First Step newsletter: Spring 2021
If you only have one minute, skip my intro to this newsletter and go straight to the ResetLife testimonial below. You’ll never read anything more compelling from us.
As the spread of COVID-19 worsens in Victoria and lockdown continues, we are all tired and over it. Through good management and good fortune, First Step avoided the swathe of tier 1 sites and closures all around us in St Kilda.
The mental health sector is stretched supporting people who were struggling before the pandemic and whose health has worsened, as well as people who were doing okay previously, but are now struggling. Of course we continue to support all those individuals, and double down on our efforts to look after ourselves and our families.
We hang in there and plan for the future.
We have had high level input into the Mental Health Act, the reform of which is being treated as a prerequisite to implementing the recommendations of the Royal Commission into Victoria’s Mental Health System. And from my role on the Alcohol and Other Drug Expert Advisory Group, I continue to emphasise the kind of client journey that we want to facilitate in the new system. One of compassion, welcome, understanding, receiving all the support that is required, engaging family, and care for as long as it’s needed.
We continue to see clients from the clinic, caring for their medical and mental health, addiction management, nursing, and COVID-19 vaccinations. Much of our legal and group therapy work is delivered online, by phone or in a hybrid format. Thanks heavens we have those resources.
We know we will be living with this pandemic for some time to come, but we look forward to higher vaccination rates and the end of lockdown. And when that comes, we will make the most of that well-earned freedom to fight for the best possible outcomes for the people we both care for and are continually inspired by. And as you will read below, there is always reason to hope.
Chief Executive Officer
ResetLife goes online
I joined the ResetLife programme straight out of yet another detox.
To be completely honest, I didn't have much hope for the programme. I just thought it would give me a few weeks extra of being clean and being able to fix up the mess I had once again caused through my addictions.
That was generally the pattern and had been so for many years. I had lost everything, but most significantly I had lost hope and any belief that my life could ever be anything but a torment. I hated the world, the struggle, people and myself, and simply didn't care anymore. My existence was just that, I wasn't living - I simply didn't know how to.
I was sick of being told that this would help; or that "I should do this", or "you should just stop". I was different and, having struggled with this way of thinking all my life, thought I knew best about my life - whatever that was. I was convinced that no one could understand my problems as they simply hadn't experienced or suffered through what I had. I honestly was not looking forward to another "re-education" from know-it-all group facilitators and self-obsessed peers with their own tales of sorrow and relentless war-stories.
Thankfully, I was completely wrong. The programme has taught me so much from both a spiritual and scientific perspective. The facilitators understood where I was coming from and helped me to regain control of the negative thinking and behaviours that had dominated my life. I learnt so much, it is impossible to put into words. Certainly impossible in a short testimonial.
The programme has reshaped absolutely every aspect of my life. It has given me structure, belief, new perspective and a humble confidence that I have never enjoyed. I am a new person. It has allowed me to take the time to find out who I am and what underlies my personality and thinking. Further to that it has given me the knowledge and the tools to fundamentally affect what I do with my life. My new thoughts and behaviours are not scary. My thinking isn't confusing. The future is not ominous and bleak. Thanks to all the facilitators, peers and the programme, I understand myself; what I need; what I want; and, most importantly, how to achieve it. I am no longer full of fear and anger. I have belief and confidence in myself. The programme has given me that.
I have hope. I am sober. I am happy. I have a life. And it is just starting.
|I always related to the symbolism of the metamorphosis from caterpillar to butterfly and the potential for radical and extreme change within oneself – ResetLife Client|
The Road Home Project
“The Board of The Ian Potter Foundation was very impressed with the vision of this project and the strong partnership with the homeless services.” – Alberto Furlan, The Ian Potter Foundation
We are excited to announce our new partnership with Launch Housing to deliver health and legal services from within their crisis accommodation sites, in a proof of concept project called The Road Home.
There are six critical support elements that together form the best-practice model for delivery of mental health and addiction care at one site: addiction treatment, mental health treatment, legal support, social inclusion support, meaningful engagement and housing.
First Step provides all but housing because we acknowledge that the provision of housing services differs significantly from the other elements, and that many of our local community partners are already doing exceptional work.
Kicking off in mid-October at Launch Housing East St Kilda, the Road Home Project will bring a First Step GP, mental health nurse and lawyer directly into crisis housing for a weekly clinic.
Over the two years of this project, we anticipate:
- Approximately 100 highly vulnerable people each year experiencing a circuit breaker in the rotating door of crisis accommodation, moving away from crisis and illness and into stability.
- Healthier clients with improved physical and mental health and control over drug/substance use.
- Happier clients with increased motivation to participate in socio-economic life, better able to manage their own medical, legal and housing needs, having trusting relationships with medical and legal staff, developing life, parenting and employment skills and growing support networks.
- A long-term reduction in the number of hospital admissions, interactions with the criminal justice system, and further reliance on the housing sector, which will in turn reduce waiting lists for emergency accommodation.
- A wide appreciation for the new model and a desire to replicate or emulate this model more broadly.
