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

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