Dr Alison Taggart

GWAHS

2 Palmerston Rd

Mt Druitt

NSW 2770

30.04.24.2024

Re: Tanya Mott (DOB: 22/10/1987) NBM10809 MHCP review

Dear Dr Taggart,

Thank you for re-referring Tanya Mott for an Aboriginal Torres Strait Islander plan for ‘anxiety and depression’ on the 26th of February, 2024. I am her allocated provider through the Wentworth Healthcare PTS program and write to provide you with feedback at the end of this plan, and to request another referral.

Tanya attended the first consultation of this plan on the 28th of February 2024. She attended fortnightly to monthly consultations, with a review being held on the 26th of April.

Initial Presentation summary (see previous correspondence for MH Ax)

At the time of her initial consultation in November, 2023, Tanya reported a deterioration in mental health following a range of psychosocial stressors including:

Tanya stated that she felt overwhelmed with all of the stressors and was unsure how to manage. Moving was a particular stress, as her partner’s belongings are extensive and difficult for her to pack up (cars, tools etc.).

Taya stated “I can’t endure anymore. She reported suicidal ideation, but stated “I haven’t acted on the thoughts and couldn’t do it to myself.”

Tanya showed signs of emotional distress, including anxiety and frequent crying when talking of her situation. Her thought processes showed a continual rumination of stressors, which was affecting her ability to make decisions and think clearly about a plan of action to tackle the challenges, not helped by her apparent lack of confidence in her ability to function independently. She was using cannabis to self-medicate, both to manage her anxiety and help sleep, which she was finding difficult.

She has a history of depression since the age of 14, and episodes of deliberate self-harm (DSH) between the age of 15 and 18. She reported a history of childhood sexual abuse. She was on antidepressant medication from age 15, but stopped 3 years ago. She has a history of cannabis use for the past 3 years to “sleep and relax”. However, now using medical cannabis. She denies other substance use.

24.11.2023 K10 score: 44/50

Supports

Tanya has been on the disability support pension (DSP) for 10 years. She has recently separated from her partner of 20 years and has moved into an independent dwelling on the same property as her parents’ rental property. She is close to her family and has two dogs.

Update

Over the last two months, Tanya has been through a period of continued heightened stress. She had received an eviction notice for her rental property and struggled to find a new home that was affordable on the DSP. This eventually resolved when her parents rented a larger property with a few independent dwellings, with Tanya moving in to one of them. Moving was particularly stressful, as her partner of 20 years, recently released from jail and on probation at his parent’s house, was unable to visit the property to pack and remove his substantial belongings. There was ongoing conflict between them as she attempted to get him to take ownership of his things and have them removed. Her brother and sister in law living in the flat underneath, also did not take accountability for leaving their flat in a satisfactory condition and Tanya is concerned that she will be held responsible of the state of the property on vacating the premises. Tanya moved last week, so these stressors should soon begin to ease.

In addition, the week of her moving house, due to actions of her partner, she took the steps to finally end their 20-year relationship. Whilst this was a decision she had been wanting to make, the finality of it was unsettling for her and she was going through mixed emotions at the time of her review, including anger and grief. Despite these challenges, Tanya has coped relatively well. She had episodes of high anxiety, and uncertainty about managing the logistics of all of the above, however she was able to get through. I observed an increase in self-confidence and more assertiveness in standing up for herself in difficult situations, demonstrating an improvement in mental health.

MSE: taking good care of personal appearance; engages well with good eye contact and easy rapport; affect is reactive and congruent with mood; thoughts are logical and sequential; no alteration in perception or expression of hallucinations or delusions; denies suicidal ideation and has hopes for the future. Is developing insight and shows good judgement in decision making and actions.

Because of the immediate stressors, Tanya has not yet been able to focus on earlier traumatic life events. I suspect that once she is settled and ready to move forward with her life, she may benefit by processing this to support her recovery. At the time of her review, she requested an additional referral. She stated that she finds it helpful to talk about her feelings and to have a place to release emotions and deal with things.

Formulation

36 year old recently separated woman of Aboriginal heritage, on DSP, presenting with anxiety and depression in background of complex psychosocial stressors and history of childhood sexual abuse.

Impression

Situational crisis.

Trauma disorder

Lack of self-confidence and self-worth

Lack of meaningful occupation and purpose in her life

Plan

Continue fortnightly to monthly sessions.

Could you please contact the NBM PHN’s PTS intake line and request an ‘extended’ care plan for Tanya?

Regards,

Michelle Hookham