How Legal Help Can Improve Your Health

Trina Filan
Thank you for joining us for this episode of talking health in the 406 where we are one community under the Big Sky I'm Trina Finland a public health evaluator for diabetes and cardiovascular health projects. And I'm Margaret Mullins the social determinants of health program manager our guest today is Robert bell the supervising attorney for medical legal partnerships at the Montana legal services association will probably refer to that as MLS a throughout the podcast so you know there's an. Robert will be talking with us today about the work MLS a does to protect Montanans legal determinants of health particularly related to housing well.
Robert Belle
Thank you for having me good morning.
Trina Filan
I got the idea to invite MSA to the podcast because I'm on a list serve for libraries and one of your colleagues sends regular legal tips for libraries to share with their patrons these legal tips made us realize that we hadn't really covered legal services. As important for supporting and protecting people 's health Robert before we get into legal determinants of health. Can you tell? Our audience about Montana legal services association what it does how long it's been around and who it serves.
Robert Belle
Montana legal services association is a nonprofit legal aid law firm in Montana. And we serve individuals with low income throughout the state in a variety of different areas and MLSA has been around for I think 60 years. It's a long time. And we have lots of different programs and attorneys that that. Serve clients throughout the state my project with the medical legal partnership encompasses several different partnership I have cases that come through me with a partnership with Providence Saint Patrick hospital in western Montana. And how that works basically is that Providence and medical providers or sometimes the social workers will refer patients of theirs to Montana legal services who have civil legal needs. And maybe that's a good point to kind of clarify what we do that and Melissa does not do any criminal law we do civil law and we generally don't take any cases that are fee generating for example a car accident case where you might sue the other driver or the insurance company you don't do those sort of things but we do have a variety of other. Civil legal issues some of the big ones for us are housing or landlord tenant kinds of cases family law cases divorces and and parenting. And we have a a lot of consumer cases as well issues related to debt or debt collection or foreclosure or things like that but we also can do a lot of other things related to public benefits and you know that might be issues with Medicaid and Medicare Social Security. Snap things like that but also just kind of anything else that might be kind of civil legal aid might fall under our. And. That. And our medical legal partnerships are general practice groups in which we might address any of these potential issues but housing winds up being a a big one for us might be 30 to 40% of our cases. We have a a series of medical legal partnerships one with Providence Saint Patrick hospital and outpatient clinics and also Saint Joseph hospital and Olson. And we also have a Montana health justice partnership which is a partnership between MSA. A number of federally qualified health centers throughout the state the Montana primary care association as well as the consortium of urban Indian health centers and the model with all of these MLP 's is that healthcare provider will meet with patients and screen. For certain social or sometimes legal issues and refer them to us for services.
Margaret Mullins
Great that's a really good overview of things.
Trina Filan
Yeah you guys do a ton of stuff Robert I have one clarification when you said you serve lower income folks do you have like a a criteria or a definition for what that lower income level is.
Robert Belle
Yes so that's generally tied to the federal poverty. Mine and different programs within MSA might have different criteria and some programs actually don't have any cap at all but for for the most part you know we're we're looking at people who are about 125% of the federal poverty line or below or. Up to 200% of the federal poverty line with some deductions for living expenses that's generally the the ballpark that we're looking at but again there are certain programs where there might be exceptions to that.
Margaret Mullins
All of that gets me thinking of a lot of questions to ask you but I'm going to start first I I guess I'd first like to provide a little bit of context. Here in the chronic disease prevention and health promotion Bureau we work with healthcare providers and community based organizations to address both the medical and non medical needs of montanans. And when we think about non medical needs we often think about access to food transportation and housing first we've had some discussions and other podcasts about food and nutrition local housing needs and the connection between housing and. Health today we're going to talk about the importance of low barrier legal services to maintaining fair and safe housing for both tenants and landlords so Robert I don't think many of our listeners have heard that term legal determinants of health before. The resources that we consider related to social determinants of health need the support of legal services to ensure everyone has equitable access to them can you just talk a little about this concept of legal determinants of health and how Montana legal services association addresses them.
