Dr C Rowe

Highway 50 Medical Practice

50 Great Western Highway

Blaxland

NSW 2774

18.06.24

Re: Patrick Mallia (DOB: 17.03.1977) Wentworth Healthcare PTS referral review

Dear Dr Rowe,

Thank you for referring Patrick Mallia for a Wentworth Healthcare PTS plan for psychological support for emotional challenges associated with grief and loss in November, 2023. I write to provide you with an update at the close of this referral.

Initial presentation

Patrick attended the first consultation on this plan on the 10th of November, 2023. He attended four appointments over the next six months, with his final review being held on the 5th of June, 2024.

At the time of his initial consultation, Patrick reported a deterioration in mental health following the death of his 19 year old daughter, Casey, who had been in a fatal MVA . He was experiencing anger at the circumstances of her death and injustice that the driver of the vehicle had not been incriminated. He stated the “roll on effects have been devastating” and his family continued to struggle to come to terms with the loss. He reported ongoing flashbacks of the accident, and hearing Casey’s screams.

Patrick reported that since her death, he suffered with chronic insomnia; increased anxiety, with heart palpitations and shortness of breath. He experienced guilt as a father, from a perception that he had failed to protect Casey. He denied suicidal ideation.

Patrick reported other stressors in his life, including his 16 year old daughter recently being diagnosed with autism.

10.11.23: K10 score: 30/50

Past history

Patrick reported a history of “severe depression and suicidal ideation” prior to Casey’s death, treated with psychotropic medication, however he felt that this had just “put a cap on it”.

Patrick had had weekly sessions previously, under the CTP cover. He had tried EMDR, which had helped change the focus of traumatic dreams.

Patrick has a past history of opiate addiction, which had been used to treat back pain. He denied current use.

He finds talking therapy helpful and is a member of Beyond Blue.

Family history

Patrick’s mother had psychotic depression, with 3 inpatient admissions.

Update

Patrick struggled in the lead up to Christmas, 2023, because it was the anniversary of Casey’s death and also the constant reminder of her not being there with the family rituals. Our sessions focused on helping him prepare mentally for the event, including grief theory, relationship and self-care strategies, which Patrick reported had been helpful. He managed to get through Christmas with less distress than expected. In the new year, he focused on work and cancelled several appointments.

At the time of his review in June, 2024, Patrick provided an update about his life's current challenges. His daughter, Autumn had been accepted into a program for Tourettes for 3 months, which required a lot of family input and travel to the city. However, they feel optimistic about her progress and hope for improvement. Once the family adjust to the new routine, Patrick plans to recommence gym with his son, three times a week. He used to do that in the past and is looking forward to doing it with his son.

Patrick reported significant improvement. He was coping better with grief and felt like the family were all moving forward. He still has bad days, however he and his wife Sue support each other. Patrick had also quit smoking, with the assistance of nicotine patches and felt committed to staying off tobacco.

In July, the whole family are going on a cruise. Patrick is really looking forward to family time and stated that they have decided to do things together as a family as part of moving forward. He realises it might be triggering, as Casey was on the last cruise Casey.

Patrick stated that coming to see me had been helpful. We discussed his therapeutic needs going forward and Patrick does not consider he needs additional support at this time.

05.06.24 K10 score: 15/50

MSE

Walking stiffly; stated he has overdone it at work and a bit sore. Good eye contact; easy rapport; Relaxed in session Described mood as "much better" Affect bright and reactive; Thought form: logical and sequential; No alteration in perception; Good insight and judgement: aware of grief and triggers and seeking help as and when needed.

Assessment

Significant improvement.

Plan

Referral has been closed, at Patrick's request. He is aware that should he need support at another time, he can either get a new referral or just book an appointment.

Regards,

Michelle Hookham