De/Medicalisation is not the problem: On the idea of a “law clinic” for people experiencing housing instability and homelessness

Abstract

De/Medicalisation has become a staple of medical sociology to make sense of social issues at the intersection of health and illness. Broadly understood as the processes through which issues assume qualities that locate them within or beyond the remit of medicine, de/medicalisation continues to inform theoretical innovation and empirical research. The emergence of law clinics for people experiencing housing instability and homelessness offers a case study of how de/medicalisation can enrich the analysis of problems at the interstices of health and social care. Law clinics, often co-located or attached to primary and tertiary health care settings, aim to augment housing, health, wellness and social care offerings. Yet, this proximity – conceptual and spatial – may inadvertently reify understandings of homelessness as an individual pathology while aiming to offer pragmatic support to people who are otherwise excluded from core institutions in society. We present findings from a Roundtable with participants from law, social and health care professions and interviews with people experiencing housing instability (n = 27), lawyers, GPs and social workers (n = 10) in an Australian urban centre. In the vexed dynamics of the law clinic in-between different professions, de/medicalisation emerges as boundary-making and boundary-crossing to negotiate responsibilities, classify problems and reconcile competing logics.

Keywords

ethnography theory social inequalities in health profession and professionalisation organisation of health services

Introduction

The relationship between homelessness and health is complex, yet, that housing is a social determinant of health is uncontested (Plage and Parsell, 2022). Concurrently, the approximation of homelessness to deviance persists; being unhoused continues to be interpreted as resulting from the transgression of social norms (Greene and Painter-Davis, 2023). Socio-cultural explanations and policy responses assign behavioural and psychosocial characteristics to people who experience homelessness, in turn, moralising and medicalising homelessness (see Gowan, 2010).

Medicalisation, that is the designation of social problems as issues that fall within the scope of medical knowledge and hence are amenable to medical intervention (Conrad, 2013) has considerable traction in practice, policy and popular culture and has piqued the curiosity of social scientists for decades (see Cockerham, 2021; Conrad, 1992; Halfmann, 2012; Illich, 1975). Medicalisation and its counter currents often reflect historical shifts in understandings and social acceptance of the behaviours and conditions so captured. The persistence of scholarly interest in medicalisation and its relation to social control indicates the versatility and adaptability of the idea. As Radley et al. (1997: 12) stated in the inaugural editorial of Health, “’health’ and ‘illness’ are used to draw distinctions between social groups and to support moral positions.” Medicalising a social condition is far from neutral; it involves an exercise in delineating what is considered good and right.

This ethnographic study took place in an Australian urban centre in partnership with a social and health care hub for people experiencing social disadvantage, including homelessness. Services include a primary health and wellness clinic, nursing and social work outreach and a law clinic embedded into specialist homelessness services intake. Throughout fieldwork, we reflected on the opportunities and potential pitfalls of an integrated care model, where the experience of homelessness is addressed through care and practice frameworks leaning into medicalised logics. We draw on a Roundtable and ethnographic interviews undertaken between 2024 and 2025 with health and social care practitioners, lawyers and the people they support to explore how health and social care intersect with legal support in the context of housing instability, including homelessness. We use a case study of the law clinic to engage with the utility of medicalisation as a conceptual tool to make sense of contemporary problems straddling various knowledge systems, professional boundaries, logics and practices.

De/Medicalising homelessness

Medicalisation is the process of how problems become understood as medical ones, including behavioural as a well as biological phenomena (Conrad, 1992). Deviance understood as behaviours that disregard social norms, looms large in the historical remit of medicalisation revealing the salience of socio-cultural context (Conrad, 2007). What is considered a problematic behaviour is contingent on shared understandings of the good life. In this way, medicalisation is neither neutral nor fixed. What kind of problem (i.e. medical or other) any issue is understood to be, will constantly shift, including, whether it is deemed a problem at all.

Homelessness and its purported medicalisation have received sustained critical attention (Gowan, 2010; Löfstrand, 2012; Lyon-Callo, 2000; Mathieu, 1993; Wasserman and Clair, 2014). Counter-arguments levelled at the medicalisation hypothesis are primarily articulated as concern about the potential for abandonment by the medical profession (Braslow and Messac, 2018; Rosenheck, 2021). Other scholars have pointed to the conceptual contradictions built into medicalisation as a process unfolding in modern societies: Isn’t every part of contemporary life in some way or other subject to medicalisation (Plage and Parsell, 2022; Rose, 2007; see also Rabinow, 1996), from sewer plants, to vaccinations, processed foods and housing that shields us from the elements?

