My biological mum left when I was 18 months old. Then I got who I call my 'real mum’ when I was nearly three. She was my first memory, and we were very close.

Unfortunately, she was an alcoholic. She was pretty good during the day, but at night she would drink. She would get up late, so she didn't have to wait too long to drink.

We would go on family holidays, and we'd go to the Pokies. That was a big thing for mum, she liked the Pokies. So, I grew up being babysat by the waitresses while they were playing. Or in the little activity room, playing by myself because there were no other kids around.

I would see my biological mum every now and then - dad would drop me off to spend time with her, and her parents. We would always go and do fun stuff together. But I remember cracking it at my grandparents’ place because I was so confused, and after that they stopped regular visits. I was only 4 years old.

School was hard for me. I was always abit slower. They tested me every year, and every year they found nothing wrong. I just liked to take my time, and that's not what mainstream schooling is about. I struggled to make friends, so I was isolated a lot. I would say to mum, 'I don't want to go to school', and she'd let me have the day off. Through high school, I was only going about three days a week. I just wanted to stay home with her. In year 11, I refused to go anymore, and got a job instead. Eventually, I did go back and try to finish, but didn't pass. Then as a mature age student I finally completed my VCE because by then, I understood that I couldn't get anywhere without it. I even got into Uni and was doing really well, but I think I was scared of succeeding, so I dropped out.
I was a big avoider. I avoided conflict. I avoided everything. I would read a book and hide behind that. I smoked my cigarettes and hide away from the world. I had started smoking when I was 16, mum introduced that to me. By 18, I turned to gambling. Every cent I had, I spent on gambling and cigarettes. And at 23, I started drinking. It's at about that time that I got engaged to a man who was obsessive, financially controlling and manipulative. We'd have the weirdest arguments and I never felt safe around him. I just didn't. It would always come down to money - he'd go on and on about money. And of course, I was gambling. In the end, I just left. I took my dog and went back home.
Mum was a nurse, so she talked me into becoming a Nurse’s Assistant, and then I trained to become a Personal Care Attendant. I did study to become a Registered Personal Care Attendant, but I didn't turn up to the last class or hand in the last assignment. That's something that I do. That's me getting scared that I could do it. I was second in charge in a nursing home hostel, but I wasn't coping. There was too much death and grief and stress. Eventually, I had a breakdown. I couldn't handle it anymore. I had been dating Matt for some time, and knew he used heroin, but I hadn't had much to do with drugs in my life. But I was at my wits end, and I started to use. First it was every three days, then I would come down and want it again. And within a month, it became four times a day. This went on for years. When Matt was sent to prison on drug driving charges, I had to dry up. Mum took me to the hospital, but they completely mistreated me, and sent me home with some Valium. I was ok during the days, but I didn't like the nights. It was nasty, but I did it naturally at that point. Once Matt was released, I moved back in with him, and I went back on it. He was very controlling, he hated me gambling and thought my Centrelink money should go to him. He would keep kicking me out, so I kept going home to mums. Until he sucked me back in and it started all over again.
Finally, I went back to my doctor, got on buprenorphine, and became an occasional user. I would use on a Sunday, like a Sunday afternoon treat. This was working well for me, until my mum died. She had a cardiac arrest on a Sunday, and I couldn't forgive myself for not being there with her. For the first year after her death, I used a lot, but then I thought, 'that's enough, I can't do this anymore.' So I cut all ties with Matt, and never used again. That was 11 years ago. I moved into my own home, started working and was feeling stable. Until I started hearing voices. I became paranoid and thought everyone in my unit block was talking about me, that they were trying to poison me. I had an extreme psychotic episode that lasted for days and days, where I tried to take my own life. I have a constant reminder of those days because my little finger will never bend straight again. My neighbours found me and called the ambulance. I was hospitalised, placed in a medicated coma for four days, and then on suicide watch for a month. They sedated me and put me back on buprenorphine - they didn't believe that I had not been using. Eventually, they discharged me and sent me home. Once home, I could still hear the voices and now I thought I was being followed. I went to the police, but they couldn't do anything. So back to hospital I went.
After a month in the psych ward, the Psychiatrist recommended that I stay for a further 6 months because I couldn't be trusted to take my medication. But my dad said no, and explained that I had been taking my buprenorphine for years without missing a day. The tribunal said I deserved a chance and they appointed a case manager and linked me to First Step. I was discharged on Friday and at First Step by Monday. First Step and the Alfred worked together to get me to where I needed to be. The legal team checked that all the AVOs were sorted. I participated in the Women's Group. I saw the GP for my medication management, to treat the Hep C and the liver cirrhosis. And brokerage funding paid for a laptop and to do peer support training. And the biggest lifesaver has been the change from buprenorphine to the Long Acting Injectable Buprenorphine. I had to take buprenorphine every day which meant I was up and down at different times of the day, and how well it worked depended on how well it dissolved. It was like having withdrawals every day. And I had to go to the chemist regularly, which meant I couldn't go away for long. It was a nightmare. With the long acting injectable, I don't ever stress about it, I don't hang out for the medication. I don't think about it.
12 months after I got out of hospital, I wanted to go away on my first holiday, so I started talking to the GP about my gambling. I wanted money to go on a holiday, so I liked this idea of saving money but realised I couldn't gamble AND save money. So, I told myself I could gamble every 3 months, but I don't take that choice up. The choice is mine now. I own it. The doctor also helped me with my drinking, and I did hypnotherapy with the First Step Psychotherapist to quit smoking. This is all saving me a lot of money! Recently, my car broke down, and it was the first time I could afford to pay to have it fixed. I felt amazing!
A little while ago, my self-talk was really negative. I was having weird thought processes and needed a tune up and some time out. So, I went to a residential mental health service for 4 weeks where I met a peer worker. He was able to help me talk about my stuff, and it wasn't from a clinicians point of view. He was one of us. And he said to me, 'you could do this, you could be a peer’. I mentioned it to my First Step counsellor, we looked up courses and I found SHARC. I've now finished the peer course and have got a certificate! The plan is to be a part time peer. I want to start off by volunteering because I want to get my foot in the door. But I eventually want to be paid, to be recognised for what I can bring to a peer role.

