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

Nancy is a 32-year-old woman with a quick wit, a love of good company and a real artistic flair. She has diagnoses of major depression, attention deficit hyperactivity disorder, post-traumatic stress disorder and generalised anxiety – all very common in trauma survivors.

Nancy moved from NSW many years ago to escape family violence. She received support from a psychologist for some time but needed a more intensive service so was referred to Mental Health Integrated Complex Care at First Step, through which she received weekly support from a Mental Health Nurse and Care Coordinator while she continued with psychology. Her support team expanded at First Step when it was realised that she would benefit from brokerage funding to overcome barriers to social inclusion.

In extensive consultation with Nancy, the First Step Brokerage Worker targeted funding at building capacity for her to work towards her goals of upskilling and giving back to the community as a teacher. Brokerage has enabled Nancy to establish for herself a sustainable income to continue to do what she loves and is obviously talented at.

While First Step continued to support Nancy with her mental health and trauma, this case study focusses on her psycho-social development.

Managing Daily Living - Nancy requested Art Supplies from brokerage to assist in managing her mental health and daily living. Prior to COVID-19, Nancy would supplement her income by teaching and selling a little art. Access to art supplies enables her to attend free art classes online and work towards her personal goals.

Education and training goals - Nancy requested brokerage to enable her to study, enrolling in an Art Course in Animation-Master Motion. This course enabled her to build capacity and skills to return to the workforce in animation design.

Vocational skills including volunteering - Nancy paid and participated in a watercolour class at the Royal Botanical Gardens in December 2021. Brokerage was used to pay for a continuation of Term 1 class in 2022. She will continue throughout the year and plans to use her new skills to reach her goal of being able to teach art at her local community centre.

Nancy reported loving her classes and has begun to teach at her local community centre, as planned. Nancy is very appreciative for being able to access brokerage to remove financial barriers toward social inclusion and the hope and encouragement that came along with that.

Nancy emailed a thank you, as follows:

'I feel so fortunate to have been able to have access to such a wonderful program that has enabled me to achieve my goals and continue to learn. Thank you for your warm encouraging words and for making a real difference in my life. I will be back in touch when I am famous!'

Nancy has completed the brokerage program, and continues contact with First Step through our GP program. She knows she can talk to her GP if her mental health or other needs increase.

* Nancy's name has been changed to protect her privacy

Heath* is a patient of Dr Niall Quiery at First Step. Heath had a colourful and varied professional life, though now at the age of 62 is facing a number of challenges relating to his mental health and many years of harmful drug use. Heath has early onset dementia, suffers from depression and anxiety, has now left the workforce and is very unlikely to be able to work again.

At the time he initially attended First Step, mid 2021, Heath had recently moved in with his father, Dean, who is in his 80s. Dean is devoted to his son but finds caring for him and helping to manage his affairs to be a great burden that is affecting his health too. To further complicate matters, Dean is also caring for his wife, Heath’s mother, who has liver cancer. Heath is very concerned about living on a pension, and even more anxious about his debts. His greatest desire at this stage is to “get on track financially and not be broke forever. Or too reliant on my dad.”

Heath was seeing Dr Quiery for support with his general health and addiction when Dr Quiery ascertained that Heath had considerable unpaid fines, primarily from driving on toll roads without registering his car appropriately.

Dr Quiery explained the Work and Development Permit (WDP)** program to Heath and his father; they could hardly believe what they were hearing, and they made an appointment with Stephanie Casey who helps administer the WDP at First Step*. Upon instigating Heath in the WDP program Stephanie discovered that Heath’s fines totalled $4,235. Heath and his father were both shocked and immediately became even more anxious about the debt. Heath expressed despair and anger, and a lack of desire to change his ways (i.e. to stop getting fines). When Dr Quiery and Stephanie both explained again how the WDP program works and that Heath could be debt free, he and his father calmed down and completed the registration process. In due course, with more counselling Heath made a commitment to not use the toll roads ever again.

That was in December of 2021. By May 2022, with assistance from his father to attend appointments with Dr Quiery and with the Cognitive Dementia And Mental Health Service (Eastern Health), Heath was not only progressing very well with treatment and support but was delighted some months ago to receive a certificate of completion from the WDP program. The ongoing elevation in mood resulting from this achievement was felt by Heath, his father and his mother. There are challenges ahead for them, but Heath and his family report feeling hopeful for the future now that Heath is getting the care he needs and has worked his way through the burden of debt.

March 2022 update: Heath continues to attend First Step and CDAMS and is not using drugs or alcohol, though we haven’t managed to get him off the cigarettes yet.

*Heath's name has been changed to protect his privacy

**The administration of the Work and Development Permit program is an unfunded role at First Step that we continue to run because of the great benefit to our clients. For more information on WDPs go to: https://www.justice.vic.gov.au/wdp

Growing up, I was a very unhappy kid. I had anxiety and depression and didn’t fit in. I got picked on and was an outcast.

