Dr Nadine Kauley

Advanced Medical Practice

George St

Windsor

NSW 2753

18.06.24

Re: Pheonix Horsfall (DOB: 24.03.1994) Wentworth Healthcare PTS referral review

Dear Dr Kauley,

Thank you for referring Pheonix Horsfall for a Wentworth Healthcare PTS plan for psychological support for psychological support for anxiety and depression back in April, 2024. I write to provide you with an update and to let you know that I have closed the referral due to lack of contact.

Pheonix attended the first consultation on the 12th of April, 2024 under the new plan. She had previous referrals to see me in 2021/2022. She did not attend the following four scheduled appointments, due to work commitments. I tried several times to contact her by phone to check in or reschedule, however Pheonix I have been unable to speak with her. With no further contact, I closed the referral on the 18th of June, 2024.

Initial presentation

At the time of her initial presentation, Pheonix reported high stress levels associated with managing a food outlet on continual night shift, and supporting her young family. Her partner had recently moved into the home with Pheonix and her three children (aged 7, 8 and 9) from a previous relationship. Work stressors included feeling a lack of understanding from managers that she was managing a family whilst trying to work nights, combined with increased tasks allocated to her. She felt frustration and resentment about this, and felt “frazzled and exhausted” by the end of each shift, with less energy for the family.

Pheonix reported feeling edgy and under high pressure. She was sleeping very little as had to manage the children and domestic load during the day, and would only get a few hours per day. She was aware the situation was not sustainable, however was struggling to consider another way of supporting the family. She was missing spending more quality time with them, but considered it a "short term pain for long term gain". She reported that a lack of sleep and stressful work in a "toxic" work environment was causing high stress levels.

Pheonix reported ongoing challenges with her ex-husband and perpetrator of physical and psychological D/V to herself and the children. He had had his hours with the children reduced to supervised contact once a fortnight, following episodes of violence towards the children – allegedly threatening and striking them about the head. The children had voiced this both at school and home, which resulted in DCJ mandatory reporting and an ADVO taken out against him. The children don't like visiting their father, however continue to attend as per the order.

Pheonix reported deterioration in physical health, including low Fe, heart palpitations and hand tremors. She was aware that her dietary intake was poor, stating that she eats breakfast with the kids and dinner but nothing else.

MSE

Behaviour: Pheonix presented in a heightened state.

Speech: pressured; uninterruptible

Thought form: logical, ordered, sequential

Appearance: petite caucasian female with shoulder length hair tied back; wearing gym clothes; clean and immaculately groomed.

Mood: anxious Affect: reactive; congruent

Content: as stated above

Cognition: not formally assessed; holding down managerial position and functioning at hyper level Insight/judgement: good; is aware of impact of current stressors and considering ways to make changes.

Formulation

30 year old Caucasian female, presenting with anxiety and depression, in background of complex psychosocial stressors and past history of domestic violence.

Assessment

Generalised anxiety disorder in background of multiple stressors, with past history of D/V relationship and PTSD from that.

Update

Pheonix did not attend the following four scheduled appointments, due to work commitments or just not turning up. I tried several times to contact her by phone to check in or reschedule, however I have been unable to speak with her. I understand that she has since left that position and was seeking alternative employment.

With no further contact, I closed the referral on the 18th of June, 2024.

Regards,

Michelle Hookham