Thank you to our photographer, Nicholas Walton-Healey.

Home was never a happy place.

I don't have many memories of my childhood, but what I do remember is dark. I always tried to be a good girl, but even when I was really, really good, I wasn't good enough. I'd still get into trouble, I'd still get beaten.

I wasn't allowed to have a voice so when I did speak up I got in trouble. I learned to just not do that. To sit down and shut up. To keep to myself.

It began with my dad and when I married, things got worse. I was absolutely consumed.

All my life, I heard that I was not good enough.

It was drummed in for so long that somewhere along the line, I began believing it. Even when I would receive external praise and positive affirmation, it was never enough. I wouldn't believe it. You could give me a gold medal and I still wouldn't think I deserved it.

But I'm starting to see little bits of me breaking through and thinking, 'well, maybe I DO deserve it'.

There is a lifetime of pain to unpack. It will take time to find a place for it.

**********

As a child there was one place that I felt love and safety: with my grandparents.

I stayed with them a lot, but I wanted to live there. I remember laying in bed at home, crying my heart out for my Nan - I just wanted to be with her.

They are my strongest, most vivid memories. My grandparents had a complicated relationship, but I always felt safe and loved in that space.

Today, the contentment and comfortability that comes with feeling safe allows me to explore the sh!t in my past and what it's like to be me.

**********

I jumped out of the frying pan into the fire. I thought I was escaping my abusive family only to find myself in an abusive marriage.

I picked up alcohol really late in life. Up until that point, I had ineffectively used other strategies to cope, but when life became completely unbearable and I felt there was no hope left, I used alcohol to knock everything out.

I wanted to leave my marriage, but I didn't know how. I didn't know where I would live or how I would support myself. I just knew I couldn't hold on any longer. I tried, again and again, to take my own life. Then it was taken out of my hands - I had a heart attack.

When I was discharged from hospital, I never went back.

I moved into the caravan my father-in-law had gifted us. I was in and out of hospital, not safe on my own. And then my husband took back the caravan and suddenly I was homeless.

I ended up in Sunshine Psychiatric Unit waiting to get in somewhere, and that's the first time I went to residential rehab.

I don't know how long it took me to detox, but I was there for 6 weeks. I felt so close to death, so completely broken.

Afterwards, again I had nowhere to go. Back to my homelessness and my hopelessness and my overwhelming lack of control.

**********

When I drank, there was no euphoria for me. I didn't even like alcohol, it just had the right effect. I functioned but had no recollection of what I was doing. Everything was completely blank in my mind, and that's what I was looking for. I completely escaped my life.

I still feel so much guilt. I probably always will. I still find it difficult to believe just how far I strayed from my own moral compass.

I can hear my father yelling that I should be ashamed of myself and I do take responsibility for what I did. But I won't regret the past, or shut the door on it.

**********

I don't remember what the catalyst was.

I was out for brunch, I got a hair cut and that's all I remember. At some point, I bought alcohol. I don't remember buying it. I don't remember drinking it.

I have brief memories of being in the back of a divvy van, crying. The police officer said my license was suspended and I asked him what would I use for ID, to which he responded, 'Madam, quite frankly that's the least of your problems'. I remember thinking how rude he was.