Whether a phenomenon falls within the scope of medicalisation is not merely semantics, as interventions sanctioned by biomedicine can produce harms to individuals (e.g. conversion therapy) or whole populations defined by approximation to deviance (e.g. reification of stigma). This point is exemplified in housing responses debating what needs to be addressed first to achieve better long-term outcomes for people experiencing homelessness: the individual circumstances that are purported to cause ill-health or the systemic barriers to accessing stable and safe housing. While the arguments and evidence supporting Housing First approaches clearly back the prioritisation of housing (Padgett et al., 2016), it is in this debate that framings in terms of de/medicalisation come to matter (Löfstrand, 2012; Lyon-Callo, 2000; Mathieu, 1993; Wasserman and Clair, 2014).

Where medicalised, homelessness is no longer approached as a problem of social inequality but becomes subject to treatment of individual pathologies linked to “housing readiness” historically layered with moral shortcomings as explanatory repertoires (Gowan, 2010). Homelessness as a social pathology is articulated in biomedical terminology, bringing distinct subjectivities into being, for example the chronically homeless (Rekenthaler and Barnard, 2025; Willse, 2010). Governance of these subjects relies on the development and validation of biopsychosocial metrics to produce statistics on incidence and severity in the population and score individual subjects to determine their eligibility for care (Willse, 2010). Critiques of the medicalisation of homelessness argue that such interventions – paradoxically – contribute to the perpetuation of homelessness by focusing on fixing individuals and creating a service industry invested in its own reproduction, rather than addressing systemic failures (Löfstrand, 2012; Lyon-Callo, 2000).

Yet homelessness does severely impair opportunities to partake in salutogenic practices such as sleeping, eating, socialising, homemaking, safety, cleanliness and future-planning that most housed people in contemporary Western societies take for granted (Plage, 2026; Plage and Parsell, 2022). The capacity to navigate participation in society in line with the expectations to maintain social order, prevent, attend to and resolve legal problems and leverage appropriate representation to access welfare entitlements is a more recent addition to the above list. Meeting legal needs assumes a double role as both outcome and precursor to the social determinants of health and is in turn, severely constrained in the context of housing instability.

The emergence of the law clinic

The range of issues people experiencing housing instability, including homelessness face include legal troubles that might expose them to criminal justice or other systems tasked with sanctioning norm violations. Concurrently, legal troubles also emanate from structural constraints on the capacity to advocate for rights and entitlements in welfare systems and matters of housing. This two-facedness of legal challenges is not neatly separable but often coincide in the life of a person, complicating their relationship with the law and their opportunities for good health.

Housing instability comprises a series of involuntary movements across social and geographic spaces that bring people into contact with different government and non-government agencies, including through hospitalisation, institutionalisation and incarceration (Hopper et al., 1997; Plage, 2026). People may violate city regulations by sleeping in their cars or camping out in public parks (Herring et al., 2020), engage in petty crime as a survival strategy (Flatau et al., 2020), or use drugs in public spaces inviting police scrutiny; behaviours that have been recognised as contributing to the criminalisation of homelessness (Greene and Painter-Davis, 2023). People experiencing homelessness are also more likely to be victims of crime and violence (Stambe et al., 2025) and have child protection agencies involved in their families (Kuskoff et al., 2022). People may also face eviction or disputes with their landlords that put them at risk of losing a tenancy (Fleming et al., 2019). Other legal issues reflect broader trends in the general population, including consumer debts (Gabbay et al., 2017), domestic and family violence (DFV; Kuskoff et al., 2025) or difficulties accessing income support (Greasley and Small, 2005; Sherratt et al., 2000). The complexity and concatenation of issues make it extremely challenging for people experiencing housing instability and homelessness, to navigate justice, welfare and health systems (Halushka, 2020).