I started messing around with marijuana and alcohol and by the time I got to year 7 was introduced to speed and pills. I fit in with the outcasts who were a bit older than me. But they were a rough crowd.

My drug habit got out of hand really quickly because it gave me relief from my mental health issues. Before, I was always on the edge, anxious, catastrophising of what bad things would happen next. But when I did drugs, it was like a weight off my shoulders. I had found something that worked, even if it was for a very short period, so I ran with that.

But my use snowballed, and it impacted my mental health even more.

Things weren’t going very well at home, and at 15 I was out on the street.

I went to rehab really young, about 16.

I was seeing a doctor for my mental health issues, and he was going to send me to youth rehab, but there were no beds available, so I went to an adult facility. But that was not a very good experience - it wasn’t a very nice place, and it wasn’t set up for youth.

I went there three times in the first year and didn’t really get the help I needed. I was left to my own devices - no one told me when groups were on, when meals were on. I was just floating around and I didn’t know what I was doing.

After the third time they refused to take me back because I wasn’t doing the program. But I was just a kid and no one showed me how.

Living on the streets was tough, especially during winter.

It’s a dog-eat-dog world. And that’s not because they are bad people, they are trying to survive as well. And I’ve done stuff that I’m not proud of because I was trying to survive out there.

If you mix with other people who are also living on the street, they can be really unwell and leave you with a lot of paranoia and trust issues.

I went through a lot of rooming houses. Sometimes those places were worse than being on the street.

It’s really lonely. There was a lot of shame. Just sitting down in front of a supermarket and people would put food in front of you, you just feel horrible. And having nowhere to go, or no one to speak to, is a horrible place to be.

I suffered with addiction for 20 years.

The first 14 years of my addiction, I was functional. I was a functioning addict. It wasn’t good. I wasn’t performing at my peak. But I was achieving things.

In the last 6 years of my drug use, I really took to IV use. I was hanging around with people who were dealing drugs, people associated with gangs. I got wrapped-up in this full on, intense, scene.

Things escalated and I had 17 heroin overdoses. I ended up in ICUs, in comas on life support. People that I was using with would have to do CPR on me. I didn’t want to acknowledge the effect it was having on the people around me.

I ended up in a psych ward. I was a mess. I had no one.

Or so I thought.

I had met Michelle (Goldberg, First Step Legal Principal Lawyer and Co-Practice Manager) at Windana, and she tracked me down. I needed legal help and she said she wanted to represent me. She seemed like a really nice person and was willing to go out of her way to help me.

I came to First Step and it was a bit of a trap!

First, Michelle dealt with my legal issues and then said, ‘right, I want you to meet the mental health team. I want you to meet the ResetLife team.’ And she linked me into everything at First Step.

I knew I needed help, but I just didn’t know how I was going to do it. I didn’t think I could do it. I just thought, ‘why not rock up to these appointments? Its going to be better than being in the rooming house.’ Rocking up sucked, but I just rocked up. I turned up to every appointment. I just kept turning up.

I’ve been through ResetLife twice.

I was doing really well the first time. I was loving it, I was getting out, focusing on recovering, then the first COVID lockdown hit and we had to jump on Zoom and I was stuck in my parents’ house during lockdown. I lost all the structure in my life. I had a relapse.

Everything came up for me in this period. I totally flipped out and ended up at Ravenhall (prison).

I was in there for a month. The day I got out, I called Benn (ResetLife Program Manager) and said, ‘I need this program’, and the next day I started again.

I put in as much as I could, and I got so much out of it. Going through the various stages of recovery is not easy, but I just turned my life around.

In my recovery, I do meditation groups, visit a Buddhist centre and go to meditation retreats. I find it really helps me with my emotional regulation – to step back and observe my thoughts, the guide my thoughts, so they don’t control me.

I go to the gym. It destresses me and makes me a lot calmer. The gym trains my body like meditation trains my mind.

Then I train my mind and body with cold water immersion – ice baths. This helps me think clearer. And I do a lot of breath work.

These are my fundamentals: meditation, breath work, cold water exposure and exercise.

I have a saying: ‘you win the morning, you win the day’, so my morning routine includes meditation, going to the gym, drink 1L salt water and a cold water immersion. I think if I set up a whole heap of achievements to overcome in the morning, anything else that comes in the day is relatively easy.

Today I work as a Peer Support Worker at Turning Point and volunteer my time at ResetLife.

Peer support work gives me purpose and makes me feel that everything I have been through was not for nothing. It’s nice to be able to relate to people. It’s hard to see them going through tough things, but I have this drive and want to be able to get them on the right track, to get recovery, and to get their life back together.