I went back to my friends house and dry retched for hours. I was not safe to be on my own and ended back in rehab to do some more work.

But I was adamant I was only doing two weeks this time.

I thought I'd be fine. I had done the work, I was going to meetings. Yet everything in my life was so hard.

I picked up a drink and it just took over again.

Back to rehab.

I would try so bloody hard, and yet, I would come out and pick up a drink. It wasn't as if I didn't have the desire to stop. It wasn't as if I wasn't focused. It's just that there wasn't a plan. I thought I could wing it on my own.

I didn't put my recovery first. My AA Sponsor recommended ResetLife, but I was really pushing myself to return to work.

Back to rehab.

I knew I needed to do something different. I needed to trust my gut - my survival instinct that includes the feeling of fear but also the feeling of safety. I had a feeling about ResetLife.

**********

When I first came to ResetLife, all I could see were the differences.

People would tell me to look for the similarities, but I felt that my story was just so different - I didn't drink for most of my life and I've never taken drugs.

But I finally realised that I have actually been an addict my whole life, it's just that I picked up alcohol really late.

I got to a point of absolute desperation. I recognised that I was doing everything that was suggested but it wasn't enough.

ResetLife was different for lots of reasons.

It was the absolute desperation and the recognition that I was doing everything that was suggested, and it still wasn't enough.

It was the care, compassion, acceptance, professionalism. It was the regularity and effort of turning up. It was the peers. It was the sharing openly and honestly. And mixing it up with people who were all different, but all the same. It was the content of the program. It was the counselling, and it was about understanding addiction and recovery.

It gave me perspective and that has been gold.

**********

I battled sadness, depression and low moods all my life, not knowing where they came from.

Now I know I have been a victim of abuse. I'm starting to unpack this because before I just didn't have the capacity. Now I can choose how I live my life moving forward. And when I start to get overwhelmed, I know I can get through it without alcohol. I've done it. I've proved I can do it.

A friend recently said to me, 'surely you're finished with that now' (about recovery). I explained that I will be doing this for the rest of my life because that's what keeps me safe and well, and more importantly, I have found my a place where people accept, support and understand what I have been through, and what I am still going to have to go through.

I have had a lifetime of trauma and can't let go of that in five minutes - it's a process and I'm working through it.

There is still a lot of fear when I'm not traveling well.

It surprises me how quickly and strongly it jumps out at me. It will start as nervousness in my belly, move into my chest and then up into my throat. But now, when it does comes up, I recognise it quickly.

I know this will be with me for the rest of my life, and but I know how to keep myself safe - I'm vigilant to stay connected because that helps keep the fear where it belongs.

I can't do it on my own. It's kind of that juxtaposition - I need to do this on my own, but I can't do it on my own. None of us can. You've got to have your team. And I've found mine.

**********

I feel like I am living for the first time. I am learning to live. To just be me.

I'm learning to set boundaries, to hold something back for myself, to attract people into my life that support and accept me. To look for connection.

I can honestly say, the desire to drink has completely left me.

I don't know how it happened, but it's completely gone. If I still had the desire to drink, dealing with the trauma I have to deal with, I would have picked up alcohol by now, it would have been too much. But it's gone.

I want to tell my story and give hope to other people who can't see a way out. It's doable. It's not easy. It's flamin' hard work, but it's worth it.

I heard people say, 'I'm grateful to be an alcoholic', and in the early days I thought, no way! But that's true for me. Had I not picked up a drink I would have continued to live the way I was.

I've still got so much life left to live and I'm going to bloody grab it with both hands and live it!

**********

I'm a nurse, I'm a carer. Inside of work and outside of work, but I'm getting better at understanding that I have to save myself first.

I needed to return to work for lots of reasons - it's an income, I'm interacting with people, it's something do with my time, a sense of normality, I can still care for people. But I can't yet go back into a high pressure role, I'm just biting off what I can chew.

I feel comfortable and content and it's a nice feeling, although sometimes it's challenging because these feelings are so unfamiliar. It's a learning curve.

I'm about to buy some land and want to build a house that meets my needs and for what's important in my life - my gardening, my cooking. And somewhere for the baby grand piano that my grandfather left me.

I've got everything I need in my life now and anything else is just a bonus.

Thank you to our photographer, Nicholas Walton-Healey.

The impact that ResetLife has had on my life has been profound in every aspect.

Prior to joining the program my life was in chaos. I feared for my future and my ability to look after my sons. I was quickly spiralling out of control with an addiction to alcohol. I felt helpless and afraid.

I was arrested for the second time for high range drink driving which was a catalyst for me to seek help.

The ResetLife Program has changed my life completely.

The program uses a scientific method to reprogram the brain. I have become aware of how the addictive brain works for an addict and how it can use tricks to try to obtain its drug of choice. Attending 4 months of intensive therapy was challenging but I understand it is necessary so that the neural pathways can be given enough time to be reprogrammed.

