Dr Raeik Kang and Dr Han

Patrick St Medical Centre

8 Patrick st

Blacktown

NSW 2148

17.02.2025

Re: Rebecca Valades (DOB: 20/06/1983) Wentworth Healthcare PTS plan review

Dear Dr Raeik and Dr Han,

Thank you for re-referring Rebecca Valades for a Wentworth Healthcare (NBM PHN) PTS plan for ‘chronic depression and anxiety’ on the 22.03.2024. I write to provide you with a review. Please see previous correspondence for a comprehensive mental health assessment and update from the previous referral period.

Rebecca has attended fortnightly to monthly consultations over the past year. She engages well in every session, and has been making steady progress throughout the referral period. Her plan was renewed in November, 2024 and is currently in progress.

Initial Presentation

At the time of her initial referral in August, 2023, Rebecca reported a deterioration in her mental health following workplace neck and shoulder injury and subsequent alleged bullying by her manager. She has since been out of the workforce and on Centrelink benefits, with an active workers compensation claim. In addition, in the middle of 2023, Rebecca’s daughter was badly bullied at school, an incident in which she lost consciousness and an ambulance had to be called. In trying to address the incident with her daughter’s school, and feeling they weren’t taking appropriate action, Rebecca became emotionally dysregulated and she was charged with common assault. This was out of character for her and Rebecca felt embarrassed and regretted her actions. She is currently on probation following this incident.

At the time of her initial session, Rebecca reported increased anxiety, with constant rumination about these distressing events. She stated that she felt overwhelmed and was “not coping”. Tears were close to the surface when talking about the incidents and had anguish about consequences of her actions. She described her mood as “sombre”. She stated “I feel burnt out, tired and exhausted. There are a lot of things I haven’t faced. I have no energy for life.”

Rebecca has a past history of post-natal depression in 2006; major depression in 2010; anxiety in 2015.

23.08.2023 K10 score: 39/50

Supports

Rebecca is a single parent on Centrelink Job Seeker payments.

She has three children living with her, age 11, 15 and 17.

Separated from her husband 10 year ago; divorced 1 year ago. They co-parent, however Rebecca is the children’s primary carer

She feels better when she is organised and the house is clean and tidy.

Yoga is helpful.

Formulation

41 year old unemployed single parent of Spanish descent, living with her three teenage children, presenting with anxiety and depression, in background of multiple biopsychosocial stressors.

Impression

Situational crisis due to recent stressful life events

Anxiety

Depression

Update

Over the past year, Rebecca has engaged well in psychotherapy. This has given her a better understanding of the underlying patterns associated with adverse past life events. This insight has enabled her to utilise coping strategies to better manage her emotions. She particularly benefits from breathing techniques, meditation practices and guided visualisation exercises, all of which give her further insight about ways to recover.

Social isolation and aversion to leave the home over the past two years has led to a deterioration in relationships. However, in the past six months, Rebecca has shown small signs of improvement in this area. She has begun a new friendship, invited the friend over to her home, and she took the children on a family outing during the school holidays, which was a positive experience for all.

Anxiety continues to be a challenge. After a gradual reduction in anxiety over the past six months, Rebecca had a recent setback when her daughters were looked at by an unknown male in a shopping mall. This triggered anxiety about her children’s safety to be out in the world, which she has been ruminating on since.

Rebecca continues to remain on workers compensation. Her neck/shoulder injury has been painful and she has tried a range of treatments, with no resolution yet. She had an independent medical examination in January, which she considered the doctor minimised her condition. She was concerned that this may diminish her claim and she would be unable to access services necessary for her rehabilitation and recovery. Rebecca reported that her neurosurgeon’s review, advised that her neck injury of 2 years was unlikely to recover and that surgery was not an option.

06.11.2024: K10 score: 36/50

Plan

Continue fortnightly to monthly sessions.

Rebecca has a plan in place at the moment. There is no action required from her GP at this time.

Regards,

Michelle Hookham