Dr Rory Webb

Kurrajong Village Medical Centre

Shop 1, 66 Old Bells Line of Rd

Kurrajong

NSW 2758

30.04.2024

Re: Dolores Craig (DOB: 05.11.1963) MHNIPS review

Dear Dr Webb,

Thank you for re-referring Delores for a MHNIPs plan. I am her allocated provider under Wentworth Healthcare’s PTS/MHNIPs programs and write to provide you with a review and to request a new MHNIP referral through Wentworth Healthcare.

I have attached a comprehensive mental health assessment I prepared for Delores’s psychiatric assessment with Dr Naaz, and also a preliminary DSP application support letter, which might be helpful for you to see my perspective.

Initial Presentation

Delores had her first consultation of this MHNIPs plan on the 27th of January, 2023. She reported a deterioration in mental health following stressors in her volunteer work place, which she had recently chosen to leave. Del stated that her moods had been “up and down” and that she was struggling to understand her reactions to the situation, including anger, anxiety and “deep sadness”. She stated that as a result of behaviours of a person in this workplace, it had triggered memories from adverse events in a previous relationship, which had triggered a trauma response. She stated “I have all this fear and terror in me” and reported that she had been crying all the time and sleeping a lot since stopping work, as feels exhausted.

Delores wanted to explore the underlying cause of her reactions to this situation and the impact it has had on her sense of self-worth. Other parts of her life were going well, including the relationships with her family and grandchildren, which had a positive influence on Del’s emotional wellbeing.

Update
Delores experienced a major setback in June of 2023. Her son had met a person who reminded her of a previous partner, who disappeared from her life without warning, and was a formal ‘missing person’. This triggered a lot of unresolved grief and trauma, which took a few months to process. During this time, Del reported increased anxiety, insomnia, nightmares, vertigo, headaches. She felt agitated and had racing thoughts, with difficulty concentrating on anything. A range of therapeutic interventions were utilised to help Del through this time. She gained insight that her PTSD stemmed from Andrew’s disappearance, following on from adverse childhood events.

In July 2023, Del had ongoing back pain from injury to L3, 4 and 5, with ‘bulging discs’, with pain extending down her legs, limiting her mobility and work options.

In January, 2024, Delores reported that the ‘dizzy spells’ were worsening. She had a neurological assessment and the outcome Del reported was ‘brain damage from alcohol abuse’, which she feels very embarrassed about. The cerebral aneurysm is unchanged. Del commenced Thiamine treatment, with good effect.

Delores had a psychiatric assessment with Dr Naaz in November, 2023, who diagnosed bipolar disorder; borderline personality disorder and generalised anxiety disorder. Del was taken aback by the experience, and did not agree with the outcome, hence did not want to commence on psychotropic medication with her other chronic health problems. After discussion, she decided to seek a second opinion and has a consultation with Dr Ruby Thavakulasingham on the 11th of July, 2024. I will attend the consultation with her, to provide support.

MSE

At the time of her review on the 10th of April, 2024, Delores was relatively stable. She described her mood as “fluctuating”, with periods of low mood where she isolates and doesn’t want to leave the house, and other times where she spends time with her family and feels very uplifted. Her affect is congruent with mood and she feels comfortable with me to express whatever emotions are coming up each time. She engages well in all sessions, though has difficulty sitting for long periods, because of her back pain. She frequently gets up and moves around to get comfortable. She continues to experience suicidal ideation in the background, with no plan or intent. It’s more the thoughts that when things get tough, it would be easier not to be here. There is no evidence of psychotic phenomena and thought form is logical and sequential. Speech can be pressured at times. Del has good insight about the underlying causes of her anxiety and demonstrates good judgement in seeking help when needed, although there can be a tendency to withdraw and avoid contact when not coping.

K10 scores over this period:

27.01.2023: 35/50; 22.04.2024: 35/50

Functioning and Supports

Delores is lives alone in a private rental property in Kurrajong.

She continues to live on Centrelink benefits – job seeker, which is not adequate to cover cost of living. She is motivated to find work, however is limited by chronic back pain from previous workplace injuries, and general functional decline.

Delores has 3 children: Paloma: 27 (next of kin), Son, Beau: 31, Stien: 35

She has a few friends, who are supportive.

Formulation:

61 year old woman presenting with anxiety, depression and PTSD in background of complex psychosocial stressors, seeking therapeutic support to reduce symptoms, improve her functioning and get her life back on track.

Impression:

PTSD

Anxiety

Plan

Fortnightly appointments or as needed.

Psychotherapeutic exploration of issues.

Care coordination as required.

New MHNIPs referral

Yours sincerely,

Michelle Hookham