This program was ideal for me because there was no way I could have attended an in-patient facility due to my personal circumstances.

I have a different life now, and infinitely so much better. I go to the gym 5 mornings per week. I have made healthy connections with others without involving drugs or alcohol. My life now has order and is the opposite of chaos. My weeks are tightly scheduled, and I understand how to manage the challenges and risks that face an addict for a lifetime. I cannot state enough how much I admire the therapists that I have worked with at ResetLife for over the last 4 months. Their devotion to helping others is just amazing and it must be extremely challenging for them at times. I have formed strong bonds with other participants, and we regularly keep in contact and help each other with life's challenges.

ResetLife has changed my life and I cannot recommend it more highly to anyone facing addiction issues.

- ResetLife client

Tony was attending a men’s behavioural change program at Star Health when he met First Step Legal lawyer Elizabeth. Tony was in his early 30s, couch surfing, dependent on methamphetamine, alcohol and cannabis, wasn’t working and felt hopeless. With Elizabeth, he was working through outstanding charges related to family violence, that he had perpetrated against his then partner.

Elizabeth identified that Tony really needed more support than he was getting, so asked Kym Coupe, First Step Team Leader Mental Health Services, to join the appointment.

Kym and Tony spoke briefly, and arranged to meet in a few weeks, but in the interim Kym told him to call if he was really struggling.

He called a few days later.

“Nine out of 10 times, people don’t call for a whole range of reasons – they’re not interested, they’re not ready, or they talk themselves out of it because they’re too anxious. But Tony called feeling overwhelmed and wanting support to manage his stress better. He knew I couldn’t ‘fix’ things for him.” - Kym

Kym discovered that Tony had a long history of childhood trauma, that his mum has significant mental illness, and his dad has substance abuse problems.

Determined to make a change, and with the support of the Mental Health team, Tony decided to stop using methamphetamine - whilst still homeless!

The team linked him to the GreenLight supportive housing program and he was placed in crisis accommodation and later supported into permanent, private rental. He was also supported to find a job which he was really enjoying, but unfortunately caught COVID-19 and was not entitled to sickness benefits.

The financial strain became overwhelming, and he began drinking large amounts of alcohol to help cope with the stress. He found himself stuck in a difficult pattern where he would drink, wake up with a hangover and full of anxiety, and then drink to manage the anxiety.

“Tony called and said he was having a bad day and wanted to ‘blow up’ his life because things were just too hard. I fed back to him that even though he was feeling deregulated, stressed and angry, the first thing he did was call me. So, there was a part of his brain that was acting protectively, because if he did really want to blow up his life, he wouldn’t have called me to talk him off the ledge.” - Kym

The Mental Health team, along with our GP Dr Niall Query, supported Tony to reduce his drinking and eventually switch over to 0 alcohol drinks.

After that, he returned to work quiet quickly, although we are now supporting him to find another job.

“Tony is kind of a unicorn. If you had told me on the day we met that he was going to call, self-cease methamphetamine, show up weekly for his appointments and work through it, that he was going to be the guy that takes on advice and implement the strategies that we talk about, I would never have believed it. He has just consistently kept at it when stuff got really hard, when he’s struggled, when he’s had little slip ups. He’s just consistently kept at it.” - Kym

Tony, the Mental Health Team and First Step Legal investigated the avenues available to him within the legal system, that prioritised his wellbeing but still addressed the legal proceedings. They agreed that the Assessment and Referral Court (ARC) was the best pathway.

The ARC is a therapeutic court process that requires monthly court appearances with the magistrate to ensure Tony is meeting the treatment goals in his care plan. To participate in the ARC, Elizabeth demonstrated that Tony’s offending was directly linked to mental illness and substance abuse and that treatment was the most beneficial, rehabilitative outcome because that is what increases his likelihood of not reoffending. Whilst normally an external case manager would be appointed, the legal team were able to have this role allocated to the Mental Health team to ensure continuity of care.

“It’s been a year since I met Tony and he has achieved so much. He has a son and, given his own upbringing, is acutely aware of wanting to make sure his son has a really good childhood that is not full of trauma. That has been his motivator.” - Kym

I cannot even begin to describe in words how grateful I feel towards everyone at First Step. Here is a little bit about my story and how ResetLife changed my life.

I started drinking alcohol in excess, in early 2020 when I went through a particularly difficult break up with my ex and my children relocated overseas. The emotional pain was too much for me to bear. Initially alcohol seemed to be the answer to numb the pain that was so constant in my heart and couldn't seem to be alleviated in any other way. Attempts to stop drinking provided brief periods of respite, but they always failed and the drinking, uncontrolled behaviour and my sense of shame and despair spiralled out of control for the umpteenth time.