Law clinics are an emergent site addressing the legal needs of people experiencing social marginalisation. Affiliated with non-government bodies like Community Legal Centres or Health Justice Partnerships (HJPs), law clinics, in Australia, offer pro bono or low-cost lawyers to assist people who are unable to afford legal advice and representation. HJPs are collaborations across law, health and social care aiming for more equitable health outcomes (Genn, 2019). In Australia, they are modelled on Medical-Legal Partnerships (MLPs) introduced in 2014 as part of the Affordable Care Act in the USA (Kellogg, 2014) and conceptually parallel social prescribing in the UK (Drinkwater et al., 2019). HJPs lean into the medicalisation of poverty aiming to improve access to the social determinants of health through legal support and greater health equity (Curran, 2017; Genn, 2019; Martinez et al., 2017; Tobin-Tyler et al., 2023). These partnerships seek to strategically embed lawyers and paralegals within health settings (Lewis et al., 2019; World Wellness Group (WWG) and Caxton Legal Centre (CLC), 2024). Peak bodies, such as Health Justice Australia carry out advocacy for the adoption of HJPs to pursue individual health outcomes at the same time as structural transformations of civil society to remove drivers of marginalisation.

There are different ways in which collaborations across law, health and social care (whether as HJPs, MLPs or other) manifest in law clinics, ranging from dedicated referral pathways (Close et al., 2021; Ollerenshaw and Camilleri, 2017), to lawyers integrated into social care outreach (Forell and Gray, 2009; Frost-Gaskin et al., 2003) and legal, welfare or citizen services co-located in General Practice (GP) or hospitals (Beck et al., 2022; Burrows et al., 2011; Moffatt et al., 2004; Woodhead et al., 2017). Some law clinics are tailored to particular cohorts who may be underserved in mainstream health and social care, including people who are culturally and racially marginalised (Fuller et al., 2020; Moffatt and Mackintosh, 2009; Plage et al., 2025), approach the end of life (Close et al., 2021; Rodabaugh et al., 2010), apply for housing (Hernández, 2016) or live in regional areas (Ollerenshaw and Camilleri, 2017). Regardless of the modality, law clinics call for integration of knowledge and care from different professions.

On the challenges of interprofessional collaboration

How boundaries are brought into existence and symbolically demarcated is highly salient in the context of how different professions emerge and relate to one another. Lamont and Molnár (2002: 168) reviewed the concept of boundaries across processes and practices such as “boundary-work, boundary crossing, boundaries shifting, and the territorialization, politicization, relocation, and institutionalization of boundaries” and defined symbolic boundaries as “conceptual distinctions made by social actors to categorize objects, people, practices, and even time and space.” We highlight here the notion of boundaries as socially produced within dynamic relationships of diverse social actors. Applying this lens, medicalisation then becomes a process of creating symbolic boundaries that assign homelessness conceptually within the remit of clinical knowledge and its practices. We emphasise here the push and pull between different social actors endowed with their own professional and care logics and who are within historically layered relations with one another as the driving force behind shifts in how such boundaries are created, sustained and challenged.

Sometimes using metaphors that imagine professions in contest for territory upon which they can bring their knowledge and logics to bear, the focus of much scholarship has been dedicated to theorising why some professions are more successful in staking a claim to assuming responsibility for an issue (Abbott, 1988). In health care, particularly the boundary-work between medicine and nursing (Allen, 1997), how order is negotiated between them in hospitals (Strauss et al., 1963) and medical dominance over other professional and lay expertise (Willis, 1989) have been well explored. More recently, such ecological approaches to professional relations, have also turned their attention to how new tasks requiring interprofessional collaboration are rejected, avoided or relegated to go-betweens (Powell and Davies, 2012), brokerage professions (Kellogg, 2014) or other intermediaries (Kirkland and Hyman, 2021).

As part of the emergent scholarship on the incursion of law into clinical settings, Kellogg (2014) examined the implementation of MLPs in health centres and found that lower-status professionals, often with no formal qualifications in either law or health step into the gap created by legal reform. She highlighted how successful MLPs relied on connecting and buffering practices from community health workers. What is especially pertinent for our study is the nature of professionally ill-defined problems in the context of new rules and practices calling for interprofessional boundary work straddling law, health and social care. MLPs present an antecedent and specific manifestation of the law clinic. While numbers of Community Legal Centres and HJPs in Australia are growing, they encounter specific and understudied jurisdictional boundary practices.