Robert Belle
Sure I think that there's more and more research that is showing that the majority of what determines a person 's health. Isn't necessarily what happens at the doctor's office it isn't necessarily what medication they take. Or their genetics or even necessarily their behavior but it has to do with complex social and environmental factors that that make up someone 's life you know one way of even framing it is the maslow's hierarchy of of needs where you know housing. This is foundational. Right and it's your environment it's where you live it's who you associate with it's also your education it's the food that that you you eat or have access to it as you noted it's all of these other things that are outside of the doctor's office. And you know as a legal aid firm there are things that we do that kind of intersect with a lot of these these needs. Sometimes it's framed as social determinants of health or legal determinants of health I might use those terms interchangeably. Hey you know as a lawyer you know I'm inclined to see problems as legal problems you know if you have a hammer everything looks like a nail but another way of framing all this is is is social determinants or or social drivers of health if we're talking specifically about housing. I think that say. Decent and affordable housing is. The the cornerstone for a healthy happy and productive life. Because shelter or housing is one of the most basic human needs that a person has you know our our home is our our physical foundation and it's something that if we're we're stably housed I think we can take for granted all of the things that it provides us you know with shelter from the elements now that it's you know winter. And snow is falling outside it might seem more obvious right that we have a dry and warm place to live our home is a place to eat and prepare meals it's a place to sleep it's a place where we have privacy where we share time with our families where we have. Intimacy where we entertain ourselves basically everything we can and want to do in private life happens in our home. And so if there are any issues with that right that can have a profound impact on your health if there's mold in the house that has an obvious effect on your health or you know a forced move or an eviction can can take all of that away from a person and you know if we just think about it as a legal issue. And something we have to solve that's one thing but there are cascading problems if there's an issue with someone 's house and ultimately what might happen is you know somebody shows up at the doctor's office. You know and they have a cough or they have you know they have stress where they have a crisis that's manifested because of some thing or some series of things that have happened out in the world. And so the doctor might try to treat the medical issue and they're perhaps they're successful or not but there are other issues outside that can be dealt with in other ways or have other causes.
Trina Filan
So. It's very complex as you've noted and I don't think that people tend to think about. The repercussions of maybe unsafe or inadequate housing or as you say a forced move. Sometimes it's viewed as just this thing that happened or you have to just deal with this but. There are lots of lead on effects as you've said that can come from these kinds of problems with housing so a couple of questions what are some of the health issues. That you've seen come up uh especially related to housing that you all know are exacerbated because of housing issues and then also when you help people with those issues do you ever bring in. And. Partners or you know work with physicians or whomever to or other groups to help alleviate those add-on effects.
Robert Belle
Yes so I should also say of course I'm a a lawyer but I I'm I'm not a medical provider so I I might know enough about medicine to sound like cool to anyone who's bona fide in that profession but we we do see lots of. Of health issues and some of the big ones nulled or or it might be respiration issues if the air is difficult to breathe if there's issues with heat if it's too cold in the winter it's too hot in the summer right that can have a profound impact on on somebody 's health and a number of other issues. And the big. One is stress. Being evicted is enormously stressful. Living someplace where you're in a dispute with your neighbors or with your landlord is enormously stressful everybody knows you know how profound the impact of stress is on your health and I think also you know a lot of the people that we. Serve you know show up already with chronic health issues. I think it's it's more common. Or. People low income people to have more chronic health issues. And I'm sure you guys know more about that than I do right but you know issues related to to trauma and and mental stress but also people with disabilities. People with chronic. Health issues people come into this situation with health issues and they can be exacerbated by unsafe conditions or they can be exacerbated by disputes force moves things like that. As far as working with physicians the model that we have with MLP is that there are corresponding authorizations to communicate back and forth about a case and so you know. Lawyers have confidentiality rules so to physicians right so it's not to say that a client a patient is referred from the hospital to us and I get access to their whole medical record and I get to monkey around with any of that it's not like that but there gets to be communication back and forth the patient or the client will author. Price that sort of communication in in one way that that's at least very helpful is to try to bolster communication it's another way to try to connect with someone something that's very common in the work that we do is we can struggle to. To make contact with people or maintain contact with people. Somebody might be referred or somebody might apply for our services we try to get in touch with. Maybe there's an issue with their phone maybe they're. Busy it happens often but at some point. They're gonna have to go to the doctor. Right and or they they have another appointment right and so there's another point of of contact that allows us to try to stay in touch with people and coordinate services and things like that.
