look at – and this is in education as well as practice – it's asking you to think about what did you do before, how did you prepare? What did you do during, what worked, what didn't work? Why did it work, or why didn't it work? For instance the why didn't it work, it might be you're in a client interview. And the client goes ballistic. So you have to think about, what was it that I said or what was my body language or what was the way in which I conducted myself that might have led that to that reaction. So it really requires a lot of honesty. It requires looking at feedback. And it also requires a level of honesty and a preparedness to break things down. The other thing reflective practice can do is you look at what outcome is a good outcome. I did this some very early evaluation work I did for Legal Aid ACT, talking to staff and the clients about what was a good outcome for them, not for a lawyer, or a court outcome – what was a good outcome for them? And they said if the process was respectful. So it wasn't... Even if the outcome wasn't good. They felt that if they had been listened to and heard and not judged through the process, and that was really important to them, it was about respect and looking at the outcome and then breaking down well – what were the elements that led to that outcome? What was the sort of things that led to that? So that's also part of reflective practice.  

I've also been heavily informed by a wonderful academic who also has run health justice partnership and she has done a lot of writing about her area of real specialisation, is reflective practice and she comes from a community legal centre background or what they call law clinics in Canada. So her research, her understandings, her unpacking of it, and also reflective practice, goes to what are the causes of problems? And what are the systems that cause... So it's not just the individual level, the practice level, it's looking at what are the reasons and causes of the injustice. And then it's about reflecting on how can that be fixed at a really rudimentary level, be it in policy or be it in community organising, giving voice and empowering local community to be able to talk to decision makers and to do it collectively, if needs be, but also to listen to trends in casework and reflecting on those and working out what's working and what's working for community. If there's poor laws or maladministration, what are the things that are needed to fix that and improve that now? Government and decision makers don't like hearing it. And how you preface it is – it's often about efficiency, effectiveness and it's about good practice, and I think that reflective practice is also about finding out what has been the outcome or the impact over time of your work and telling those stories and those narratives so that people understand the human side. And that can then shape and inform an improved system, because I think laws and their administration are terribly blunt if there's no reflection about the significance of what the experience of people on the ground is. 

Peter Noble: Dr Curran – in the creation and the operation of health justice partnerships, you've recounted some really interesting comments that partners have made, for example, what has the community said? And what have you heard? You've also talked about some important principles like co-design and self-determination. To me, those things resonate this kind of idea of empowerment and client voice. And I was wondering if you could, you know, share a bit more about what those concepts mean to you and how they best manifest in health justice partnerships.  

Dr Liz Curran: I think where client voice is heard loudly, and there's a space for it, and clients are asked – that bodes well for an effective, good, successful health justice partnership. The health justice partnerships, and I know many that haven't been successful, are the ones that forget about client or patient voice. And so you have to create a space. I'm going to use an anecdote, if I might. I was talking to a lawyer. And I've been drilling down on the concept of trust and disclosure. What is the relationship between someone disclosing and someone not disclosing? Because in order to be a good lawyer, you need to actually hear the client's story so that you can actually be responsive. But if the client doesn't trust you, they're only going to disclose what they what they want you to know, things that could be shaming or embarrassing, they won't disclose. So I was talking to the lawyer and she said, “oh, I don't have a problem with disclosure, blah blah, blah.” And I said, “Can you just tell me how you conduct a client interview?” And oh my god, the way she conducts her client interviews. I've written a book on this and I just said “Right, you've just – basically you do everything I said in the book was good practice.” And she said, at the end she said “Ohh, I'd probably consider it unprofessional.” And I said to her, “You are the most professional”, I said. Because a good lawyer has to tailor the advice to the client and if you give the client the space at the time, and the lawyer was recounting a situation where the client had given her all of the information that she needed for the particular issue. It was involving fines or something, and then they had a bit of time and space and she knew from the way the client presented that there was more to the story, so she stopped. And she thought. She... the client had said something that she sort of thought – there's a story there. She asked the question. And that question led to “Ohh that was because I was abused as a child and always have been.” That person had never been asked and never shared it with anyone. And of course flowing from that, this person now has a claim for victims' compensation and is now getting all the support services, like grief and trauma counselling, and that's because she allowed for the time in the interview to ask the question. So client voice comes in many shapes and forms.   

I haven't talked about education of lawyers and professional development. I spend a lot of my time working on that, and again it goes back to what you said about reflective practice. The way in which we are trained is very different. Very similar, I understand, from doctors, to doctors – that's a problem. But we are trained very differently, for example, to nurses where reflective practice and client-centred decision making and voice and health promotion are core and key. I think our law degrees are poorly taught on the whole. I don't think that there is enough training of law students about actual human – the human side. You can't ignore emotion. We train them to be technicians, legal technicians, and then they come out and they have no idea how to interact with human beings and clients and community. And so that is a huge and important piece. And I also think the role of community legal education or community development and working with community to empower them to know their legal rights, peer to peer learning – lawyers are not trained in the importance of that type of work and what they do is they go and they talk for 15 minutes at community and that's their community legal education. Adult learning doesn't really take a role and they're not taught that lawyers are expected to train other people. They have no training in how to train other people or adult learning approaches. I think lawyers need some better training, not just in being technicians. And what I've seen so many lawyers, because I’ve supervised so many lawyers, what they do is they put emotions in a box. But if a client is traumatised and upset and distressed, you cannot do your job as a lawyer effectively unless you actually acknowledge the emotion and have some strategies to manage it, because then you'll get the best out of your client and it becomes a team effort. They're the experts in their own lives, not the lawyers. 

