Abstract
There has been growing interest in medical-legal partnership (MLP), a model which connects healthcare facilities with legal clinics to help address clients’ civil legal needs (e.g., evictions and child custody matters). More research is needed on best practices for legal needs screening and identification of subpopulations vulnerable to complex legal issues. In this study, we examined client intake and other linked administrative data from the Connecticut Veterans Legal Center which is partnered with the Veterans Affairs Connecticut Healthcare System. We aimed to examine (1) the frequency of accurate client self-reports of legal issues as compared to the legal issue identified by an attorney, (2) the extent to which clients reported repeated past and current legal issues, and (3) associations between clients’ mental health diagnoses and number of self-reported legal issues. Among 73 clients in the sample, 47 (64.4%) had a match between their self-report legal issue and the attorney-identified legal issue and 46 (74.2% of 62 clients who reported past and current issues) had at least one repeated issue. In adjusted Poisson regression models estimating the association between mental health diagnosis and clients’ number of current legal issues, clients with posttraumatic stress disorder (b = 0.32, 95% CI = 0.01, 0.63), and alcohol use disorder (b = 0.45, 95% CI = 0.15, 0.74), reported more current legal issues on average compared to those without these diagnoses. Future research should examine how best to identify and support clients’ legal needs, and how these needs interact with mental health challenges.
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Data Availability
Data for this study can be made available upon reasonable request by contacting the last author with proper institutional review board approval and authorization from the Connecticut Veterans Legal Center.
References
Blodgett, J. C., Avoundjian, T., Finlay, A. K., Rosenthal, J., Asch, S. M., Maisel, N. C., & Midboe, A. M. (2015). Prevalence of mental health disorders among justice-involved veterans. Epidemiologic Reviews, 37(1), 163–176. https://doi.org/10.1093/epirev/mxu003
Currie, A. (2006). A national survey of the civil justice problems of low-and moderate-income Canadians: Incidence and patterns. International Journal of the Legal Profession, 13(3), 217–242. https://doi.org/10.1080/09695950701192194
Edwards, E. R., Barnes, S., Govindarajulu, U., Geraci, J., & Tsai, J. (2021). Mental health and substance use patterns associated with lifetime suicide attempt, incarceration, and homelessness: A latent class analysis of a nationally representative sample of US veterans. Psychological Services, 18(4), 619. https://doi.org/10.1037/ser0000488
Girard, V. W., Cannon, Y., Bhatnagar, P., & Coleman, S. (2021). How medical-legal partnerships help address the social determinants of mental health. Archives of Psychiatric Nursing, 35(1), 123–126. https://doi.org/10.1016/j.apnu.2020.10.014
Greenberg, G. A., & Rosenheck, R. A. (2009). Mental health and other risk factors for jail incarceration among male veterans. Psychiatric Quarterly, 80, 41–53. https://doi.org/10.1007/s11126-009-9092-8
Magee, L. A., Fortenberry, J. D., Rosenman, M. B., Rosenman, M. B., Aalsma, M. C., Gharbi, S., Wiehe, S. E., & Wiehe, S. E. (2021). Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees. Health & Justice, 9(1), 1–10. https://doi.org/10.1186/s40352-020-00126-2
Marple, K. (2015). Framing legal care as health care. The National Center for Medical Legal Partnership. Retrieved April 21, 2023, from https://medical-legalpartnership.org/response/i-help/
Martinez, O., Boles, J., Muñoz-Laboy, M., Levine, E. C., Ayamele, C., Eisenberg, R., Manusov, J., & Draine, J. (2017). Bridging health disparity gaps through the use of medical legal partnerships in patient care: A systematic review. The Journal of Law, Medicine & Ethics, 45(2), 260–273. https://doi.org/10.1177/1073110517720654
National Center for Medical-Legal Partnership. (2016). Start a partnership with the MLP Toolkit. Milken Institute School of Public Health, George Washington University. Retrieved April 21, 2023, from http://medical-legalpartnership.org/
O’Sullivan, M. M., Brandfield, J., Hoskote, S. S., Segal, S. N., Chug, L., Modrykamien, A., & Eden, E. (2012). Environmental improvements brought by the legal interventions in the homes of poorly controlled inner-city adult asthmatic patients: A proof-of-concept study. Journal of Asthma, 49(9), 911–917. https://doi.org/10.3109/02770903.2012.724131
Pleasence, P., & McDonald, H. (2013). Crime in context: Criminal victimisation, offending, multiple disadvantage and the experience of civil legal problems. Updating Justice, 33, 1–6.