My addiction quickly progressed to the point where I was unable to go a day without drinking and the horrific effects of withdrawal which I could only eliminate by drinking even more. What followed were the most horrific two and a half years of my life, in and out of hospital, rehabs and always promising those dear to me that this was genuinely the last time.

I eventually ended up in St. Vincent's Hospital with withdrawal and alcohol related complications, it was there that I had some time to contemplate the havoc and insidious powerful nature of addiction that I could not shake on my own, this was a disease that had to be tackled with sound tactful intellect rather than sheer willpower alone.

I was told about a program called ResetLife at First Step that had helped many people achieve sobriety. I was sceptical at first but willing to try anything at that point.

I initially had a phone call with Benn who reassured me that I was not alone and with the right help and willingness I could beat this seemingly insurmountable disease. Initially, I found it confusing, wondering what I was supposed to say in the group sessions and puzzled by some of the language, the rules and procedures.

But the mist soon cleared, and I found myself amongst a group of wonderful people from all walks of life, whose lives, like mine, were being destroyed by addiction of one kind or another.

For the first time I found I was able to be open and honest with my peers and therapist about my addiction and its consequences.

The positive impact Resetlife has had on my life is a perpetual stream of overflowing goodness.

ResetLife helped me gain a better understanding of myself, my addiction, and a set of tools and strategies for sustaining my recovery in the outside world and not just survive but thrive.

I am now taking all this incredible wealth of knowledge and experience that I have gained and forging a career to help others in similar situations. If I have one piece of advice for anyone struggling with substance abuse/addiction it is to ask for help, because help is out there.

- ResetLife client

Our client, we’ll call her Sophia, is a 32 year old professional, working full time in advertising. She completed university, was excelling at work and showing great promise. She was kicking goals and meeting big milestones.

But after a sustained period of business and stress at work, her mood and behaviour started to change. She thought she was managing, but her employer and colleagues started to notice some odd behaviours emerging, for instance, hyper focus on particular things, erratic deadlines, paranoia around other people, critical of her own work.

Eventually, she asked to leave. Sophia became very overwhelmed, and an ambulance was called as her employer was concerned about her manic state.

In hospital, she was diagnosed with bipolar and treated with mood stabilising medication.

Bipolar is a mood disorder with a combination of depressive episodes and manic episodes, that usually present in people’s late 20s or early 30s. Often, it is triggered by something like workplace stress.

On discharge, Sophia was referred to the Mental Health Integrated Complex Care program, at First Step, to monitor her medication, provide her with psycho-education and support her return to work.

Not being able to work, at least in the short term, meant that Sophia faced another major hurdle – how was she going to pay for rent? Or buy food? Or pay for medication?

At First Step, our care coordination and case management team worked with Sophia to address her short term immediate needs, like supporting her application for Centrelink, overcoming paranoia and managing anxiety around the paranoia; and also, her long term goals, like returning to work.

We also worked with her employer, helping them understand the effects of particular medications and planning her return to work.

Over 6 months, Sophia was able to maintain stability with her mental health and return to work, initially three days a week.

By doing the hard yards at the start to educate Sophia’s employer and to advocate for her return to work with increased supports, means that in the short term, Sophia had stable income and housing. But in the long term, we have reduced the chance of chronicity, dysfunction and disability.

This approach has protected her self-identity, proving that she is not defined by her illness.

Kym Coupe, Team Leader Mental Health Services

18 October 2022

The death of Jack Charles, Uncle Jack, evokes many, many thoughts and feelings.

I never met him, though I know people who did.  I saw him around St Kilda and other parts of Melbourne, read his autobiography, saw his films. And maybe partly because of my line of work, I felt like I knew him a bit.

As his state funeral looms in sight, I reflect on the fact that he is probably the first career criminal and unashamed injecting drug user to be thus celebrated. (A quick reminder might be helpful: Uncle Jack’s 60th was his first birthday ending in a zero when he wasn’t incarcerated).

The Herald Sun continues its war on the Medically Supervised Injecting Room. The term 'junkie' lingers. And it’s obvious that many people in society have no real appreciation of the trauma that so often lays the fertile ground for a heroin addiction (often involving out-of-home care like Uncle Jack, and pre-teen injecting drug use to dull the pain of an almost intolerable life).  

So, what does it take to for such a person (a thief and injecting drug user) to be thought of as a real person with hopes, dreams, friends, quirks, struggles, talents, potential? Do you have to be a famous thespian? Unfortunately, I suspect the answer is yes.

I imagine that Uncle Jack wouldn't want flowers at his funeral.  I imagine he might want you to have a kind thought for the many people who suffered abuse like him but never made it. I imagine he might want you to send a care in the direction of the Medically Supervised Injecting Room, or anywhere else that people turn for support when much of society shuns them.