Peter Noble: Dr Curran, people working in the field, especially those starting out in health justice partnership, want to know practical tips about doing the work. And you've already shared some great nuggets, some great examples. So for example, you talked about the communication process and skills around voice and interacting effectively with clients and community and you also talked about connecting with colleagues in the lunchroom. But I'm sure you've got other examples of, you know, tips or other kind of sage advice about starting or perhaps even persisting with the partnership. What else springs to mind? 

Dr Liz Curran: Humility – nothing else will follow. Get rid of your ego. Put it in a bag outside the door and leave it behind. Be authentic. I mean, these are these are sort of they're not really skills, but they're absolutely critical when you're starting out. Be authentic. Use plain English. Don't be judgmental. Listen and learn from your colleagues who are not lawyers. Ask them what will work for the particular client. Identify barriers for your colleagues and then see if there's other ways, because often – I mean again using a little nugget from last week, you know when an authority says it, for example, say Care and Protection says it – “grandparents don't have rights under the law.” Uncover the trusted intermediaries’ misconceptions – because in fact, that's not correct, and people with power and influence can be wrong. In fact, it was the Bendigo project that you commissioned, Peter, where a mental health nurse says, “I always thought that when an authority said something, it was a yes or a no. Now I know it can be a maybe, and the lawyers taught me that.” That's really critical, I think. Obviously we have client privilege and all the legal frameworks, but there are really good things that we can do. You know, it's not an either or. I mean, there are health justice partnerships all over the country who are managing that really well. Talk to other health justice partnerships. And you mentioned the word persistence. Respect and trust have to be earned. They're not something that happens because you're a lawyer. Too many lawyers think that they will earn trust because they've got a law degree. And that's definitely not the case. So I think those are the key things I'd say: humility, authenticity and really, really working closely with your colleagues and learning from them. And also picking up where your colleagues might not be across the law and have assumed things are the case that aren’t, because opening that little door can really help clients and so many clients... We know from the research that basically people give up, they have other things, it's overwhelming. The studies show that most – a significant proportion – of people in the community think the law is for people other than them. I.e. the resourced, the companies, the corporates. And they don't own law. And that goes contrary to the whole rule of law, that is the fabric of our democracy. Equality before the law. The law is the best kept secret from the poor. And so these new workers, if they see the bigger picture and their role in that, that can be, that's inspiring, that's passionate, that keeps them for the long haul. So see their work not as activities, but the fight for justice and equality before the law. 

Peter Noble: Well, that's a great little segue to the final question I've got for you to close this out and we're asking this question of anyone who speaks on the Let's Talk Health Justice podcast, and that is, what drives you to continue to research partnership, to research the law, to work with partnerships? What keeps you motivated and passionate? 

Dr Liz Curran: I think when I when I come off the back of something like I have from last week at Albury Wodonga Aboriginal Health Service and Hume Riverina Legal Service... It's inspiring, the good work they're doing. To hear from, community the changes in their lives, dramatic changes, you know, they can pay their bills, they get on, they've got their children back, that they're not, they're not self-harming anymore. They've got their mojo back, they've got some dignity back. And that’s because often they’ve resolved their... So that keeps me inspired. It's the incredible goodwill and conviction and commitment of people in this space. And it's also my desire to reduce inequality and prevent harm coming to anyone. The system is problematic. The whole justice system is about people fitting into the legal system. The legal system should serve the community and that's my life work is to get the legal system to be responsive to the people it should be there to help. And at the moment I think it's got the whole thing around the wrong way. I think it's all about fitting into categories and boxes that others set for us. Often, I'm sorry to say, people who are white and privileged and who have no experience of what it's like – and yet could be a hair’s breadth away from that in their own life. I see myself as a vessel to, with my privilege, to ensure that voices are heard and to enable and facilitate people to have their own voice, rather than me having to speak for them. 

Peter Noble: Dr Liz Curran, as always, it's been inspiring thought provoking, stimulating and emboldening speaking with you and reflecting on what makes health justice partnerships an interesting and potent service innovation. Thank you so very much for giving your time and sharing your wisdom with us. 

Dr Liz Curran: And good luck to everybody out there on the other side of this and your endeavours in health justice partnerships. 

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Cath: Thanks for listening to this episode of Let's talk health justice. And a big thanks to Peter Noble and Dr Liz Curran for your time and for sharing your knowledge and experiences with us. 

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