Dr Therese Roberts

Kellyville Village Medical Centre

Shop 10, 90 Wrights Rd

Kellyville

NSW 2155

15.07.2024

Re: Julie McGrath (DOB: 13.10.1965) Mental health assessment (MH Ax)

Dear Dr Roberts,

Thank you for referring Mrs Julie McGrath to see me in February, 2024, under Wentworth Healthcare’s PTS program, for ‘complex trauma reaction and depression’. I am a Credentialed Mental Health Nurse (CMHN) in private practice, and write to provide you with a mental health assessment and update. I also include my report to Centrelink to support her application for the disability support pension (DSP), for your information and reference.

Julie had her first appointment with me on the 18th of March, 2024. She has attended fortnightly to monthly consultations since then and has gradually started to open up about her past history of traumatic life events and the impact they have had on her life and functioning.

Initial Presentation

At the time of her initial appointment, Julie stated that she didn’t like talking about her life, however, was able to begin sharing her challenges stemming from a 10-year history of domestic violence by her ex-husband (see below for more information), who she described as “extremely violent, aggressive and manipulative.”

Julie was the victim of domestic violence between the years of 2003 to 2013. The relationship with her husband broke down in 2005, however the alleged coercive control, intimidation, obsessive stalking, and verbal threats continued until 2013. Prior to the D/V, Julie had an active social life, was confident and enjoyed her work. However, through prolonged exposure to D/V, she reported feeling “degraded”, lost her self-confidence, self-esteem, her supports and has come to realise that she had been in “survival mode” since then, with frequent episodes of fight/flight activation.

The adverse events associated with the D/V include legal proceedings and losing custody of her second child for four years, all of which have had an ongoing impact on Julie. She continues to struggle with anxiety, worsening depressive mood and reliving past traumatic events. This contributes to mood instability. Julie stated “I get cranky really quickly; I get upset easily; I don’t have patience or tolerance; I try to avoid conflict; I worry about my response; I lash out and am always hypervigilant; always on guard; fear of ex finding me; I’m always scanning the environment for threat or danger.”

Julie has experienced other stressors more recently. Her mother passed away in October 2018 and Julie had been living with her as her primary carer during the final states of her terminal illness. Subsequently, Julie felt lost, as she went from full-time carer to “having nothing to do.” Two years later, her father passed away, further compounding her grief and loss. This was triggering for Julie, as she felt unable to protect her daughter from harm. Further, Julie’s car was involved in a MVA in February, 2024 and her car insurance claim has been unresolved since, causing ongoing stress.

Mental health history and current presentation

Julie had no prior history of mental illness prior to the D/V relationship.

She saw a counsellor occasionally whilst going through relationship difficulties, and child custody issues, referred by her GP, Dr Roberts and the court.

Physical health

Julie has physical health challenges

Cardiac disease – pace maker inserted in January 2019 to manage AF; stents;

Dressler syndrome (lungs fill up with fluid); atrial fibrillation (AF)

Sees cardiologist at Royal North Shore Hospital

Type 2 Diabetes diagnosed in 2019

Arthritis

Sleep apnoea

Cyst on left lower eyelid

C-Section with second child wound infection and sepsis

History of multiple fractures as young child from sporting injuries

Developmental history

Julie grew up in Carlingford until age 21 when she married.

She is the youngest of four children: Oldest brother is deceased; second oldest brother (65) lives in Foster and Julie is estranged from him; third sibling is a sister and aged 60.

Julie described her childhood as “good; close family and friends”

Went to Carlingford High to year 10, then worked as a travel consultant until 1989, when she had her first child.

Met first husband age 15; had first child, Jade, in 1989; separated amicably in 1991.

1992: worked for Sherriff’s Office, as District Court Officer, until 2004, when Kimberley was born. Julie enjoyed this work and regretted not having studied to become a lawyer.