In addition, differing professional logics need to be considered (see Kirkland and Hyman, 2021). Adopting the term clinic as the site for law practice, portrays the language of social pathologies situated in the bodies of people experiencing legal problems and points towards an underlying medicalising logic. A nuanced understanding of the law clinic and its relation to other epistemes requires a dynamic definition of medicalisation that enables attention to space, time and bodies in conjunction. Thus, we approach medicalisation not as a political movement to displace medical care (Conrad, 1992) or transplant medical discourse onto law. Neither are we invested in the question if ill-health causes homelessness or if homelessness is caused by ill-health and how law intervenes in this causal relationship (Plage and Parsell, 2022). We resist the linear ordering of events that greatly reduces the complexity of experience and invites judgements. Instead, we ask of our case study, how in the messiness of health, legal and social care for people experiencing housing instability, issues are identified, delineated and allocated to a knowledge system to be addressed by a designated profession.

Methods and materials

We took a theory-informed approach (Jackson and Mazzei, 2022) to make sense of the law clinic as the confluence of de/medicalising knowledge processes traversing professional boundaries. We support our arguments with data produced with diverse participant groups and methods between September 2024 and October 2025.

First, participants were invited to a Roundtable if they were active in the health and social care landscape in the Australian urban centre where this study took place and if housing fell within the remit of their work. 15 participants attended the half-day Roundtable including three lawyers, five social workers, three health professionals and four support workers in correctional facilities. Participants were prompted to reflect on intersections in their work and the role of legal support for addressing poor health driven by housing instability. They were also asked to discuss a vignette to categorise issues as social, legal or medical (see Appendix 1). The roundtable was audio recorded with informed consent and a video summary was circulated among participants (Plage and Baker, 2024).

We then conducted 10 semi-structured interviews with five lawyers, four GPs, three nurses and one social worker supporting people experiencing housing instability, including homelessness. While most interviews were undertaken individually, on three occasions we interviewed two participants jointly to accommodate their busy schedules. Interview guides covered topics such as the role of legal issues in health inequalities and the potential of co-located legal and health services to address these issues. Interviews lasted between 32 and 61 minutes and were audio recorded with informed consent.

Finally, we conducted 25 interviews with 27 people (7 male and 20 female, aged between 28 and 71) who had experienced homelessness. Participants were recruited with the help of our partner organisations, including warm introductions to clients they had supported and posters in the primary health clinic. A significant number of participants were recruited via word of mouth, that is study participants circulated recruitment materials in their own networks. Participants received a $50 voucher for their contribution.

Interviews were audio recorded with informed consent and took place in a crisis accommodation facility, community day centre, public spaces (e.g. café or food court), over the phone or via zoom, depending on participants’ preferences. Most interviews took place individually, but on two occasions participants requested to be interviewed as a dyad. While participants had experienced homelessness as defined by the Australian Census, at the time of the study their housing status varied between tenancies in public or community housing (7) or the private rental market (1), staying in temporary or crisis accommodation (15), a boarding house (1), in a rehabilitation centre (2) or living in a tent (1). Throughout the process of recruitment and interviewing, we emphasised the voluntary nature of participation in the study, reassured participants that their participation or non-participation would not affect their relationship with our partner organisations and left it up to them to disclose potentially stigmatising experiences with the criminal justice system. Seven participants shared that they or a close family member had been incarcerated, and 13 disclosed having sought support from a legal service. All participants identified issues in their lives which were relevant for this study, even if they did not themselves designate them as “legal.”

Data from all sources were transcribed and analysed supported by NVivo. We began with the analysis of the Roundtable to map issues and organisations active in the local health and social care sector and refine research aims. In doing so, we tracked how issues were designated “medical,” “legal” or “social” within everyday practices. We then conducted interviews, read and reread the transcripts using annotation and memoing to familiarise ourselves with their content. Based on this stage of the analysis, the tension between countervailing medicalising and demedicalising processes became the analytical focus to which we returned when coding the transcripts, before organising them into key findings. We deepened insights by engaging conceptually and empirically with the extant social science scholarship on care across professions and organisations. Data excerpts in this article were assigned pseudonyms.

Throughout the analysis our roles as researchers affiliated with Australian Higher Education institutions (all authors) and health care practitioners (second and third author) shaped the analysis. We were deeply aware and reminded daily of our relative privilege with respect to our living and working conditions and the valuation of our knowledge. We debriefed after interviews, revisited details in conversations with participants for analytical leads we might otherwise overlook and reflected on potential other ways to make sense of our findings. We recognise that a differently composed team of researchers might have arrived at different answers to the questions we posed – or even at different questions.

Findings

The law clinic as a site that matters for transitions that matter

Transition periods emerged as an intense pressure point but also an opportunity window for improving housing and health where support services were made available. Tony and Ray shared their experiences after they served time in correctional facilities.

