Dr Cristina Arguedas

My Health North Richmond

Level 1, North Richmond Village

6-16 Riverview St

North Richmond

NSW 2754

23.04.2024

Re: Lorraine Skolyszewski (DOB: 01.04.1962) NBM9031 Review

Dear Dr Arguedas,

Thank you for referring Lorraine Skolyszewski for a Wentworth Healthcare Extended plan for psychological support for ‘moderate depression and PTSD’. I am her allocated provider under Wentworth Healthcare and write to provide you with a review at the end of her plan.

Lorraine attended her first consultation on the 19th of July, 2023. She attended fortnightly to monthly consultations as needed, with her review being held on the 15.04.24

Initial Presentation

At the time of her initial consultation, Lorraine reported that she had been “depressed for a long time,” but had been particularly worse the eight months prior to her first session. She attributed this to multiple psychosocial stressors, including the following:

Her son’s separation from his partner and subsequently becoming primary carer for his two children aged 1 and 3.

Poor relationship with her son

Her son’s incarceration and ramifications of that

Subsequent requirement to put the children into FaCS foster care 6 years ago, as was not coping

Grief, loss and guilt about this decision

Relationship breakdown with her own adoptive family following the death of her (adoptive) mother. “Siblings told me I wasn’t good enough daughter, so changed her will to exclude me.”

Adoptive siblings allegedly changed will to exclude the adoptive children. This led to feelings of shock and rejection

GP suggesting employment, but this puts increased pressure

Relationship stressors from adoptive siblings triggered frustration, anger and sense of injustice. She stated “I have lost two families: my birth family and adoptive family.”

She has a history of not talking about emotional stressors

Lorraine stated “I feel like I’ve lost the plot.” She reported difficulty making decisions and had no motivation to leave the house or exercise. Her sleep was “terrible” and she was taking Melatonin to help. She reported feeling drained and exhausted.

19.07.23 K10 Score: 43/50

See previous correspondence for comprehensive mental health assessment.

Update

During the second half of 2023, Lorraine attended monthly consultations. A range of psychotherapeutic interventions were utilised to support her recovery. Lorraine was able to work through her situational stressors, including difficulties with neighbours and family members, and explore underlying causes and triggers for anxiety, with good effect.

In December, Lorraine reported medical issues, including low Fe and blood in stool test. She was referred to a specialist. At that time, her mood was low. She considered that her deterioration in mental health was attributed to the change in medication, from Dothiepin to Cymbalta. The constant pressure from Centrelink to look for work was feeling overwhelming for her and we discussed voluntary work as a more manageable option. We also explored the possibility of attending local social and craft groups. We explored trauma and attachment theory in relation to Lorraine’s life experience, which helped her develop insight into her adverse life events and their impact.

Lorraine’s need for psychological support decreased in 2024. At the time of her review on the 15.04.24, she reported that she was “much, much better; I just started to feel better about a month ago.”

She had started volunteering and had met new people. She had had a few life crises, but had been able to manage these well without experiencing a major set back. She was seeing more of her grandchildren and more of her ex-husband, which she was enjoying.

Formulation:

61 year old unemployed female, living in DoH villa, presenting with resolving depression and PTSD in background of multiple psychosocial stressors.

Impression

PTSD; depression. Currently doing well

Plan

Referral has been closed.

Should Lorraine need additional support at another time, I would be happy to see her.

Yours sincerely,

Michelle Hookham