I’m pretty sure he wouldn’t disagree with this sentiment.

Vale Uncle Jack.

#lifewithaddiction #firststep 

Patrick Lawrence Chief Executive Officer

Everyone knows me and the fact that I am not shy when it comes to calling people out over stigmatizing or discriminating behaviour. 

I reached out to you in desperation when I needed to see a doctor but was unable to get in anywhere. You were kind enough to let me know about an availability with a GP at First Step, and I was really grateful for that. I don’t know what I would have done if you weren’t able to help?

So, I just wanted to take a few minutes out to let you know just how impressed/pleasantly surprised/stoked to find the service that I received at First Step to be so awesome!

From my initial phone inquiry all the way through to sitting in the waiting room, and then in to see a doctor, I was treated with respect and dignity. Personally I don’t think that is a big ask but from my experiences (and I have had a lot of them) it’s not something that is common or easily found especially within this sector.

Over the years I have made complaints and been told that …..it’s hard enuf to find good staff to sit behind a reception desk and be nice to everyone, as front line workers they have been abused, spat on and all sorts of horrible things so I should just appreciate the fact that whatever service I was talking about even had a human prepared to do the job.

I understand that front line staff are subject to all sorts of harassment and abuse, I have worked on the front line for more than 20 years so believe me when I say I get it! I still don’t think that is a good enuf reason for staff to treat innocent people badly, just because someone else has been before them and acted inappropriately; and I am also aware that people have bad days (including staff) and not everyone can be nice 100% of the time, but just wanted to acknowledge the staff at First Step.

They treated me so well, they were so nice and friendly and welcoming and it makes a world of difference to be treated that way. And it wasn’t just me, I overheard them speaking on the phone to other people as well as saw them interact with other patients as they came and went and they treated everyone with the same amount of respect and it was just so nice to see.

I am sure you are already aware but you have a wonderful bunch of people working there and I’d really like them to know that whilst people are very quick to complain, there are also some like me who actually remember to acknowledge how great they are.

It makes a world of difference to be treated well and I just wanted to let you know.

- First Step client

I have never seen such an escalation of an issue so central to First Step. Not mental health. Not addiction. Bulk billing! In short, the Medicare rebates have not kept pace with costs and bulk billing clinics are either ceasing to bulk bill or shutting down altogether.

As much as First Step is a multi-disciplinary clinic, GPs are still the central pillar of care. They provide opiate substitution therapies, write care plans and team care arrangements, refer to our other services as well as external services, and see people as often as they need to be seen.

And, like everywhere else, we are struggling to find enough doctors and we are struggling to keep the clinic financially sustainable - precisely because these bulk billing rates are so low.

Medicare rebates $40 for a 19 minute consult. So, that’s $120 for an hour to pay the GP, pay the receptionists and cover the clinics operational costs. Obviously, the more GPs we have the more income we make, but the GP workforce shortage is also at a crisis point.

We know, and there is a strong evidence base to prove, that opiate substitution therapies save lives, reduces harm and improves quality of life. Our GPs save lives.

The issue we have been faced with our whole history, has now become mainstream. Read below as Dr Peter Wright provides brief history on why Medicare is failing to adapt to our changing needs.

And if you know a GP who wants to work with vulnerable people, please ask them to stop what they’re doing and call First Step!

Patrick Lawrence Chief Executive Officer

As more bulk billing practices charge fees, First Step feels the pressure

I’m one of the newest members of the First Step team and am seeing first-hand the impact the bulk billing crisis is having on medical services to the broader community.

As a registered psychologist, I offer psychological therapy under a GP mental health treatment plan, and often find my clients can’t afford to pay for the essential care they need.

Does that mean a service shouldn’t be available to them, just because they can’t afford it?

I don’t think so.

Personally, I believe access to physical and mental health care is a basic human right that should be available to anyone, regardless of their income.

Unfortunately, in community health services we are seeing an increase in costs to deliver services, and eventually this increase is passed on to the patient - who may, or may not, be able to afford it. A gap payment from the patient almost seems inevitable when you consider the pay cut to practitioners working in bulk billing services versus those in full fee practices. Unless the government puts more investment into general practice care, we will continue to see costs rise, and practitioners opting out of the bulk billing services and into full-fee-paying clinics.

As more bulk billing practices begin to charge fees or aren’t able to meet demand due to staffing shortages, inevitably we see pressure put on remaining clinics like First Step, in the form of increased patient numbers and waitlists. From my viewpoint, it appears like an unavoidable widening of the gap in access to medical services.

Already, after only working at First Step for a few months, I’ve had to put a stop on new referrals and begin a waitlist because demand for psychological services is so high.