And I’m also learning all the time doing peer work and going to groups. It helps me with my recovery, and I always come away with gold.

I love my clients and I love connecting with people.

I found it really hard to fit in in my younger years and my drug using years, because I didn’t have any trust.

Now I have this community I can trust. People I can trust. I thought there were no good people out there, but since being connected to the recovery community, and meeting people whilst they’re in recovery, I love people now!

Back then, I couldn’t see that life could be this good. I want my clients to experience this, I want to show them that if they just stick with it, it can be this good for them too.

In the future, I want to study to be a therapist, but for now, I have not intention of moving on from peer work.

Recovery is a process. That’s why First Step worked for me. I could turn up to my appointments, they knew that I was using but they planted the seeds. I didn’t feel judged. I didn’t feel shamed. It opened my awareness to what was possible.

It doesn’t matter how much you want recovery, or how hard you hit rock bottom, getting recovery is about giving it enough time, to see how good it can really get.

Thank you to our photographer, Nicholas Walton-Healey.

God, how I hated my ringtone. The sound of it, the feel of its vibration in the pocket of my jeans, flooded my soul with black dread. Because I knew it was only a matter of time before it would be the police, telling me Anna was dead. My smart, funny, tortured girl.

She was 24 years old, but wrapped inside the drug-addled young woman was a baby so beautiful I could barely believe she was mine, a sweet and baffled child who could not understand why anything bad ever had to happen to any animal or person.

Her father and her sister and I begged her to see how much potential she had, how good her life could be. But we couldn't stop her going to the sex shop to spend her Centrelink payment on synthetic 'weed', a horrible chemical which ate away her intelligence and reason. When her money ran out, we had no right to stop her flouncing off in a tiny dress to the train, where she would pick up strange men who would give her attention, and drugs.

Sometimes she would give into our pleading and let us drive her to a hard-won stint at a detox facility. But we couldn't keep her from walking out a couple of days later, when the staff decided it was time to taper off the Valium.

Anna found a man on the train who introduced her to ice. Now the ghosts who had whispered to her since she was a child turned into howling demons. She was prescribed antipsychotics. How could we keep her from swallowing four at once, chased by a bottle of vodka? While she craved the oblivion of sleep, I was terrified she would stop breathing. I lay in bed beside her, held her close and only called the ambulance when her lips turned blue. They kept her in the ER until she sobered up, then told us to take her home.

Home degenerated into horror. We locked up the knives but Anna rampaged through the nights, finding ways to hurt herself. She became convinced that John and I were evil replicas of her real parents. She accused us of the most reprehensible abuse, she insisted on bringing ice users to the house, and she threatened us.

After a particularly harrowing weekend we did what I could not have imagined: we told our beloved daughter she could no longer live with us. A few months later we did get a call from the police. But it was not what we had dreaded. Our girl was alive, but she had killed an innocent man.

So many times I've asked myself in my pre-dawn soul-searching: were we wrong to make Anna leave? Probably. But we were heartbroken, exhausted and afraid. If we'd had the right kind of support, perhaps as a united family we could have dealt with Anna's addictions, and the unforgiving voices she tried to silence with drugs. 

We were unable to find the help that we needed, but days like today (International Family Drug Support Day) are about making it easier to access support services. One thing I know for sure is that no one, and no one family, can do it alone. 

Mary Pershall, Author

The Road Home project sees our unique integrated team embedded in crisis accommodation 1 day per week. Working with Launch Housing East St Kilda, a First Step Legal lawyer, GP and mental health nurse provide wrap around services to some of Melbourne’s most vulnerable women.

The project has been running for 6 months and in that time 28 individual residents have attended 113 appointments.

Brianna* is one of the clients who has seen practitioners across all three disciplines.

Brianna hasn't had somewhere safe to sleep for over a year. She started living in her car after her ex-partner assaulted her (again), but then the car got stolen.

Brianna comes to Launch Housing with a very long list of things that are stressing her out – she is in debt and her Centrelink payments are about to be suspended, she has outstanding legal matters and she hasn't been able to get advice about an intervention order against her ex, she hasn't been able to see a doctor in a while and she is running out of medication, and she is not sleeping and is noticing that she feels anxious all the time, has very little tolerance for others, and sometimes thinks about how much easier things would be if she just ended it all.

Through the Road Home project, Brianna is able to see a doctor for her medication and some overdue health checks, talk to a lawyer about her legal matters and see a mental health nurse who works with her on developing strategies to help her feel less anxious and manage her mental health better.

The Road Home collaboration meant Brianna’s Launch Housing case worker could refer her to receive brokerage funding which paid for new glasses. Brianna reports that these things have helped her gain confidence about what is next for her and is very appreciative of the support she has received.

