The legal needs of people with chronic illness or disability, Justice issues paper 11 ( 2009 ) Cite this report
A relatively unique feature of the survey reported by Coumarelos et al. (2006) is that it recorded the type of chronic illness or disability. These survey data have been used in the present paper to compare participants with different types of chronic illness or disability in terms of their experience, handling and outcome of legal events. However, the survey was not specifically designed with this purpose in mind. The participants with a chronic illness or disability cannot be considered fully representative of the corresponding population and there were also small numbers in some of the disability type sub-groups in the present study. Furthermore, it is possible that the differences reported between these sub-groups could in part be due to the severity or longevity of the illnesses or disabilities rather than to the type of illness or disability. Consequently, the present results should be treated as suggestive rather than conclusive.
Coumarelos et al. (2006) reported that participants with a chronic illness or disability, when compared with other participants, had increased rates of reporting legal events overall and increased rates of reporting nine of the 10 most frequent types of events. The present analyses indicated some differences in reporting legal events of any type among the disability type sub-groups. When compared with the average reporting rates for all types of chronic illness or disability, sensory disabilities were associated with lower reporting rates, and chronic conditions were associated with higher reporting rates. The extent to which these findings reflect differences in the type of chronic illness or disability rather than in its severity or longevity is not clear. Nonetheless, these results suggest that there may be important differences in the experience of legal events by people with different types of disability, and highlight the importance of future investigation to further tease out this issue.
With the exception of health legal events, the present analyses did not find significant differences in the rates at which the disability type sub-groups experienced different types of legal events. Due to mental health-related issues such as problems with mental health care and involuntary psychiatric hospitalisation, participants with a mental health problem were more likely than the other disability type sub-groups to report health legal events overall. However, participants with a mental health problem did not retain a higher incidence of health legal events when mental health-related legal events were excluded. Nonetheless, the legal events related to mental health care that are experienced by participants with a mental health problem appear to set them apart as having some unique legal needs. Recent qualitative research by Karras et al. (2006) supported the notion that people with a mental illness are a financially and socially marginalised group who can face legal issues that reflect their symptoms and their marginalisation. This qualitative research also suggested that people with a mental illness can face barriers in accessing legal assistance that are related to their individual circumstances and symptoms, such as their difficult behaviours, feelings of being overwhelmed, communication problems, disorganisation, and mistrust of divulging personal information (Karras et al. 2006). In addition, recent analyses of the English and Welsh Civil and Social Justice Survey data revealed higher rates of non-health related legal problems for people with a mental illness than for people with other chronic illnesses or disabilities (Pleasence & Balmer 2007; forthcoming). Thus, the present findings and other recent findings are beginning to identify people with a mental illness as a particularly vulnerable group with special legal needs.
The present analyses not only supported the conclusion that people with a chronic illness or disability are more vulnerable to experiencing legal problems, but also that when they do experience legal problems, they tend to experience a greater number of legal problems. The present findings also indicated a similar propensity for experiencing multiple legal problems for all five disability type sub-groups. These findings add further weight to the conclusion from recent legal needs surveys that people with a chronic illness or disability constitute a vulnerable group who have increased likelihood of having multiple, complex and interconnected legal and non-legal needs (e.g. Coumarelos et al. 2006; Pleasence et al. 2004b).
The increased propensity for experiencing multiple legal problems is even more alarming when it is remembered that people with a chronic illness or disability appear to have reduced success in resolving their legal problems (e.g. Coumarelos et al. 2006; Currie 2007). Interestingly, as reported by Coumarelos et al. (2006) these reduced resolution rates cannot be attributed to lower rates of seeking help when confronted with a legal issue. Consequently, the reduced resolution rates achieved by people with a chronic illness or disability suggest a decreased capacity to deal effectively with these problems. Coumarelos et al. (2006) hypothesised that the legal resolution process for people with a chronic illness or disability might sometimes be strained by their special health needs, or by having to deal with multiple (legal and non-legal) issues simultaneously or serially. It is also possible that they have greater difficulty resolving their legal problems because they tend to experience relatively more serious legal problems.30 Whatever the reasons for the reduced resolution rates, these rates suggest that people with a chronic illness or disability may require additional or broader support, including both legal and non-legal support, in order to address their legal issues effectively (Coumarelos et al. 2006). The present analysis indicated that, like the entire group of participants with a chronic illness or disability, all five disability type sub-groups similarly had reduced resolution rates despite no reduction in rates of seeking help. Accordingly, the conclusion that people with a chronic illness or disability may require additional or broader support to resolve their legal issues appears to apply to all of the disability type sub-groups examined in the present paper.
Despite the finding that participants with a chronic illness or disability sought help at similar rates to other participants, the present analyses indicated some differences in the type of adviser first consulted by those with and those without a chronic illness or disability. Participants with a chronic illness or disability were less likely than others to use published sources as their first adviser, and more likely than others to use non-legal professionals and non-legal community groups as their first adviser.31 These findings are consistent with the conclusion that people with a chronic illness or disability can have multiple, complex needs to address, including non-legal needs such as health needs. In some cases, they may prioritise their non-legal needs over their legal needs. In other cases, their first port of call when a legal problem arises may be a non-legal adviser that they have already consulted for a non-legal problem.32
The high use of non-legal professionals as first advisers for people from all walks of life is a common finding across recent legal needs surveys (e.g. Coumarelos et al. 2006; Genn 1999; Pleasence et al. 2004b; 2006). This finding has provided impetus for the argument that non-legal professionals could be used to ‘signpost’ legal problems and act as ‘gateways’ into legal services (e.g. Balmer et al. 2006; Coumarelos et al. 2006; Pleasence et al. 2004b). The aim would be to equip non-legal professionals with the skills to be able to identify people who have legal problems and refer them to appropriate legal services. The present finding that the use of non-legal advisers for legal events is even higher among participants with a chronic illness or disability lends particular support to the potential usefulness of having health care professionals play a role in identifying people with legal problems.
In summary, the present findings further highlight the importance of ensuring that legal services meet the legal needs of people with a chronic illness or disability. People with all types of chronic illness or disability appear to have an increased propensity for experiencing multiple legal problems and a reduced ability for resolving these legal problems. Furthermore, given the health needs of this demographic group and their high use of non-legal advisers, the present findings add credence to the argument that the more effective coordination of legal services with non-legal services such as health services is likely to improve both health and justice outcomes for this group (Balmer et al. 2006; Pleasence et al. 2004b; 2008). Nonetheless, future research into the nature of the association of chronic illness or disability with legal needs has the potential to further inform the tailoring of legal services to meet the needs of people with different types of chronic illness or disability. For instance, such research could help identify the forms of coordination between legal and non-legal services that are likely to be particularly beneficial for people with different types of chronic illness or disability.