While I am so happy to work for an organisation like First Step that opens its doors to everyone and anyone, I am somewhat saddened when I think of the overall system, and how it supports our community’s most vulnerable.

Personally, I wish there were 1,000 more First Steps across Victoria. Where anyone can have access to medical care, and those practitioners were paid as much as practitioners at any other clinic. Because in my experience, the services provided are just as essential.

Siobhan McKenna, Psychologist

Renegotiating our social contract

We have a bulk billing crisis in Australia because Medicare is a monopolised, one-provider, nationalised insurance scheme.

It is not a nationalised medical system.

It was originally introduced in the Menzies era as a financial incentive for doctors to streamline and simplify billing, and not bill privately.

But now, there is good evidence to show that the bulk billing rates of remuneration to doctors have fallen behind the cost of living making it an unattractive alternative.

What this means for patients is that they are not insured for enough. Obviously, they can’t negotiate a deal with a doctor, but they also have no choice of insurer.

It is totally different from the UK or Canadian models, and, in fact, is unusual by world standards because it’s a hybrid system, with hospitals allowed multiple insurers.

People should be angry at this monopolised, national insurance scheme that no longer meets their needs.

The solution is an informal renegotiation of the social contract. That is a broad ranging conversation that needs to happen across many platforms, and will take time.

What percentage of people should we expect to be bulk billed when they go to the doctor? It has never been 100%. At the peak of bulk billing, it might have been around 60%, but it is falling.

There are people in Australia who believe there should be no cost to see a doctor, but that would start to breach the constitutional obligation not to co-opt labour. You cannot mandate a profession to charge a certain amount just as you can’t compel all doctors to bulk bill.

All GPs have the right not to bulk bill. There is no obligation. It’s just a convention and has been a common practice, normally tied to people with a welfare card. At the discretion and good will of the doctor.

So, the best we can hope for is a renegotiation of the social contract – who are the people that should get bulk billed for Australians to feel that it’s right and fair?

 Dr Peter Wright, GP

A crisis of epic proportions

The trickle of media stories about Australia’s General Practitioner (GP) shortage has turned into a flood. In fact, I think it is the first time an issue so critical to First Step has received sustained media focus.

We have gone mainstream!

The media focus is affirming but doesn’t get us any closer to solving the problems.

And what are those exactly?

1) Medicare rebates are so low that GP clinics are abandoning bulk billing en masse. As a result, millions of Australians are struggling to access free GP care, the cornerstone of universal health care.
2) There is a serious shortage of GPs nationwide, and it’s much worse in the country.
3) Trainee doctors are choosing general medicine at record low rates, down from approximately 40% twenty years ago, to 15% now.

Put those things together and you see the result of years, perhaps decades of neglect of one of the things that defines us as Australians: a nationwide belief in universal health care.

As bad as the general GP situation is, it is much worse with Addiction Medicine GPs.

It’s probably worth a quick explainer here:

The medical intervention for opioid (including heroin) addiction is the prescription of daily doses of methadone or buprenorphine. These medications have been proven to reduce the amount of heroin people use (often to zero), reduce harms such as overdoses, accident and injury, crime, hospital admissions, and deaths, and reduce the impact on families and society.

These medications are prescribed by doctors called Opiate Substitution Therapy (OST) prescribers, just ‘prescribers’, addiction doctors, or methadone doctors. We call them Addiction Medicine GPs.

At First Step we believe that everybody deserves every chance to turn their lives around. Without the workforce, this is unachievable.

To our enormous frustration, we turn multiple people away every day because we have a 3-month wait list to see a GP. And we have, what is generally considered in the sector as a large GP team – 4 doctors equating to just over 2 full timers.

We have been in active recruitment for GPs for as long as I can remember. We’ve used recruiters, advertised, made noise in the media, and in the last 6 years successfully recruited only one – the wonderful Dr Niall Quiery.

In addition to the systemic shortage of GPs, this kind of coalface, gritty, life-saving and challenging work . . . well, I suppose it’s not for everyone.

Then there is the general societal stigma around drug use, and lack of understanding of underlying childhood trauma’s that often predict co-occurring addiction and mental illness. And to add insult to injury, and this is said with the greatest of respect to our own GPs, they are aging and retiring.

These factors have ramifications not only for our clients, but also for our financial feasibility. Like in any GP clinic, GP billing forms a percentage of our income. With year-by-year government grant funding, contracts that are not indexed, and this GP crisis, it gets harder and harder every year just to keep our doors open.

We are trialling an Alcohol and Other Drug Nurse Practitioner program on behalf of the federal government; we’ve formed a recruitment partnership with Star Health and the Salvation Army, and we are pioneering programs to increase the scope of practice of pharmacists in addiction medicine.