If you’re going out on parole, you can apply for housing to get a place in a hostel or boarding house or something, but when you do full time, you can’t. So, you can’t access anything like that while you’re in there. So, I ended up coming out, and I was living on the riverbank. (Tony, crisis accommodation)

Where do I go? . . . I’ve got no social connections. I’ve lost contact with my family, my kids. So I went into my job, and I survived for about a month in hotels where everything just got too much, and I had a breakdown, right? Then I went into hospital. It’s then when I experienced homelessness. [. . .] The thought of sleeping on the street or somewhere or whatever, that was not safe and secure, I’d rather decide that I’d be dead. (Ray, public housing)

Tony considered himself lucky: an outreach team made up of multiple professionals from different agencies engaged him when he was sleeping rough and placed him into crisis accommodation. While he was hospitalised for his acute mental health deterioration Ray was supported by an embedded lawyer, who helped facilitate Ray’s transition into social housing and access to financial assistance for victims of crime.

Ray and Tony’s situations point to a gap post-release that would enable successful transitions from punitive to caring interventions. Supporting such transitions was not recognised as legal need as the relationship with law and justice systems is considered closed upon serving a sentence. The problem frame deployed to negotiate these transitions remains medicalised and it is primary health care providers who are called upon to prevent, address and monitor deviance placing them in an ambiguous role between care and compliance.

When they discharge from or release from the prisons, the parole officer says, “Go and have a Mental Health Care Plan.” . . . It’s like ticking a box. . . I’ll do it for [the patient], just to keep him out of trouble. And doing a mental health care plan does not help his mental health at all. (George, GP)

Here medicalisation occurs concurrent to decriminalisation, shifting from punitive to ostensibly caring interventions, reflecting a subtle trend to relocate correctional services closer to care than punishment. This does serve to situate a social or legal issue in the remit of mental health and individual treatment, while, as these health professionals illustrate, such mental health care plans are rarely efficacious. They do not produce better health for the person. Treatment was primarily considered a moral exercise, something that would produce medical evidence that the person was trying to work on themselves, “to show the court making some progress” (Jacinta, GP).

As these participants highlight on the example of release from incarceration, health and social care professionals are entangled with criminal justice, housing and other welfare systems in moments of transition in which the law clinic emerges as an institutional space in-between. Lawyers described the law clinic as a physical location embedded in the spaces where homelessness support occurs. At the same time, the relationship between different professions and the kind of issues they seek to address were inseparable from temporal logics.

Everything’s quite interrelated in how we work, that people might kind of ebb and flow in their experience. (Julia, lawyer)

In this way, the law clinic appears as an extension of social and health care that needs to be carefully calibrated – or timed – to achieve beneficial outcomes for the people they support. Almost all participants articulated an understanding that housing instability and homelessness follow temporalities with which services needed to synchronise. The importance of the “ebb and flow of experience” resonated across accounts of participants from social work and health care as much as among participants with experience of housing exclusion. Below we elaborate how medicalisation in this way serves as a process that brings knowledges into relation with one another and how the law clinic configures its own space in these relations.

The law clinic in confluence with social work and medical knowledge

Medical professionals were acutely aware of limitations of their professional practice in isolation and its inherent contradictions. Asked whether they considered completing forms for housing, criminal justice and welfare proceedings to support their patients as part of core medical practice elicited mixed responses.

GPs are basically filling out some forms . . . that are used to triage the value or where they sit on the housing list. . . I sometimes feel a bit disillusioned myself that that we’re just splitting hairs trying to find housing for someone when there’s just not enough housing. (Adam, GP)

Adam did not reject the notion of lending medical authority to a patient’s demonstration of housing need but questioned the utility of the medicalised logic which housing allocation followed. Nonetheless, Adam and other doctors we interviewed responded pragmatically to these requests, rather than resisting them as misguided medicalisation of social problems. Indeed, they integrated an understanding of housing as a social determinant of health into their rationale for accepting this work within their practice.