Margaret Mullins
I think that that's a really interesting point that you bring up because we deal with that here in our Bureau a lot we work with providers and they will have patients come in for a medical need but often these days providers are screening their patients for certain social drivers of health and. They will refer them if there is an. Feed and following up on that process. Is a really? Really important step so bidirectional referrals is what we call them so that a patient gets referred but then the physician also follows up to make sure the patient went and it sounds like you're doing very similar things and the more people you have sort of working on behalf of that patient. Or that person that you're assisting obviously the better and I am a little curious if you have found over maybe the last few years. I can imagine when you were doing this initially and talk talking to providers. There may have been I don't know that I would say less receptive but maybe providers weren't as accustomed to serving their patients outside of the healthcare setting but I'm curious if you have seen that become a much more natural process and what you do.
Robert Belle
I think. Around the country you know medical legal partnerships have been have been around for a long time but they are becoming more and more common I think what we've heard. Uh is an idea among the medical community of Oh no lawyers oh we're getting sued. Or some there's some issue right there's a medical malpractice thing and and and or there's some you know kind of hackles get up where there's a perhaps defensiveness. And I think that's you lessened to some degree because for one thing you know we don't do medical malpractice right we're we're not. Here to to try. The. You know sue doctors for not meeting the standard of care with patients but we're trying to do is you know serve patients in other ways and what we've seen over time with providers that that are able to utilize our service with patients is that it takes some of. Some of the things that they're dealing with off their plate and the way that it's blamed sometimes is trying to allow everybody to work at the top of their license. So a patient might show up at their clinic with a social issue and they might have to try to address it even though that's not really what their their job is right they're they're trying to treat the medical issue right but if you can refer pieces of that out to people who are trained to do it. It is within their their bailiwick to deal with those other issues it allows everybody to try to do what they're really trained to do. And I think that the providers who've been able to utilize these services they see the value in that and they're relieved to be able to have. That service that they can kind of get off their plates and provide a better service. As I said I'm not a a doctor I can't diagnose or treat anybody 's anything right I can't tell someone that they have diabetes or what they need to do about it but I can help someone with diabetes you know access their snap benefits or or other things like that. Allowing people to do what they're really trying. To do I think is one of the the great benefits and. I think people who use it are are becoming more receptive to that.
Margaret Mullins
That's a great explanation I think that you have a lot of people the more people you have in the mix that can service those patients and that you know interlocking web of factors you've explained it really well that's necessary sometimes to service what a patient actually needs and I guess one of my next questions for you is talking about that. Web of factors about health and housing. I'd like to. Discuss or have you discussed some of the problems that can arise regarding housing specifically especially rentals some of the things that.
Trina Filan
Come up and we have a whole list of different possible. Sure maybe we can just go down this list. Uh. And see what pops up yes let's do that so for example you touched on first moves and people can have housing instability for a whole bunch of reasons and eviction.
Robert Belle
Sounds good.
Trina Filan
Is one of those reasons right so would you be willing? To talk about. Eviction and eviction prevention from your perspective.
Robert Belle
There are a number of reasons why an eviction might happen I think when we describe it in terms of eviction it's it's a process that the landlord has started. Versus the tenant you know voluntarily trying to to move and and why am I sometimes not call it eviction but a a forced move. One of the common issues is that rent is late or not paid another basis for eviction might be a violation of the lease we live in a community in a state and in Missoula in particular where where I am but also throughout Montana where the cost of housing is very. I and.
Speaker
And.
