Dr Susan Beattie

Norwest General Practice

5/1 Celebration Drive

Bella Vista

NSW 2153

03.02.2025

Re: Lina Thomas (DOB: 30/09/1972) MHCP review

Dear Dr Beattie,

Lina Thomas was referred to see me for psychological support through Head to Health in November, 2023. She attended her first consultation on the 24th of November 2023. She has been unable to attend regularly because of demands of caring for her family and disabled daughter.

Lina has advised me that you are her GP. I write to provide you with a review at the close of this referral.

Initial Presentation

At the time of her initial presentation, Lina reported feeling overwhelmed by the burden of caring for her daughter, Ava, who has a severe disability requiring full time care. Lina is her primary carer, hence unable to work outside of the home, contributing to financial stressors. Lina has also been impacted by a reduction in NDIS supports and occupational therapy for Ava, because of her behavioural and complex needs.

Prior to Ava’s birth, Lina had been part of a close-knit friend and church group, however since then, most of these friends had withdrawn, leaving Lina to feel left out and with no one to turn to. Ava has sleep apnoea and night terrors, and Lina has to sleep with her, which affects her quality of sleep.

She stated “I feel exhausted and don’t know how to cope or carry on; I need to get my life back.” She reported an aversion to leave the house and see people. She reported feeling guilty for Ava’s condition and for the effect her disability and care needs have had on the quality of life for the whole family. However, she is a devoted mother to Ava and wouldn’t consider having her cared for outside the home, not even for respite.

Lina was diagnosed with Hashimotos 6 years ago and reported migraines that can last for four days.

Lina has been taking Lexapro for the past year.

24.11.2023: K10 score: 39/50 – very high level of psychological distress

Update

Ava required multiple surgeries and post-operative care during 2024, which resulted in Lina spending many hours in hospital with her. A lack of support made it difficult for Lina to attend consultations with me, however I called her every few months to check in and have a chat by phone. She expressed appreciation for the support.

At the time of her review on the 22nd of January, 2025, Lina presented in person. She provided an update about challenges with Ava and financial stressors, indicating that nothing has changed in the demands on her role. Lina spoke of wanting to return to work for financial reasons and to get out of the house and socialising with others. We explored ways to proceed, however there were many limitations with Ava's pending surgeries and appointments, making it difficult for Lina to see a way forward.

Ava is due for an NDIS review, but until renewal of her plan, there has been no support since November. Lina advised that you had prescribed Seroquel for her, however she reported finding it too sedating the next day.

Supports

Lives with her husband, 10 (Ava), 16, 19 and 21 year old children

She receives carer support.

Formulation

53 year old Caucasian female, living in home with husband and four children, and primary carer for the youngest of whom has a disability requiring full time care; presenting with a history of low mood in background of complex psychosocial stressors.

Impression

Carer burnout.

Plan

Discussed care plan going forward. Lina is seeing psychologist at the hospital for Ava and to support her parenting challenges. She is aware that this referral has closed, however she would like to get another referral for herself to see me after March and will leave that with you both to discuss further.

If there were a way to establish regular carer support and respite care for Ava, I believe that would be the most beneficial avenue for Lina to have time out and recharge.

Regards,

Michelle Hookham