Having a stable place to live is important part of the health . . . it should be our role. But then, you know, there need to be some support available to do that job. (George, GP)

The buck stops with me. I’m responsible, and I accept that responsibility. In private practice, I’ve limited my financial earnings by spending extra time doing that. (Jacinta, GP)

What was considered part of GP practice was dynamic, needed ongoing reflection and justification. The legal professionals we interviewed saw here an important space for the law clinic to step into and indirectly progress health through legal expertise:

We’ve had partnerships in the past with mental health services, and we’ve worked with them where we’ve got somebody who’s in unstable housing. But trying to address like a mental health plan, and how does that work when you don’t have the basic necessities of life covered? . . . That’s part of where we see our role, is to remove some of the barriers, to allow individuals to address some of their health concerns. (Ethan, lawyer)

Addressing the social determinants of health was positioned within interprofessional collaboration beginning in clinical settings. Lawyers considered a physical presence achieved ideally by co-location in health care settings as conducive to building capacity and trust with other professions, but also to provide a low-threshold entry point for legal support given the standing of the General Practice in the community.

Socially, we hold the medical professions to high esteem, because they are like the healers in our community. . . People go to them naturally for support. . . . Whenever we go to a new site, whenever we go to a new hospital . . . our training is just about. . . demystifying the legal process, demystifying referrals. . .. create the confidence in them to engage with a legal service (Alan, lawyer)

Tony confirmed when asked if health care settings are the right place to deal with socio-legal problems:

I think so, because . . . it can stress you to the point where . . . you start to spiral, and you can have an episode like, and so being able to take some of that stress away, that would be a major thing. (Tony, crisis accommodation)

Medicalised terminology like “episode” alongside the semantic proximity to health care implied in the “law clinic” indicate how participants and legal practice leaned into the clout bestowed by biomedicine. However, depicting experiences as a “spiral” also alludes to the spacetimemattering when professionally ill-defined problems exacerbate one another. Clair shared in detail the overwhelming sense of loss coming from strained family relationships and being denied access to her grandchildren after bereavement.

My son died last year. . . . And. Um, and I became homeless. . . . I stopped work when he died, and I haven’t worked since. . . . They found some cancer cells in my uterus and my cervix. . . . I was very grief stricken . . . I unfortunately had conflict in the family, and I was just struggling. So I booked myself into a rehabilitation center for alcohol. . .. I thought, if I go into a rehab center, I will have support around me. I’ll be able to talk to people about my grief. (Clair, transitional housing)

In Clair’s narration grief, a cancer diagnosis, the loss of her employment and tenancy in a private rental, alcohol use and recovery and the legal processes she pursued to get visitation rights for her grandchildren paint a picture of total struggle. Seeking help from a medical institution became her departure into accessing other types of support, including a lawyer. Stories like hers are quite common and not reducible to classifications that then trigger separate medical, social work or legal interventions. These are always more-than medical, social or legal. How they are defined depends on the context or the professional knowledge to be brought to bear on this experience. The confluence of challenges calls for a confluence of knowledge.

Embedding the law clinic within health and social care

We found that health, legal and social care professionals considered boundary practices (Lamont and Molnár, 2002) in the deliberation of where their scope ends and another one’s begins as crucial to achieving working partnerships. Lawyers affiliated with law clinics were strategic in their practices of carving out scope for legal support, often framed as educating their partners about appropriate referrals, their timing and ethical considerations around the privacy of the doctor-patient relationship and legal privilege.

I once had an email from a doctor saying, “Please help this lady.” And just like, attached all these documents. . . .. I couldn’t even figure out what the legal issue was. . . . So, then I had to call the doctor and say, “oh, you know, I’m grateful for the referral, but. . .” and I sent him [the referral form] and talked about the process. (Alan, lawyer)

Participants from other professions, in turn, expressed their reluctance to offer clients legal support they considered beyond their practice, recognising the potential for added value from having a law clinic to partner with.

Coming from domestic family violence, it’s a big stressor on a lot of the victim survivors’ minds about what their legal proceedings will look like, or what their future and the legal system looks like in terms of their safety, as well. So, it’s a big stressor in terms of their mental health, and my role is really to support them with that mental health. And I haven’t really approached, I guess, that legal aspect of it, because it’s been so out of my scope. (Bianca, nurse)

GPs, we don’t have a proper understanding of the legal system, right? . . . We can breach privacy easily by supporting patients. So, I mean, do harm as well . . . I’ve said sometimes privately to the patients, to go and get a lawyer, but . . . It’s not our job. . . . I really like to know where the boundaries are with medical practice. (George, GP)

Most of the lawyers we interviewed likewise respected the boundaries drawn around others’ professional knowledge.