Robert Belle
The supply of affordable housing is is. Lower than what the population. Needs. At least in Missoula you know the the median rental price is more than what the the typical family in this community can't afford financial experts say that you should be spending about a 3rd of your income on housing and the median rental income is higher than what that is. Or Missoula in particular and I think other communities throughout the state are are similar. Which means that? Combined with you know the notion that most Americans are living paycheck to paycheck already it's very easy for people to get behind on their rent. You know not paying rent is a is a perfectly legitimate reason to you know force the tenant out of the rental.
Margaret Mullins
No.
Robert Belle
And so that's a very common reason that that happens and you know unfortunately you know there's not really a defense to that. The statute is fairly clear that if renters rent is owed the the landlord can force the tenant out and get possession of their rental back to. And really the only defense there is to try to work something out you know and sometimes. Landlords are are willing to do that I think actually oftentimes they are. To work out a payment plan go IOX amount will pay back that you know a little bit over over time or or something like that they're. Used to be. For a few years emergency rental assistance funds that were administered through the states this is kind of a result of of some of the COVID things there's money available to pay back rent to pay other sorts of things all that money is is is dried up. There are small charities that I think here and there are little pockets of money that they have sort of emergency rental assistance that can help people pay back rent or also get into new rentals and pay security deposits and first month rent and and things like that. But really you know the only defense to being late on rent is going to work out a payment plan or maybe some money shows up somewhere. Another way that somebody can be forced out of their rental is if there's a violation of the lease. And there could be a number of reasons for that a lot of people have a rental agreement I don't know that anybody 's read all the terms of it but there's lots of stuff in there. Lots of things that you're agreeing to do or not to do and I don't think people always realize what's what's in their rental agreements but it could be you know having an unauthorized guest it could be there are other sorts of rules that a landlord might impose that might be broken and there are also rules. Kind of laid out in statute about what a landlord 's obligations are and what a tenants obligations are and. One thing that happens sometimes is perhaps a landlord has reason to believe that a tenant is damaging the unit perhaps they're not maintaining the premises in the way that a tenant 's supposed to or you know causing damage or something like that. And I think what can also happen is that. Perhaps a tenant will complain about the need for repairs. Ohh the stove is not working with the furnace is. Out. Or maybe there's mold and that is the landlord 's duty to fix and some landlords when they realize how expensive it is to fix the tenants problem they try to find a way to force them out and there are provisions in the law. To prevent a retaliatory eviction like that but to raise that sort of defense usually requires some knowledge of what the laws are and some ability to advocate for oneself or get a lawyer to can do that for you.
Margaret Mullins
You just mentioned repairs and you got me thinking a little bit obviously eviction just a huge topic in the rental community but also one of your colleagues Amy hall she gave a presentation to our asthma home visitors on mold and lead and drafts and so when you talk about repairs. I wondered if you could just talk a little bit more about those kinds of problems and the resources. That are available to help.
Robert Belle
So. And I'm familiar with that presentation Amy hall has been doing this work for a very long time and you know she knows more about housing law in Montana than just about any is as far as I can tell the basic structure. The the laws that the the landlord has duty to maintain property and make sure that it complies with applicable housing and building codes. And to keep the property in a fit and habitable condition make sure that common areas are clean and safe. Make sure that all electrical plumbing heating ventilating air conditioning other appliances are in good working order supply reasonable running water and also provide heat between October and may garbage containers maintain the common areas things like that but tenants also have corresponding. Please you know tenants have a duty to maintain the premises to not damage the premises to not engage in criminal activity on the premises and so there there are corresponding rights and duties of each.
Trina Filan
Robert. 2. Talk a little bit more about if if you have this information available where can both tenants and landlords find out more about their rights and obligations because it's a relationship right you're entering into. A relationship that is mutual should be based on trust and you know this mutuality of responsibility but sometimes folks don't fully appreciate all of. That stuff don't appreciate how to address those issues if those the relationship is not being met on either side that that relationship is really important to maintain right so are there resources for each party and also do you have any recommendations for. Maintaining a good relationship. Communication that kind of stuff.
