Dr Fuiaava Sipeli

Windsor Street Family Practice

131 Windsor St

Richmond

NSW 2753

16.06.2024

Re: Trent Dwight (DOB: 12.08.1977) MH PTS plan – close of referral

Dear Dr Sipeli,

Thank you for re-referring Trent for an Extended Healthcare Plan under the Wentworth Healthcare PTS program for ongoing care and psychological support for depression. I write to provide you with an update and to let you know that I have closed Trent’s referral, due to his persistently missing appointments.

See previous correspondence for other referral periods.

Update

At the time of Trent’s last appointment on the 17th of April, 2024, he reported a relapse in substance use, the first in several years. He stated that this was due to the reduction in methadone and not being able to get benzodiazapines to manage withdrawal symptoms. Trent had been working towards transitioning from methadone to suboxone, once methadone was down to 20mg. However, over the Easter break, he went to his chemist requesting valium and serepax two days earlier than his script and they allegedly said they wouldn't see him any more. Trent reported that he was not sleeping; was waking frequently and unable to switch his mind off without medication. At that time, we discussed options for dealing with addiction, however Trent was reluctant to commit to residential rehab or attending a medical detox unit. Further, Trent also stated that he had to find another Dr to prescribe methadone, as his current doctor was no longer available. Subsequently, he had to increase methadone back to 40mg per day. I referred him to Dr Yeow, Advanced Medical Practice, in Windsor, and he attended an initial appointment, however I am unsure if he has continued with him.

Trent reported ongoing psychosocial stressors at home, following his aunty moving into the premises, which he stated was impacting his self-worth. During this period of time, I had several phone calls with Trent’s mother, Teena, who reported a significant deterioration in his mental health. She reported that Trent was increasingly agitated and antisocial in his behaviour, which she was finding it difficult to tolerate in the home. He is thus at risk of homelessness. We discussed Trent’s deterioration in functioning, disorganised thought form, mood swings and anger outbursts. The outcome of the conversation was that we would like to request that Trent has a brain scan for assessment and to rule out any organic causes.

Trent did not attend the next several appointments, despite confirming attendance. Consequently, I closed his referral and asked Teena to let Trent know. I have not had any further contact with him since that time.

Past history

Trent initially presented in June 2020 with low mood with “thoughts of not wanting to be here”. He contributed this to several factors in his life, including unsatisfactory housing, significant debt and social isolation. In background of this is a history of substance use disorder, previous relationship breakdown, and having his children removed and fostered to other relatives. He stated “I break down every night.”

Low mood has led to functional decline, including decrease in self-care and loss of motivation. He has been unable to maintain employment.

Suicidal ideation includes thoughts to cut wrists or stab himself to “stop the pain”, however thinks about the impact that this would have on his mother, which is a strong protective factor. He stated that he had no plan to act on these thoughts at the time of this consultation.

Trent became emotional talking about the death of his father and not being able to attend the funeral in 2017.

He expressed low self-worth about the position he finds himself at this time of his life; the negative feedback he receives from his mother and his physical appearance of neglect compared to how he used to be.

Past history

History of aggression when provoked.

Suicide attempt by hanging; head injury and neck injury from banging his head against the wall whilst incarcerated.

2020 – 1 week admission to Nepean Mental Health Unit.

AOD

History of past IV drug use.

Long-term management with Methadone from clinic at Kenthurst – Dr Adam Gaudry.

Methadone reduced in January 2022 by 10ml to 55ml (was originally 120ml, then 70ml for a long time).

Support

Lives with his mother. Trent feels that he is not valued and feels marginalised in the home. He is on Centrelink benefits and has some occasional part-time work.

On Work Development Order (WDO), sponsor: Michelle Hookham.

Formulation

44 year old Caucasian male, on Centrelink benefits and currently unemployed; living with his mother; presenting initially with low mood, suicidal ideation (May 2020) and functional decline in background of chronic substance use disorder and biopsychosocial issues. More recently, has had a relapse in substance use disorder which is impacting his mental health and functional capacity.

Impression

Substance use disorder – currently working towards recovery; with associated functional decline.

Consider: brain injury or organic causes – thought disorder/disorganised thoughts; losing things continually; forgetting appointments and other memory challenges.

Plan

Referral has been closed.

Yours sincerely,

Michelle Hookham