* We have changed the clients name to protect her privacy

-    Kym Coupe, Project Manager, Road Home                   

I grew up in a typical Aussie home in the ’80s. Big sprawling house. All the neighbourhood kids hanging out together. My three sisters and twin brother playing at the pools in the summer. Family trips to Bright. I had a great family life and a fabulous childhood.

Until I was 7, when my mum left.

In my early-teens, some issues started to emerge for me – even though I looked masculine, that’s not what was inside me. I’ve always had a feminine side.

I was nervous about being around people and fitting in, so when I started going to parties, I found that alcohol could be the lubricant for confidence. But instead of fitting in, I would end up the joke of the party. Once, my brother shaved off my eyebrows when I was passed out!

My drinking accelerated after I finished school, and this was the start of 30 years of alcoholism.

There were a few years in my late 20’s when I felt I was getting my life together. I met a woman, and we had a child together. I went to University to study and was drinking only on the weekends.

But this didn’t last long and soon I was alone, lonely and miserable – and drinking every night. Twice, I lost my license and had to explain to my daughter what the ghastly interlock device on my car was. She was too young to understand, but I was so humiliated.

The first time I tried to take my life, I was admitted to a psychiatric unit and was diagnosed with Schizophrenia. Thirty years of alcohol abuse really pickled me. But I didn’t stop. Until one evening when providence intervened, and I thought: ‘Why am I drinking this? This is foul. What am I doing?’ And from that moment on, I never drank again.

Unfortunately, I replaced alcohol with drugs to fill the void, and that didn’t turn out so well for me. The drugs interfered with my Schizophrenia medication, so I decided to stop taking the meds. I began to hallucinate, I was paranoid, I wasn’t showering, I wasn’t eating, and my apartment had a cockroach infestation. I barricaded myself at home and thought there was a death squad out to kill me. I was frightened and couldn’t trust anyone.

I had hit rock bottom. My dad came, and so did the Crisis Assessment Team. Enough was enough.

Now, I am on the right medications every day, which means I can speak fluently without any voices in my head. I have the ResetLife Program at First Step, which helps me keep accountable to my own abstinence journey. And a long list of people to call for support.

ResetLife taught me about the physiological side of drug abuse. That my brain tried to keep me in addiction, but the longer I was into recovery, the more the logical brain took over and I could rationally consider, ‘Why would I want to take drugs when everything is working right now? Why would I want to take drugs when all of my relationships have recovered?’

All of my important relationships have rebounded.

I have reconnected with my mum. My sisters are more active in my life. My dad continues to be my rock. But most importantly, the relationship with my daughter has flourished. It’s incredible! She is the pride of my life. She accepts me for who I am, and we spend hours on long walks where she shares her stories with me. I feel so privileged that she trusts me! And so lucky to have great people in my life supporting and mentoring me.

I feel so good.

And now I want to get back into society – to work, study and volunteer. My graphic art has been a constant outlet over these years, but I really love writing so am looking at doing a writing and editing course. And I want to get involved within my local LBGT community so I can give back there too.

Everyone who sees me says, ‘You look so much better’. I have recovered.

Mandy - ResetLife client

Sammy is a 22 year old gifted artist and talented writer.

Sammy is a survivor of sexual abuse, perpetrated by her stepfather.

She was referred by Headspace Elsternwick, when it was determined that her complex PTSD and mental health needs would be better managed by the First Step Mental Health Integrated Complex Care (MHICC).

In exploring what her goals and aspirations were, Sammy identified that she wanted to again create art – she had previously made art to manage her mental health symptoms and as a form of income, selling her works at street and art markets.

On Sammy’s behalf, we applied to the National Psychosocial Flexible Funding Brokerage program to purchase art supplies. This program is designed to support people with severe mental illness overcome financial barriers to social inclusion. In other words, we can pay for those things people need to really start being active, contributing and using and developing their skills.

For Sammy, it provided an outlet for her emotions and assisted in the healing process during her self-reported ‘dark days’. And it allowed for her to make new social connections selling at the markets.

Sammy’s work was discovered by a local artist who invited her to present at an upcoming exhibition. This opportunity broadened her life skills, increased her confidence and resilience, and made significant improvements to her self-worth and wellbeing, as measured by her treatment team.

As a teenager, Sammy journaled to help process her experiences. With the team, she identified some training goals to complete a short creative writing course. This was supported by the Flexible Funding Brokerage program.

Each week, Sammy would share with her treatment team what she was learning and what her challenges were. Working together, she learned to use her writing as a coping strategy to manage her emotions.

Sammy continues to face all her life challenges with admirable strength and self-reflection, and no longer needs such intense support. She fills her days with art, gym and has recently taken on the responsibility of owning a puppy! Although we miss seeing Sammy (and her puppy) weekly, not needing us in the same way is indicative of all the hard work she has put in.

by Hayley Pedley
Care Coordinator, Mental Health Services
NPS Flexible Funding Brokerage