Robert Belle
Yes and and these are are are good questions and we're great source for resources is our website montanalawhelp.org there are a lot of short FAQ 's also form letters to be used in certain circumstances also linked on our website and I can share this with. You as well. Vermont purge has put out a landlord tenant guide. Which is pretty comprehensive kind of going over just a a nice overview of all the applicable law? And I should acknowledge. My role is is a tenants council right so my perspective might be different than than perhaps somebody else 's right I I am also a rencher myself and in my work in my professional life what I see are the circumstances where something. Has gone wrong for a tenant and there is a crisis there is an issue to address? What I don't see? In my professional life are all the. Circumstances where. There were no issues where everything went well where the relationship between landlord and tenant was was good and and I've had some landlords personally that we had a great working relationship had some issues with tenant landlords personally where things kind of got off. The rails but as far as you know trying to maintain that that good working relationship. I think having some knowledge of each person 's corresponding life and duties is important maintaining open communication can be important and can mitigate. Some issues I think oftentimes. When an issue is elevated to crisis level is because? Communication has. Failed. And nobody 's talking anymore nobody 's willing to work through issues especially if you know there's an issue regarding a need for repairs you know there's a process to kind of address those. What the law contemplates is that you provide proper notice in writing about? Any sort of? Issue and I think what happens a lot of times is that a landlords and tenants communicate more informal. Like uh the the faucets running just call me or just text me. Or the next time landlords coming around the property you just talk to them you just have a conversation and for a lot of circumstances that works really well. Where you have a responsive landlord you have attendant who's communicating in a in a mature? Way and sort of informal communication like that in person you know over the phone that works really well also what's becoming more common now with bigger property management companies is a lot of them are using online portals. Or or things like that for people to make requests for repairs on the online portal they also will pay the. Rent through there. You can see notices on there. I think that there are some issues with with those that can sometimes it it's more convenient or it's easier to be able to just fill out an online form or just maybe you have an automatic deposit that goes into the. On my portal for your rent or something and it's it's easier the issue with those is sometimes they can be less personal. And with some of these property management companies it's impossible to get. A real person on the phone to. Talk to them about issues. And sometimes these these softwares don't really work very well where they're a little wrinkles like any software anywhere that there can be issues with that that can make things more more difficult again circling back to the the law which was written you know 50 years ago. You know it it. It wasn't contemplating online portals and it wasn't contemplating texting or even emailing me none of those things existed when the law was struck. Did you know it contemplated writing on paper to provide notice of a lot of things which I'll say that if you are very interested in in creating a paper trail that you provide notice of something in writing you know if if a if a landlord wants to access the the unit on a given day? You know it's it's a letter in in writing. A text might suffice but you really want to you know have a good paper trail it's it's a letter same thing with the request for repair you can call the landlord and say you know the the faucets running but what's what's better in terms of proving. It later is a letter in writing. And. Again what that sets up a situation where maybe there's a fight later that has to go to court and you have to prove what happened there's a lot clearer. Evidence if there's a paper trail then. Phone calls.
Trina Filan
Thank you that's really good information and your discussion of online portals made me think about patient portals that are popping up everywhere for healthcare systems right these portals have pros and cons and sometimes the con. For a patient portal is that older folks or folks with disabilities may not. Uh have as easy a time getting on to that you know that mode of communication and me need a a different way of doing business which isn't maybe how the healthcare system or the management company. Is is willing to operate so so this is a windy pathway to me asking how? Often do you come across issues. Yes uh landlords or with housing in general that bumps up against the needs of people with disabilities or older folks people with some particular needs how do you support those.
