Dr Dilani Balendran and Dr David Chow

Tindale Family Practice

115 Lethbridge St

Penrith

NSW 2750

25.06.2024 CONFIDENTIAL

Re: Jasmine Wilson (DOB: 26.12.1951) Mental health assessment

Dear Dr Balendran,

Thank you for referring Jasmine for an Extended care plan for therapeutic support for “depression and anxiety disorder” in October, 2023. I am her allocated provider through the Wentworth Healthcare PTS program and write to provide you with a review at the end of this referral.

Jasmine was previously referred to see me via Head to Health in August, 2022 and by Dr Arun Reddy in January, 2023.

Initial presentation

At the time of her initial presentation in August 2022, Jasmine reported feeling depressed. A single woman living alone, social isolation related to Covid lockdowns had impacted her. She stated that she had lost confidence in herself and expressed low self-worth.

Jasmine lives in a flood-prone area of the Hawkesbury and experienced increased anxiety about evacuations in 2022.

Jasmine reported a lack of energy, “with a feeling of heaviness as if hard to lift the feet and walk”, however medical tests had been NAD.

Over the course of her previous plan, Jasmine outlined a history of complex psychosocial challenges stemming from her childhood and two previous marriages. These have resulted in difficult relationships with some of her children, which continue to cause emotional distress.

22.08.22 K10 score: 21/50

22.01.23 K10 score: 16/50

See previous correspondence for comprehensive mental health assessment.

Mental health history

Disordered eating – reported a history of emotional binge eating and associated guilt; “acting out with food”. Jasmine reported a history of brain fog after bingeing and also anxiety about social engagement afterwards because of the impact of this on her digestive system.

Physical health

Asthma since age 7; on inhaler medication

Allergies

Irritable bowel; digestive issues

Family history

Mo: stroke – died 20 years ago; paranoid thoughts moving constantly.

1 sister has schizophrenia and had multiple admissions and ECT.

Tania (daughter) diagnosed with BPD.

MGF: “talked to self and possibly had mental illness”

Supports

Retired 4 years ago.

Active with Probus.

Has become engaged in many hobbies, including yoga, pottery and drumming.

MSE:

Appearance: petite 70 year old retired, single female with short grey hair, dressed in smart casual clothing; good attention to hygiene and grooming.

Behaviour: Bright and reactive; eager to engage; good eye contact and easy rapport.

Speech: normal rate, tone and volume

Mood: was depressed, however after the first plan, stated “I feel much better in myself.”

Affect: reactive; congruent with mood. Tearful at times when speaking of past experiences.

Thought form: logical, sequential.

Content: as stated above

Perception: No alteration in.

Cognitive: not formally assessed, however is able to process complex questions.

Insight: developing. Is beginning to see the underlying cause of distressing emotional experiences.

Judgement: good; is keen to continue therapeutic engagement whilst working through adverse past events.

Update

Over the past six months, Jasmine has continued to process emotional challenges associated with previous adverse life events and associated negative core beliefs and behaviours. She enjoys the deep psychotherapeutic work and the insights she gains about her responses and coping strategies.

Unfortunately, she has had an ankle injury and back injury during this time, which have limited her ability to go out and socialise, compounding her feelings of social isolation, contributing to low mood. She has been seeing a physiotherapist for these issues, however progress has been slow. Jasmine had planned to attend her daughter’s graduation in Europe in July, however cancelled because of her concern about managing her physical health challenges.

Jasmine continues to have a strong focus on food, which causes ongoing anxiety and self-reproach. She reports a pattern of emotional binge eating, then feels remorseful about it. She feels more positive when she adheres to a strict diet of very plain food. She reports a history of irritable bowel syndrome, and a range of foods cause her ongoing discomfort, flatulence and diarrhoea. She also has a high fibre diet, which may also contribute. Jasmine worries about socialising when her gut symptoms are worse, which also causes her to not engage and to maintain a strict diet. We have explored beliefs around food and intolerances, with no fresh insights developing at this time. Jasmine’s main goal is to retain her strict eating habits.

At the time of Jasmine’s review on the 17th of June, 2024, she reported feeling much better in herself. Her mood was bright and reactive and her mobility had improved.

Formulation

70 year old retired, single female, living alone in her own home; presenting with a history of anxiety and depression in background of complex psychosocial stressors.

Impression

Anxiety

Low self-confidence

Plan

Jasmine recently requested an additional referral to see me. Unfortunately, Dr Chow provided her with a standard GP MHCP, which is not ideal, as the gap fee is not feasible for Jasmine. Could you please contact Wentworth Healthcare intake line and change her plan to a PTS Extended plan?

Thanks and regards,

Michelle Hookham