You’re not expected to be a health professional. . . . My room is next to the psychologist. So, if I’m doing an appointment and someone’s having a panic attack . . . and I need to get a psychologist, we can do that. . . . What makes Health Justice Partnerships work really well is when all the practitioners have very strong boundaries and understanding about what their role [is]. (Camille, lawyer)

The exemption was a lawyer running a pro bono law clinic at a community centre. He reflected on how he attempted to engage in practices that were considered core medical remit.

I see my role as to try to give [clients experiencing homelessness] some counselling, . . . legal problems are a symptom of the main disease, which is usually drug addiction and the psychiatric illness . . .. You can’t just call up their doctor and say, or the prison and say, “Hey, can you get an MRI scan done?” You can’t do that. You got to go through these channels and trying to speak to psychiatrists was almost impossible. . . . I almost felt like it was adversarial. (Frank, lawyer)

It was striking how these strategies were largely framed in relational terms as collegial, when carefully negotiated, but as adversarial where a lawyer ventured into counselling and medical imaging. This speaks to accounts of ecological approaches to maintaining or negotiating boundaries that include medical professions. Frank espoused an approach to lawyering that once more indicates the entanglement of narrow medicalising discourse (“symptoms,” “disease”) with the violation of social norms, when he later described his clients’ situations as “a failing of morality” (Frank, lawyer). This contrasts with most participants who did not position any epistemological stance as superior.

Broader systemic stuff, there is a space that they are really interlinked. The fact that I talk about legal issues is because I’m a lawyer, but they’re the same issues that a healthcare professional talked about or a social worker. They just use different terms, but it’s still basically income and money, housing, health and relationships are the four key areas that are that basis of stability that we’re looking to address, and that often it’s the same thing for our social workers. (Ethan, lawyer)

The confluence of legal, medical and social care knowledge among professionals in this site, the law clinic, came up against challenges and required constant deliberation and good will from all involved, while also a tacit understanding of when to refer to other experts. Following Ethan’s reasoning, employing medical vocabulary or enlisting medical professionals in the resolution of social problems, is no more problematic than referring patients to lawyers to address social determinants of health. De/medicalisation here becomes a process linked to integrated care practice that is strategically and flexibly deployed in individual-level advocacy.

This raises the question, how the experiential knowledge of the people who were supported within integrated care models, fits into this picture. The interviews with participants who had experienced housing instability and homelessness indicated that system navigation – integrated or not – required a steep learning curve.

You can’t approach an organization like any, as yourself, like me, as an individual. I can only go through an advocate. . . . You certainly need to know where the door is. (Rose, transitional housing)

Many participants shared Rose’s sentiments and admitted that they did not know where to begin seeking support with housing, employment, justice proceedings or any other unmet legal need. While this superficially supports the notion that law clinics have a role to play and should be made low-threshold accessible within health care settings, the overwhelming sense of not knowing what to do, points to a systemic issue. In this way law clinics contribute to solving problems that would not exist if welfare and adjacent systems were responsive to immediate needs for housing and health and attuned to the lay knowledge of the people who come into contact with them.

Discussion and conclusion

We drew on empirical evidence alongside our reflections on medicalisation as a key concept of medical sociology to explore the idea of a law clinic for people experiencing housing instability and homelessness. Our findings demonstrate that a sophisticated engagement with these complexities needs us to attend to processes, practices and relations between professions and how these enfold space, time and knowledge.

While we used transition periods post incarceration as an example, we heard similar stories about people being put at risk of losing their homes due to legal disputes with landlords, neighbours or even family members that greatly affected their opportunities to pursue good health. Transition periods might be emerging from the life course, for example ageing that increases the need for care and poses a threat to autonomy, or from transitions across government systems that punish, care and evaluate a person, sometimes all at the same time. This is exacerbatedwheninterlinked housing, health and welfare agencies are ill-equipped to integrate their services to wholistically support a person in crisis. We recognise that the experiences of people experiencing housing instability and homelessness with modelsthat integrates law into health and social care presents a much larger topic of investigation than what we could address within the scope of this article.

We focus here on the nature of processes, institutions and organisations providing health, legal and social care and how they variably re-frame issues. Barnard (2025) explored how different frames are deployed in psychiatry hearings in France and the USA to constitute serviceable rather than governable subjects. Given that care is relational, we acknowledge that the way problems are medicalised (or not) also implies how the people experiencing them are constituted as subjects. These processes of subjectification are beyond the scope of our present manuscript but merit further exploration. Likewise, we recognise that go-betweens (Powell and Davies, 2012), brokerage professions (Kellogg, 2014) and other intermediaries (Kirkland and Hyman, 2021) play an important role in the processes of allocating problems for resolution and facilitating multiprofessional care and collaboration. In the present study, we found that social work frequently intervened in a mediating role across professional boundaries, which we will analyse in greater detail in forthcoming work.

