Dr Toby Taleb Nasr

135 Metella Road

Toongabie

NSW 2146

18.06.2024

Re: Lawrence Attard (DOB: 21.11.1964), Review

Dear Dr Taleb Nasr,

Thank you for referring Lawrence for a Wentworth Healthcare’s MHNIP’s program in May, 2023 for psychological support for anxiety, depression and suicidal ideation in background of childhood sexual assault. I write to provide you with a review. Please see previous correspondence for information pertaining to previous referral periods. Refer to previous correspondence (20.01.20) for mental health assessment and background history.

Initial presentation

Lawrence experienced a significant deterioration in mental health in September, 2022 following an adverse court outcome, culminating in a suicide attempt on the 26th of October, 2022 and an acute admission to Orange Hospital. Following discharge, he had a period of low mood, with constant ruminations and questions about the trial, the associated injustice and associated lack of acknowledgement and validation of his adverse childhood events. At this time, he reported feeling very tired and was spending long periods of time in bed.

Update

Following a further deterioration in mental health at the end of 2023, Lawrence engaged in a more intensive weekly psychotherapeutic program, with good effect. Over this time, he was able to explore unhelpful patterns of thinking associated with his trauma history. Lawrence gained good insight into underlying causes of distress and gradually started to improve. In February, 2024, Lawrence, Esther and I attended a meeting with his lawyers for a debriefing about the outcome of his CSA hearing in 2023. The lawyers were able to provide Lawrence with information about his verdict and answer Lawrence’s questions which had been causing anguish ever since. Lawrence also got to express to the lawyers the level of distress he experienced as a direct result of the legal process and verdict. Whilst it didn’t validate Lawrence’s experience of childhood trauma, I think it helped him move forward to have this feedback. The level of rumination about the legal matters has decreased significantly since.

Lawrence continues to struggle with physical health issues, related to his chronic knee, back and elbow problems. His orthopaedic surgeon has indicated that he may need to consider retirement in the near future, which has caused further anxiety because of ongoing financial stressors. Lawrence’s mood is better when occupied and being productive, so retirement might cause challenges for his mental health. He continues to wait for the outcome of his work cover claim, which is another cause of frustration.

At the time of his review on the 12th of June, Lawrence reported feeling general improvement. He had had a set-back the previous week with low mood, however this passed in a few hours after being distracted by a work challenge. We discussed his progress, noting that he is able to move through set-backs quicker and continue to move forward. We discussed trauma theory via a metaphor of an iceburg; that there is still potential challenges under the surface, that could be triggered by family events where he feels poorly treated, or triggers related to CSA. However, the work he have done this round of treatment has given him the tools to notice the underlying patterns and be able to observe the pattern and not be as triggered by it. We discussed his care plan going forward. Lawrence was reluctant to close referral as unsure about future relapses.

Lawrence has started attending hydrotherapy for physical rehab.

Assessment

Doing well. Currently stable and managing well, despite significant financial stressors.

Plan

During the session, I contacted the WHL intake line and they agreed to extend Lawrence’s current plan for a couple of months. We agreed to decrease his sessions to monthly, and if Lawrence continues to be stable in mood, we will close the referral in the second half of the year.

02.05.22 K10 score: 33/50

11.11.22 K10 score: 45/50

03.05.23 K10 score: 21/50

13.12.23 K10 score: 32/50

12.06.25 K10 score: 21/50

MSE

Appearance – Middle aged man of Maltese descent, dressed in work clothes; good attention to hygiene and grooming.

Behaviour: Comfortable in consultations. Easy rapport. Good eye contact.

Describes mood as “I’m OK; a bit better; still up and down.”

Affect – Brighter; reactive; able to laugh and joke

Content – as stated above.

Thought form: logical; sequential.

Perception: denies alteration in.

Oriented to time, place and person.

Cognition: not formally assessed; no obvious loss of function.

Insight: Able to focus on other things and redirect negative thoughts more easily

Judgement: Good. Is aware of emotional challenges and actively taking steps to seek help and manage his emotions.

Formulation

59-year-old male of Maltese descent, with history of anxiety, depression and suicidal ideation in context of multiple psychosocial stressors in background of childhood trauma, currently recovering from a set back in mental health in November 2023.

Plan

Continue on the MHNIPs plan.

The plan has been extended for a few months, no further action is required from you at the moment, Dr Nasr.

Regards,

Michelle Hookham