This project has been made possible by the philanthropic support of The Ian Potter Foundation, The Jack Brockhoff Foundation, The Marian & E.H. Flack Trust, The Helen Macpherson Smith Trust, and the Spencer Gibson Foundation.
Long-Acting Injectable Buprenorphine - unexpected results that changed my mind
I first became aware of the Long-Acting Injectable Buprenorphine (LAIB) six years ago at The Australasian Professional Society on Alcohol and Other Drugs conference.
I clearly remember thinking, as Professor Nick Lintzeris spoke, what an incredible game changer this could be for the clients at First Step on the pharmacotherapy program, particularly those on stable suboxone (buprenorphine). I was then super disappointed to hear that it had not even begun a trial phase.
Fast forward a few years, and I heard murmurings that the LAIB had passed trials and was being rolled out into the community treatment space. Despite its availability, I, and several of my clients, felt hesitant about something that had only been proven ‘on paper’.
For many clients who had been on pharmacotherapy programs for a long time it presented an enormous decision. On one hand, attending a pharmacy daily or weekly posed a significant risk – they might bump into someone they know, what if they missed a dose, what if they were judged by the pharmacist? On the other hand, moving to a 28 day cycle was intimidating in itself – attending the pharmacy is an important link to their community, and sometimes, the pharmacist might be the most regular human contact some clients have.
We began small by providing it to people initiated elsewhere, or clients who specifically requested it. It was at this point that I met Stacey (not her real name), the patient whose story significantly shifted my opinion of this treatment option.
Stacey is a 59 year-old woman who started using opiates in her mid-teens and had been on the methadone program for more than 20 years. Throughout this time, she had continued to use heroin and it had continued to cause issues in her life. In June 2020, Stacey admitted herself into a residential withdrawal unit to transfer from methadone to the LAIB program, and we picked up the management of this after she left.
When I first met her, she was demanding, unreasonable and difficult to engage with because of her brittle manner. Our time together over the first three months largely consisted of her telling me what was wrong, and what she wanted me to do to fix it.
Then something shifted. Slowly, and quite subtly, at first.
One of the things we speak about at First Step is the idea of ‘incremental whole –of-life improvements’, and this description perfectly described my interactions with Stacey. On paper, she had only had a slight shift – she had remained on pharmacotherapy, albeit a different type and delivery system. But the effect of this in her life was profound.
The first significant change we noticed was attitude. Stacey was more patient, understanding and could recognise situations around her that were affecting more than herself. She was more polite dealing with people, and the staff recognised this.
From there things just seemed to ‘incrementally improve’. Stacey started to dress differently, as she described, “more appropriate for my age”. And she began planning, weeks and months ahead for things, something she had previously been unable to do.
Over the next couple of months, Stacey would excitedly attend appointments, telling me with an enthusiasm I didn’t believe she had, that she was studying for her Learners, with the view of getting her license for the first time.
It is important to note, LAIB is not a ‘miracle cure’. Stacey committed a tremendous amount of hard work to achieve everything that she did. A clever psychiatrist once told me, ‘pills don’t teach skills, but they give the brain a chance to learn them’, and this was never clearer than with Stacey.
It was a humbling experience watching an adult woman’s life change slowly before my eyes, watching her discover new things she had not thought herself capable of previously.
Clinical Care Coordinator
Health Justice Partnerships
The last quarter has been a time of significant growth and expansion at First Step Legal, despite the constraints of lockdown.
After months of service design and planning, we have proudly commenced two new health justice partnerships: one with the Star Health family violence program, and the other with Alfred Health’s St Kilda Road Clinic.
The Star Health family violence program delivers men’s behavioural change groups supported by family safety contact workers and family violence counselling for affected family members and specialist support services for affected children. We were impressed with the client-centred model adopted by Star Health and its integrated, holistic approach to working with perpetrators and victim survivors to achieve long term behaviour change. In May 2021, our family lawyer, Tom Mainwaring, started working one day per week from the Star Health service in South Melbourne, with regular visits to other locations as client needs demanded.
The St Kilda Road Clinic provides outpatient, community mental health services via five differentiated case management teams. It also operates the Homeless Outreach Psychiatric Service, the Mobile Support Team and the Brief Service Response. While some specialist legal services target mental health inpatients, the legal needs of community mental health outpatients are chronically underserviced. In July 2021, our criminal law and generalist lawyer, Elizabeth Frampton, began operating from the St Kilda Road Clinic for two half days per week.
As always, our approach has been to embed legal help in collaborative case management practices that address the underlying drivers of our clients’ contact with the justice system. Already, we have assisted over forty clients whose legal needs may otherwise have gone unmet, assisting them to navigate the legal process and privileging their voices and perspectives along the way.
Integral to the stability of each new partnership is a set of formal protocols and an overarching operating agreement. Each is governed by a Steering Committee, with representation from consumers and senior management of the partner organisations.
These new partnerships are a welcome addition to our longstanding collaboration the Windana Therapeutic Community at Maryknoll, enabling us to reach a greater number of clients in a wider range of settings.