Social, medical and legal professionals are constantly called upon to appraise the issues their participants, patients or clients present with and integrate diverse knowledge and practices for the benefit of the person they are supporting. Who takes ownership of a particular issue depends not only on the professional remit, but also on broader societal dynamics of professional standing. We found that doctors continue to carry authority when it comes to processes of certification, and producing evidence to back up claims to eligibility, regardless of whether their contributions to care were considered efficacious for producing immediate health benefits. Despite the privileging of medical knowledge, we do not consider this indicative of medical dominance or the medicalisation of social conditions. The law clinic demonstrates how different knowledge practices become integrated into a larger collective effort of addressing social problems. Medicalising or demedicalising issues in this context is not a problem: it is a necessary part of care integration.

While previous scholarship has traced how reward and incentive structures associated with the adoption of interprofessional collaborations favour the emergence of go-between or brokerage professions that might capitalise on the opportunity to carve out space for themselves and elevate their status (Kellogg, 2014; Kirkland and Hyman, 2021; Powell and Davies, 2012), it is less clear how structural constraints, such as resource allocation, metrics of success and time-limited and narrow funding mandates further inflect different professions’ dispositions to work together. Given that the workings-together of legal, health and social care professions are still in the early adoption stage these are rendered particularly malleable to larger societal forces. It is important to complement the focus on symbolic distinctions in the objects and subjects to which professions attend with a focus on material resources. We found that the health care professionals in our study cited time and money pressure as a key factor for their capacity to engage in activities beyond the traditional remit of biomedicine, while legal professionals identified this as an opportunity to add value. Socio-material conditions have serious implications for what kind of care is possible.

We conclude by reiterating that complexity is insufficiently addressed in compartmentalising an issue within a professional scope through medicalisation as a totalising logic. What is needed are health and social care structures that enable greater tolerance to sit with ambivalence and apply shifting problem frames flexibly and jointly to provide holistic care for people experiencing housing instability, including homelessness. Narrowing conceptual focus on whether an issue falls within the remit of medical or non-clinical professional knowledge may miss what matters in the ebb and flow of experience. We have traced how the confluence of interlinked processes can generate meaningful insights into how issues like housing, health and law defy any categorisation as either-or. To say something is a medical, a social or a legal issue is a sorting tool that tasks then professionals from different epistemological standpoints with their resolution. The law clinic is a focal point for de/medicalising issues as a pragmatic response that follows the demands for integrated care.

It was not our aim to demonstrate the fallacies of shifting social issues into the remit of the medical clinic, nor do we claim that medical issues moved into legal and social work practice constitutes a form of abandonment on the part of medicine. Medicalisation in the law clinic is part of the processes that tie different forms of knowledge and the practices together. Only in the confluence of professional expertise can systematic failures to provide safe housing, opportunities to look after oneself and others and access to legal entitlements be remedied.

Footnotes

Appendix 1 Acknowledgements

We gratefully recognise the generous contributions of time and insight of all study participants. We also thank Micah Projects and Inclusive Health Partnerships, Caxton Legal Centre, LawRight and Health Justice Australia for their in kind support of this research.

ORCID iDs

Stefanie Plage

Kirsten Baker

Nancy Sturman

Ethical considerations

This study was reviewed and approved by the University of Queensland’s Human Research Ethics Committee (2024/HE001184).

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was partially supported by the Australian Research Council through the Centre of Excellence for Children and Families over the Life Course [CE200100025].

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Author biographies

Stefanie Plage is a Research Fellow with the ARC Centre of Excellence for Children and Families over the Life Course. In her work, she explores the intersections of health and social care in the lives of people experiencing extreme social disadvantage.

Kirsten Baker is a wellbeing coordinator at Micah Projects/ Inclusive Health Partnerships and Senior Research Assistant at the University of Queensland. Her research interests include the role of integrative care to improve health equity for marginalized people explored through interdisciplinary collaboration.

Nancy Sturman is a General Practitioner and Clinical Lead of Homeless Health Care at the University of Queensland. Her research interests include medical education and GP patient relationships.

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