Ryan, A. M., Kutob, R. M., Suther, E., Hansen, M., & Sandel, M. (2012). Pilot study of impact of medical-legal partnership services on patients’ perceived stress and wellbeing. Journal of Health Care for the Poor and Underserved, 23(4), 1536–1546. https://doi.org/10.1353/hpu.2012.0179
Sandefur, R. L. (2015). What we know and need to know about the legal needs of the public. South Carolina Law Review, 67, 443.
Sandel, M., Hansen, M., Kahn, R. S., Lawton, E., Paul, E., Paul, E., Parker, V. A., Morton, S., & Zuckerman, B. (2010). Medical-legal partnerships: Transforming primary care by addressing the legal needs of vulnerable populations. Health Affairs, 29(9), 1697–1705. https://doi.org/10.1377/hlthaff.2010.0038
Sege, R., Preer, G., Morton, S. J., Cabral, H., Morakinyo, O., Lee, V., Abreu, C., De Vos, E., & Kaplan-Sanoff, M. (2015). Medical-legal strategies to improve infant health care: A randomized trial. Pediatrics, 136(1), 97–106. https://doi.org/10.1542/peds.2014-2955
Selnau, K., & Goldberg, R. C. (2019). Medical-legal partnerships in the VA. Intersections between Mental Health and Law among Veterans, 59–87. https://doi.org/10.1007/978-3-030-31664-8_4
Teufel, J., Renner, L. M., Gallo, M., & Hartley, C. C. (2021). Income and poverty status among women experiencing intimate partner violence: A positive social return on investment from civil legal aid services. Law & Society Review, 55(3), 405–428. https://doi.org/10.1111/lasr.12572
Tobin-Tyler, E., & Teitelbaum, J. B. (2019). Medical-legal partnership: A powerful tool for public health and health justice. Public Health Reports, 134(2), 201–205. https://doi.org/10.1177/0033354918824328
Tsai, J., Blue-Howells, J., & Nakashima, J. (2019). Needs of homeless veterans: 5 years of the CHALENG Survey 2012–16. Journal of Public Health, 41(1), e16–e24. https://doi.org/10.1093/pubmed/fdy076
Tsai, J., Jenkins, D., & Lawton, E. (2017a). Civil legal services and medical-legal partnerships needed by the homeless population: A national survey. American Journal of Public Health, 107(3), 398–401. https://doi.org/10.2105/AJPH.2016.303596
Tsai, J., Middleton, M., Retkin, R., Johnson, C., Kenneally, K., Sherman, S. E., & Rosenheck, R. A. (2017b). Partnerships between health care and legal providers in the Veterans Health Administration. Psychiatric Services, 68(4), 321–323. https://doi.org/10.1176/appi.ps.201600486
Tsai, J., Middleton, M., Villegas, J., Johnson, C., Retkin, R., Seidman, A., Sherman, S. E., & Rosenheck, R. A. (2017c). Medical-legal partnerships at veterans affairs medical centers improved housing and psychosocial outcomes for vets. Health Affairs, 36(12), 2195–2203. https://doi.org/10.1377/hlthaff.2017.0759
U.S. Department of Veteran Affairs. (2022). Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) Fact Sheet. Retrieved July 25, 2023, from https://www.va.gov/homeless/chaleng.asp
Weintraub, D., Rodgers, M. A., Botcheva, L., Loeb, A., Knight, R., Ortega, K., Heymach, B., Sandel, M., & Huffman, L. (2010). Pilot study of medical-legal partnership to address social and legal needs of patients. Journal of Health Care for the Poor and Underserved, 21(2A), 157–168. https://doi.org/10.1353/hpu.0.0311
Funding
Writing of this manuscript was supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Health Services Research, the Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System (for I. Griesemer). In-kind support was provided by the Department of Veterans Affairs, National Center on Homelessness among Veterans and the Connecticut Veterans Legal Center.
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The authors (Griesemer, Carter, Weir, Tsai) declare they have no conflicts of interest. Weir and Carter work for the Connecticut Veterans Legal Center which is the study site.
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Griesemer, I., Carter, S., Weir, A.M. et al. Clients’ Self-reported Legal Issues in a Medical-Legal Partnership: Accuracy, Prevalence, and the Role of Mental Health. Psychol. Inj. and Law 16, 408–415 (2023). https://doi.org/10.1007/s12207-023-09484-2
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DOI: https://doi.org/10.1007/s12207-023-09484-2