Robert Belle
Well on the online portal discussion if if I had a dollar for every time a client said I don't know nothing about computers I would have several dollars. It it's it's a very common. Thing not just older clients or patients but perhaps people with limited education have issue navigating the online world that we all are living in or are forced to live in. And there's often not a great. Way of of dealing with it somebody who's more tech savvy or or more accustomed. To the online tools of the day will say oh it's easy you just get online and you do the thing and you click on the button and then it's done and but that's pretty overwhelming for a lot of people and what they'd rather do is just go into the office and and talk to somebody so. There's there's a rub there. As far as serving clients with disabilities there are ways. Perhaps housing accommodations like landlords are required if they're if they have a certain number of units to comply with the fair Housing Act which means accommodating certain disabilities or making certain changes to. The rental or the rental. Agreement to allow someone with disabilities. To have access to. The rental. Again on the topic of of online portals we've had colleagues who have requested on behalf of clients that perhaps they don't have to use that system to coordinate with their landlord that notices be provided a different way maybe notices be provided in writing or or something like that. People with learning issues might have or memory issues might have issue talking over the phone as well right so you can talk to him on the phone and they might say ah yeah sure but then. 2 days later they forgotten so they they need the writing and writing in perhaps in a particular way to be able to understand what's happening and remember it later. We've also had circumstances where somebody 's on a fixed income. Because their sole source of income is perhaps Social Security disability and those payments come up at certain day of the month same day every month which might not align with the day that wrench is due. So we have some circumstances requested an accommodation to allow. 8 disabled tenant to pay rent at a time that better corresponds with when they get their disability benefit. There might also be circumstances where you know it's it's more of a question about the. The rental you know itself right you know if someone is wheelchair bound there are certain things that. Are going to be necessary for them to be able to move around their house or if somebody is is blind right there are different things that might be requested to better accommodate that persons needs? Those are a few examples. I guess the big one that also comes up the emotional support animals. Those are actually one of the most common ones or or service animals we get a lot of requests about those essentially the process for that is that if someone has some diagnosed. Medical issue. They can ask. Or. A reasonable accommodation. From their landlord to allow them to have certain animal or a certain purpose dogs and cats are probably the most common. The rules on that are that. It's no hard line rule about what that might be allowed into or for any other accommodation there's no hard line rule. Brand list of. We have this issue you can get this accommodation it it all comes down basically to some level of reasonableness. That you know if someone has a mental disorder and they're medical provider believes that they would benefit from having a pet a service animal or an emotional support animal they can get a letter from a medical provider documenting the need for that that animal and how that will allow them to. Basically the fair use of a rental property. And again there's no right line rule about you know this animal as good of that animal is bad it's not that yes the horse is too much but a chinchilla is fine comes down to reasonableness and it like I said most of the time it comes down to. Usually people are asking for dogs or cats.
Margaret Mullins
You've talked about some of the legal logistics around you know changes to rental agreements and security deposit issues and how having a paper trail is really beneficial. What advice do you have for listeners to make sure that some of those potential challenges get handled correctly beyond the paper trail and some of the steps that they take in the process of trying to get answers what happens next what do I do if my paper trail is leading me still to unanswered? Questions and conflict where do I.
Robert Belle
Go someone can reach out to an attorney whether that's Montana legal services association or another about kind of next steps. Umm. With regard to request for repairs there is a process that if you requested a repair and in your request the law sets out certain timelines for that request to be to be honored if it's if it's not the tenant has a couple of options they can. In some circumstances make the repair themselves and deduct the cost of the repair from their rent as long as it's under a certain amount they can choose to terminate their rental. In either case you know there there. Might be uh. An opportunity for a lawsuit for damages if the other party doesn't comply with what they want but again the other thing answer your questions yes they can be referred to Montana legal services association or or advice on on on next steps or or another attorney to potentially. Talk about what they could do and that might be that might be court action.
Trina Filan
OK uh which I'm sure everybody would like to avoid so let's think about all of those other processes before something like that has to happen.
Robert Belle
When we've talked? About stress the stress of these issues. Going to court. Is enormously stressful and it also doesn't might not get the outcome that somebody wants? The judicial system is sort of limited in the kinds of remedies that it offers and they tend to be all or nothing kinds of outcomes you win or you lose you're owed money or you're not you know landlord gets positioned or they don't it's it's it's kind of a lot of wonders wonders zero kinds of outcomes and. It's very stressful to go through port and it could also be costly it's costly for well what we do we're a nonprofit so our clients don't have to pay us anything in terms of. The services we provide if a landlord has to hire an attorney they're going to. Want to be paid. And so there's there's cost involved there's time involved there's there's stress involved but also like I say you take the issue out of your own hands speaking and put it in a judges hands to make the resolution. And. If? You don't take that. Yep and you can sometimes have a better craft a better outcome for yourself between the if you're able to work it out with the parties the course of one or both parties are being unreasonable there's no prospect of resolution that's that's really what court is is for. Going back to trying to maintain relationships trying to work things out you know informally to try to resolve things rather than escalating to. This point where. It's in the judges hands to well one. Way or the. Other and that's what it's going to be.