All these things might help, but they are long term incremental improvements to a current and epic problem.

 Patrick Lawrence, CEO              

Please remember, we are here to help

It’s no fun telling a client we don’t have a doctor available.

Clients have said to me, ‘well, aren’t you a doctor’s surgery?’ Yes, we are. But we don’t always have GPs available. The majority of our doctors work Monday, Tuesday and Wednesday, with limited availability on Thursday and Friday.

I understand their frustration. We’re frustrated too. We wish we had more doctors, but we don’t.

One way to alleviate this pressure is to make sure clients book their appointments in advance. And keep their appointments!

We know that for many of them, forward booking appointments can feel overwhelming, and unavoidable circumstances force them to miss their appointments, but we encourage them at the end of each appointment to book for the next one.

Sometimes, I print a list of all the clients that have attended in a week, cross check what medications they are on, and if they don’t have an appointment booked before their script ends, book them in. This is a really time consuming process.

Inevitably, we always receive those last minute, urgent calls from clients on a Thursday or Friday, needing a methadone script.

We really do go out of our way to find a solution and to help. But I once had a client say to me, ‘you guys are the reason I’m going to have to use.’ I know it’s not true, but that was hard to hear. After all, I didn’t get into this job to say ‘no’ to people, I want to help.

Thankfully, that is rare as our clients know that rude or aggressive behaviour is not welcome at First Step.

For most of our clients, when they arrive and see a welcoming smile, their face lights up. And it’s the same for us. We get to know them and want to have meaningful interactions. For some, we might be the only interaction they get all day, so we want that to be positive.

We know that our clients are appreciative of the care and support they receive. We want to remind them to be patient, to book their appointments in advance and remember we’re doing the best we can.

And of course, the clients that really make us happy are the ones that bring in their dogs!

 Stephanie Casey, Receptionist           

21 September 2022

The trickle of media stories about Australia’s General Practitioner (GP) shortage has turned into a flood. In fact, I think it is the first time an issue so critical to First Step has received sustained media focus.

We have gone mainstream!

The media focus is affirming but doesn’t get us any closer to solving the problems.

And what are those exactly?

1) Medicare rebates are so low that GP clinics are abandoning bulk billing en masse. As a result, millions of Australians are struggling to access free GP care, the cornerstone of universal health care.
2) There is a serious shortage of GPs nationwide, and it’s much worse in the country.
3) Trainee doctors are choosing general medicine at record low rates, down from approximately 40% twenty years ago, to 15% now.

Put those things together and you see the result of years, perhaps decades of neglect of one of the things that defines us as Australians: a nationwide belief in universal health care.

As bad as the general GP situation is, it is much worse with Addiction Medicine GPs.

It’s probably worth a quick explainer here:

The medical intervention for opioid (including heroin) addiction is the prescription of daily doses of methadone or buprenorphine. These medications have been proven to reduce the amount of heroin people use (often to zero), reduce harms such as overdoses, accident and injury, crime, hospital admissions, and deaths, and reduce the impact on families and society.

These medications are prescribed by doctors called Opiate Substitution Therapy (OST) prescribers, just ‘prescribers’, addiction doctors, or methadone doctors. We call them Addiction Medicine GPs.

At First Step we believe that everybody deserves every chance to turn their lives around. Without the workforce, this is unachievable.

To our enormous frustration, we turn multiple people away every day because we have a 3-month wait list to see a GP. And we have, what is generally considered in the sector as a large GP team – 4 doctors equating to just over 2 full timers.

We have been in active recruitment for GPs for as long as I can remember. We’ve used recruiters, advertised, made noise in the media, and in the last 6 years successfully recruited only one – the wonderful Dr Niall Quiery.

In addition to the systemic shortage of GPs, this kind of coalface, gritty, life-saving and challenging work . . . well, I suppose it’s not for everyone.

Then there is the general societal stigma around drug use, and lack of understanding of underlying childhood trauma’s that often predict co-occurring addiction and mental illness. And to add insult to injury, and this is said with the greatest of respect to our own GPs, they are aging and retiring.

These factors have ramifications not only for our clients, but also for our financial feasibility. Like in any GP clinic, GP billing forms a percentage of our income. With year-by-year government grant funding, contracts that are not indexed, and this GP crisis, it gets harder and harder every year just to keep our doors open.

We are trialling an Alcohol and Other Drug Nurse Practitioner program on behalf of the federal government; we’ve formed a recruitment partnership with Star Health and the Salvation Army, and we are pioneering programs to increase the scope of practice of pharmacists in addiction medicine.

All these things might help, but they are long term incremental improvements to a current and epic problem.

#lifewithaddiction #firststep 

Patrick Lawrence Chief Executive Officer