The Architecture of Medical-Legal Partnerships

11.05.2015

By MARK HANIN (J.D. ’17)

Every Friday I help provide legal aid to veterans struggling with mental illness, homelessness,and poverty. The Connecticut Veterans Legal Center (CVLC) in West Haven, where I volunteer, shares a large partitioned space with a VA outpatient clinic. The medical-legal partnership between CVLC and VA embodies an integrated model of care: veterans will heal faster and remain healthier if their legal issues are quickly resolved and lawyers and clinicians can coordinate effectively.This therapeutic role for law does not resonate in the popular imagination.

Photo courtesy of Mark Hanin

There, law commands, prohibits, shames, and punishes; it rarely rehabilitates. The coercive image of law has its architectural embodiment in a courtroom, where a judge examines evidence and imposes sanctions for violating legal rules. A blindfolded lady justice looks on with sword and scale, weighing the equities and punishing wrongdoers, often through imprisonment. This trial-oriented, punitive iconography is reinforced in leading treatises on law and architecture that focus on courtroom and courthouse design.

But law is about much more than orders, sanctions, and courts. Delivering legal aid through the medical-legal partnership highlights two other ideas about law. First, law not only constrains but also empowers. We help veterans exercise valuable rights to claim VA healthcare benefits, receive disability insurance, and apply to upgrade an army discharge status. Second, law can be flexible and humane if approached in the right way. Today, the vast majority of civil cases do not result in trials. The life of the law is in paper filings, negotiations, and settlements. When we help veterans navigate coercive aspects of law—threatened evictions, child support duties, outstanding tax bills—our goal is to compromise and stay out of court.

If timely resolution of legal problems improves veterans’ health, can architecture represent this therapeutic vision of law? The CVLC-VA center offers useful clues. The center is housed in a stately converted textile mill built at the turn of the twentieth century on a prominent street corner. At the time, Connecticut was a leader in manufacturing elastic web for suspenders, corsets, and other consumer goods. The American Mills Web Shop complex fuses a single-story 1.5 acre weaving room finished in 1903 with a two-and-a-half story administrative wing completed in 1914. The mill’s architect is unknown. But its layout is innovative. Emphasizing functionality and simplicity, the design uses extra-large windows and skylights to reduce artificial lighting, make room for bigger looms, and minimize structural subdivisions. The exterior, completed in red-brick Italianate style, is elegant and reserved. A corbelled cornice spans much of the building, accentuating the arched windows. The external façade lacks almost any other ornamentation, creating a spare, disciplined look fit for a business in a competitive but prominent industry.

Located on the mill’s second floor—where fabric was treated in the initial step of the manufacturing process—the center pulses with energy. Opening up from a foyer illuminated by an oversized skylight, a vaulting great room serves as the center’s architectural and spiritual core. On weekday mornings veterans gather there to mingle, pass the time, and share stories about service, illness, and the road ahead. The room is dominated by long maple-colored tables with maroon leather-backed chairs. Along the perimeter there is homey bric-a-brac: a dusty electric piano, partly wilted plants, metal bookcase, a whiteboard with the day’s lunch menu.

This versatile great room is not lavish, but it is inviting. Sunlight streams from handsome windows topped with arched lintels and set off by exposed whitewashed bricks. Slender wooden posts with iron caps rise from floor to ceiling along the tables, breaking up the room and shrewdly carving out intimate spaces for conversation. A maroon ventilation pipe crisscrosses the space above, adding visual zest and gravitational force to balance the verticality of the room.

Today at the center law weaves its way into veterans’ lives through a zigzagging referral system: from the VA system to CVLC and back. Last Friday, I met with a homeless veteran who had to vacate his apartment due to fire and later lost his wife. After discussing his legal challenges we referred him to a VA social worker down the hall, just past the VA homeless services desk where he was initially seen.

The center’s spatial arrangements echo this fluid path of referrals. The hallways are narrow and packed. When rounding a corner, you unexpectedly bump into familiar veterans and diverse colleagues—lawyers, nurses, social workers, doctors, staff. There are no formal gatekeepers to the law, unlike at courthouses or law firms. A veteran with a medical appointment next door might simply drop by to see a lawyer.

Lawyers share workspaces, constantly adapting. I meet with clients in a small nurse’s office flanked by medical equipment. If all the private rooms are occupied, lawyers discreetly see clients at the communal tables in the great room. Our ‘offices,’ without trappings or status, show law at its best—responsive and common sensical.An ethos of mutual reliance and urgency links lawyers and veterans at the center. Its architecture opens up a window to new dreams and possibilities. In particular, the legal staff hopes to extend the benefits of the medical-legal partnership concept to virtual architecture: electronic medical records should include a summary of a veteran’s legal situation so that clinicians are aware of legal problems and can offer appropriate medical support and referrals. Here, law is no longer siloed; it is placed at the service of veterans’ well-being, becoming a part of medical care functionally and visually.

The center offers a number of lessons for medical-legal partnership architecture. It succeeds in cultivating a sense of community through mixed-use spaces that foster informal exchanges and group activities. Drawing on this model, architects should include multi-function spaces that help veterans form personal bonds and nudge clinicians and lawyers to interact. At the same time, architects should steer clear of unlivable perfection. Designs that are too sleek and refined—far from ordinary life—will backfire by causing veterans to feel ill at ease.

Unlivable perfection also risks marginalizing memory and the passage of time. On this score, the center has room to improve. Dated photographs line the hallways and an underwhelming display case in the foyer showcases mismatched memorabilia, including plastic soldiers, dusty medals, and model cars. Based on my observations, few people pause to look at the photographs or display case. New projects should find creative ways of linking memories of service to present difficulties and hope for the future without nostalgia or grandiosity. These challenges are considerable. But they are worth taking up given the pressing needs of many American veterans.