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Royal Commission into Victoria’s Mental Health System

Case study:

First Step

First Step

First Step is a mental health, addiction and legal services hub in St Kilda, Melbourne. It provides clients with support from a team that includes doctors, psychologists, drug and alcohol workers, lawyers, mental health nurses, care coordinators and educators as well as from outpatient psychiatric services.

First Step uses a single team approach to care that supports the broad needs of consumers. First Step’s CEO, Patrick Lawrence, said that having such a range of relevant disciplines in the one building means First Step ‘can build a team around a client simply by walking across the corridor’.

Mr Lawrence said that First Step focuses on ‘incremental whole‑of‑life improvements’ to support people facing multiple challenges such as mental illness, addiction, homelessness, social isolation and a history of trauma. Having an interdisciplinary staff team on site means that a consumer’s support team can include, for example, alcohol and other drug education, counselling and medication support, general medicine, mental health therapy and legal representation. The support team can quickly expand or change around a consumer at any time to reflect the type of support they need. Mr Lawrence believes that services should aim to provide all the help people want and need from one team in one place.

If … an individual has multiple areas of their life … that are adverse enough to be debilitating, then each area of deficit is likely to hinder improvements in each other area.

According to Mr Lawrence, communication is vital to providing interdisciplinary care.

Planning and implementing care as a team is not possible unless the staff can communicate in a variety of forums, with or without the client present: clinical meetings, case conferencing, ad hoc conversations etc.

Megan* is currently participating in a program run by First Step. She notes that one of the main benefits of First Step is that ‘all the right people to refer me to are in the same hub’. Previously Megan had felt that her health services were disconnected from each other, but First Step was able to provide her with a range of health services and legal services in a supportive environment.

With all of my connections at First Step, I couldn’t believe that all these people took an interest in me and my wellbeing. I felt safe and was able to disclose things, including a legal matter … I was able to avoid a conviction because I was represented by people who knew me.

Mr Lawrence reiterated the importance of providing all of the services under one roof and the effect this has on building trust with clients.

In addition to this life‑saving convenience around service delivery, our approach is also based on the building of trust that comes from team building rather than referring or directing clients to other service providers.

First Step also provides support to carers. While Natalie’s* son was provided with therapeutic and legal support services, Natalie was also able to access support herself.

It didn’t occur to me [that I too could access support] before someone from First Step reached out to me and asked if I needed help … First Step had a mental health nurse look after me and my hyper anxiety, my confusion about what addiction was, the pharmacological changes that were going on in my son’s brain and my own reaction and behaviour.

Source: First Step, , [accessed 16 July 2020]; First Step meeting with Commissioner Armytage, 7 April 2020; Witness Statement of Patrick Lawrence, 28 May 2020; RCVMHS, Carer Human Centred Design Focus Group—Alcohol and Other Drugs: Record of Proceedings, 2020. Note: *Names have been changed to protect privacy.

Photo credit: Patrick Lawrence