Julie met her second husband, Chris, at work in 1991 (he was in the police force), and started dating a few years later. He was diagnosed with PTSD and medically discharged from service in 2000. He had multiple admissions to SJOG and suicide attempts.

Following their separation in 2005, Julie lost custody of Kimberley, from age 10 – 14.

Moved to Harrington once she resumed custody of Kimberley, to enable the continuation of her schooling.

Returned to Sydney after that period and currently resides in the Hawkesbury.

Domestic violence

Julie reported that her relationship with Chris was initially good, however Julie stated that he “treated my first child terribly”. Their relationship deteriorated after a few years, when Chris became paranoid of Julie’s activities and controlling of her movements and relationships, culminating in a prolonged period of alleged domestic violence, characterised by physical, verbal, psychological, financial violence, entrapment, and stalking. However, because of his seniority in the police force, Julie considered that he had been protected by his colleagues, resulting in her reported episodes of assault and abuse not being recognised or addressed by the justice system. Julie stated that Chris used his knowledge of the legal system to have Julie deemed an ‘unfit mother’, and she subsequently lost custody of their daughter, Kimberley, when she was 10. Kimberley was initially fostered by Julie’s sister and went to live in Baulkahm Hills, until Chris won custody, after which she lived with him in Taree from age 12 to 14. Julie was permitted supervised visits once a week. For Julie, the injustice that her experiences were not believed or validated were very difficult for her to comprehend, especially as her own siblings did not support her position. And then to lose custody of her daughter to a man she knew to be violent caused significant anxiety and distress over a prolonged period of time. As soon as Kimberley was old enough to legally leave her father’s care, she ran away from home, returning to Julie at age 14.

Family history

Mother died of Hodgkinson Lymphoma in October, 2018.

Julie’s youngest child has anxiety and depression from adverse childhood events.

Father died in 2020 at age 89 of old age health problems.

Update

Over the last six months, Julie has opened up more about her past traumatic experiences. One of the emerging areas of insight through the psychotherapeutic work has been the realisation of her protectiveness towards Kimberley because of her forced removal from her mother’s care as a child. Julie has become aware of these subliminal patterns and is working towards changing the associated behaviours.

As Julie has started to improve, she has begun to systematically clean out her garage, including boxes of stored items, papers and photos. This has been cathartic, as Julie has uncovered things from the past, triggering memories and emotions from difficult times. Even so, she has found it therapeutic to throw things out and declutter.

Julie’s garage flooded in April, 2024, adding an additional stress. I tried to connect her with flood recovery services, which she followed up, however she was not entitled to any financial assistance.

Functioning and Supports

Julie lives in rental accommodation on Job Seeker, with medical certificate.

Has to move often, which contributes to anxiety.

She has her own car, but no savings. After the breakdown of her marriage, there was no financial settlement that she benefited from and had to take money out of superannuation to live on.

Both her parents are deceased.

Julie is currently on Centrelink benefits – Job Seeker, with medical exemption, however work is not realistic at this time, and both yourself and Centrelink have recommended that she apply for the DSP, which she is in the process of doing. I have written a report to support her application, which I have enclosed for you reference.

MSE

Appearance: Caucasian woman

Behaviour: Good eye contact; at time guarded to talk about traumatic life events

Speech: normal rate, tone and volume

Thought form: Logical, sequential.

Affect: congruent with mood. Reactive; weeping and showing anguish when talking of traumatic events

Mood: “I feel devastated”

Content: as stated above.

Perception: no apparent alteration in perception.

Insight/judgement: Julie is becoming more aware of the impact of trauma on her emotional wellbeing and overprotectiveness of her youngest daughter.

Formulation:

58 year old Caucasian female, living in rental accommodation with her 21 year-old daughter, presenting with CPTSD, anxiety and low mood in background of a D/V relationship with her ex-husband.

Impression:

Complex PTSD.

Plan

Fortnightly consultations or as needed.

Yours sincerely,

Michelle Hookham