Trina Filan
Robert one other thing that is probably a big can of worms uh to open up but we think it would be worthwhile to talk about is subsidized housing.
Speaker
Really.
Trina Filan
Do you have any input to help people with their applications? Do you have any guidance that you offer people cause the process of getting even onto a list to get into subsidized housing housing is quite a lot right there's there's a big process So what what kinds of input do you give people? For for that kind of housing.
Robert Belle
Sure what I'll say is that there are many different kinds of subsidized housing there are many different kinds of of vouchers for for different people and different kinds of rentals and so I might not comment on the specifics of any one of them. But that is a service that that we can provide and we have people on staff here who are experts in different kinds of subsidized housing and each program presents unique rules that might go above and beyond what the landlord tenant act says. So we we do have people that can advise on particular issues there are for example. Sometimes extra protections from somebody who's in a in a given kind of subsidized housing notices that are specific notices that are required for certain actions it can all get. Fairly complicated also. The people that qualify for subsidized housing I think the stakes are higher for them. Because. You know they. These programs are generally attached to some income level or resource level. And. For them to lose that subsidized housing can be the states can be much higher for them. Because of who they are with. Right if you're a disabled person who's on a fixed income and he has a housing voucher where your your rent is connected to the amount of income that you have which is fixed because of your disability. To lose that voucher and to be. You know forced into a more of a market rent situation can be catastrophic because that person can't. Afford market rent. You know just an example you know I might have a client. We received $1200.00 a month in Social Security disability they might be in a subsidized housing rental where they pay a 3rd of their income on housing which they. But forward but if they lose that voucher and they're trying to find market but you know $1200.00 is. Most places are more expensive it's going to be very hard to find that that sort of place. So we do try to prioritize serving clients that have that are in subsidized housing because the stakes for them to lose that are very high.
Margaret Mullins
You have given us such a great overview of the different issues and topics that come up for both renters and landlords I think you've really laid out a good picture and you know there are many challenges that arrive and it's also clear to me that the Montana legal services association really provides. A lot of assistance to people who may need it which is great and I'm wondering are people able to access your services from anywhere in Montana.
Robert Belle
Yes and. I don't want it to be sound more complicated than it is but there are a couple of. Different ways that people can. Access our services we have a website where people can apply online we have a phone number that people can call and apply online anywhere in the state anybody can apply. With our medical legal partnerships though we have a bit of a different model where we to reserve services from our group we take referrals directly from the healthcare providers that we have partnerships with so. You know for one of my friends they might interact with a social worker at Saint pass hospital and those that are referral form and that comes directly to me it doesn't go through our general MSA intake and the same thing for other partnerships with our fairly qualified health centers and the urban and need health centers that they. The people who. Receive services there can get a referral directly to our practice group but we also have our our general intake. It's available statewide to every.
Speaker
Hey.
Margaret Mullins
Great that's really helpful I guess what I'm wondering next if there's anything that you might like to share with us some final thoughts that you might have about some of the things that we've talked about in regards to legal services and housing and chronic illness anything else you might. Want to share.
Trina Filan
Or anything that we didn't cover that. You wanted to talk.
Margaret Mullins
That also.
Robert Belle
Well in preparation for this discussion I was reviewing some some research. Polls. At different people who are doing research on medical legal partnerships and with housing the survey data is is showing that. Being able to secure housing and sometimes with the legal intervention is making differences in peoples health something that you know I believe in my heart to be true but there's actual survey data that is. Backing it up there's been a couple of study focusing on. Veterans and legal services provided through the veterans administration there was a 2 year study in New York and Connecticut through the VA healthcare and it found more vets received you know MLP services. Related to housing it led to. An increase in the days that they stayed housed and this is specifically focusing on actually veterans who are homeless or at risk of homelessness but MLP services increased the days that they were housed and decreased the days they were unhoused but also over the course of a year these vets. So it decrease in symptoms and anxiety depression hostility anoia psychosis which is the and substance. Is so you know it's kind of connecting yeah the legal service or intervention to the increase in housing which is you know leading to a measurable improvement in mental health symptoms or or behaviors you know that's one example but there's more things like? That that I that I could share with you guys. But what I'd like to see more sort of research on that and if we could do some sort of study in in Montana I'd love to see that sort of thing to kind of show some measurable health outcomes but what we're seeing around the country. Is it's it works?
