Dr Poonam Baskaran

My Health North Richmond

Level 1, North Richmond Village

6-16 Riverview St

North Richmond

NSW 2754

06.10.2024

Re: Alison Falzon (DOB: 24/08/1972) GP MHCP review

Dear Dr Baskaran,

Thank you for referring Alison Falzon to see me under a GP MHCP in April, 2024, for anxiety and depression.

Alison attended her first appointment on the 25th of March, 2024. She has had fortnightly to monthly consultations over the past six months. I write to provide you with a review of her care, and to acknowledge the additional sessions you provided her in July, 2024.

Initial Presentation

At the time of her initial consultation, Alison reported struggling with anxiety and low mood in her personal life. This contrasted with work (customer service management), where she felt confident and ‘high functioning’. She reported that emotional difficulties stemmed from her past relationship with her ex-husband, in which she was the victim of physical, emotional, financial and psychological D/V. They were married for 20 years, separated 10 years ago, and had 3 boys, now aged 19, 21 and 23. Alison reported that following their separation, her middle son was influenced by his father in a way that created a difficult dynamic in the house, with episodes of explosive verbal abuse and hostility. The situation escalated to a point where Alison felt threatened and intimidated, which culminated in her son moving to QLD to live with his father. Estrangement from her son has contributed to emotional distress.

The relationship stressors with her ex-husband impacted Alison and she considers that she has not recovered from it. She reported an undermining of her sense of self, including loss of confidence and ability to make decisions. She continues to live in fear that he may turn up at her house and establish previous patterns of intimidation/coercive control.

Life stressors include working full-time to support her family as a single mother, with little time for self-care; feeling unsupported in the home by her adult children; estrangement from her middle son; youngest son has ASD. This is compounded by low self-worth stemming from relationship patterns within her own family (parents and siblings) that make her feel unappreciated and dismissed.

Mental health history

No previous mental health history

Medical history

2006: Hysterectomy, vaginal with AP repair (from GPs referral)

Medication

Circadin 2mg prolonged release tablet nocte

Saxenda 6mg/mL pen device, 0.6mg once a day, increasing to 3mg daily

Supports

Alison lives in her own home with two of her 3 sons. Her 3rd son has been estranged for the past years, however they have recently reconnected.

Alison has a partner, however she prefers to live separately. They own an investment property together, which they had planned to eventually live in together, however they have recently decided to sell the property.

Both her parents are still alive and live locally.

Update

Alison engaged well in all sessions, gradually developing insight about the underlying causes of emotional distress. As a result, her mood improved and she developed better work/life balance. A range of psychotherapeutic interventions were utilised to support her recovery, and some of these resources and strategies Alison was active in following through to create changes in her life. These included improving communication with her children, parents and partner and managing anxiety. She reported feeling stronger and being able to speak up more for herself. In September, Alison had contact with her estranged son, resulting in the first steps towards repairing the relationship. This was a positive turning point for Alison, however she is anxious in case the improvement is not maintained.

On the 5th of October, Alison contacted me following a series of issues at work, culminating in a communication exchange where she felt victim of verbal abuse by an aggressive staff member. Alison became overwhelmed with emotion and had to leave work. Whilst this staff member was out of line, Alison also realised there was a connection with his manner and her ex-husband’s communication style, which was triggering. She had also been working long hours with no time for self-care and came to understand that she was experiencing exhaustion and/or burnout. Following an exploration of the issue, Alison planned to take a 5-day break from work to focus on relaxation and recovery.

MSE

Behaviour: settled in sessions; good eye contact and easy rapport.

Mood: “I feel overwhelmed and anxious” (following a period of sustained improvement in mood)

Affect: congruent with mood; generally, reactive;

Thought form: Logical/sequential.

Speech: normal rate, tone and volume

Cognition: not formally assessed, however has high functional capacity at work.

Perception: No alteration in perception expressed.

Insight: developing insight about underlying causes of distress

Judgement: Good. Seeking additional support when needed.

Formulation:

52 year old employed single mother of Italian descent, living in own home with 2 of her 3 adult children, presenting with anxiety and depression in background of previous D/V relationship.

Impression:

Consider: anxiety; trauma disorder

Plan

Alison would like to continue seeing me until she has reached a point where she no longer requires psychological support. You have provided her with extra sessions under Medicare, however Alison advised that she has been told by Medicare that there are no more rebates available for this year to see me. This could be because I am a credentialed mental health nurse (CMHN) and not a psychologist. Unfortunately, people can only see CMHN under Team Care Arrangements, which allows up to 5 sessions per year.

Yours sincerely,

Michelle Hookham