Trina Filan
The things that we've been talking about. Really emphasize to me. How integrated everything is? To positive outcomes right we tend in our programs diabetes cardiovascular health to really think about blood pressure and blood sugar and stuff like that right but those measures are intimately linked.
Speaker
No.
Trina Filan
2 stress and mental health which impact the behaviors that we engage in or our ability to sleep and those things are impacted by our environment like whether we're able to be housed stably. Whether our housing. Uh is adequate and safe so that we don't have you know asthma or COPD exacerbations whether our housing has accessibility so that our if we have mobility issues we're able to move around right safely and feel secure and all of those things. Are related to all of the factors all of the individuals all the organizations that support? Those quality infrastructure that socioeconomic socioeconomic environment or emotional environment right so so when we think about chronic illness arthritis or diabetes or asthma or cancer or cardiovascular health etcetera. All of those. Disease dates or illnesses are intimately tied to everything else and this discussion has really emphasized that that that things that we may not think about can impact our ability to have health like our access to legal services. So as we appreciated that yeah.
Robert Belle
No that's exactly right and I think it is a very complex web of connected issues and you know we've we focused on housing perhaps for our discussion but you know our our practices is general in terms of the services that we provide and something that I guess I want to emphasize is that that that supporting housing. In supports many other factors of somebody 's life and vice versa. So you know supporting other. Social determinants of health can support stable housing. And all of this then is connected to health in in a way that I believe can be causal. Or at least it's. Correlative but if we take the person with diabetes as an example right somebody you know might show up at the clinic in their. You know their blood pressure is is is high or as low or their their blood sugars are spiking or or peaking or dropping for different reasons and you might try to deal with it medically but maybe it turns out this person is going through a divorce which is enormously stressful and so they are. You know not eating very well right or maybe this person. It has lost their snap benefits so they've lost you know their income that they would be spending on on food or maybe like you said there's a transportation issue so they can't they move out out in the woods so they can't you know drive to the grocery store or something like that or maybe they're. Hmm. Being evicted which again could be enormously stressful which has an effect of itself but maybe they have to move someplace and kind of start over on their life right and they have to find a different way to get to the doctor or they have to find a new grocery store they have to find a new pharmacy and. Or there's a disruption in their income. Right for any of these things in so it all kind of comes together and the idea being that we tried not to think of people and issues and silos right but every person is a whole person.
Trina Filan
Hmm.
Robert Belle
Umm. That is alive 24 7 that has things happening to them all the time and there are these things are all. All related.
Speaker
Yes.
Margaret Mullins
Yeah absolutely you used the phrase earlier you talked about cascading problems which is sort of what you're referencing here that one thing can really lead to another and and it is a web I. Hey likewise I'm thankful that Montana legal services association is here because there needs to be a place where people can turn and just as easily as things can cascade into a bad place I believe they can they can climb upwards also by fixing one problem you can you have the strength and ability to kind of get to the next. So it goes both ways and I also appreciate you sharing some data here in the in the public health world sometimes data is not very interesting to some people but I think we all need to know what those numbers are and to be able to show people you know validate some of those things that it's useful and it's really necessary. Often to back up what we sort of know. Intuitively. So I appreciate appreciate that too. Thank you so much on behalf of Trina and myself and the crew behind the scenes thanks also to our guest Robert bell whose work protects montanans legal determinants of health. If you would like more information on what was discussed today visit our website at talking health in the406.mt.gov where there will be links to the information discussed and if you haven't already Please remember to rate review and subscribe to our podcast and until next time be healthy and be well?