Dr Z Parvez

Advanced Medical Practice

Windsor

NSW 2756

17.02.2025

Re: Julie Fink (DOB: 07.02.1971) Review

Dear Dr Parvez,

Thank you for re-referring Julie Fink for a Wentworth Healthcare’s MHNIP program, which was recommenced in March 2024, following a 3-month break in consultations, at Julie’s request. I write to provide you with a (long overdue) review of her care over the past year.

Initial Presentation

Julie was initially referred to see me under the Wentworth Healthcare SOS program following a presentation to Nepean Hospital/TAC in December 2020. At that time, she reported low mood and suicidal ideation. She was prescribed medication and discharged home for follow up with the Access Team.

At the time of her initial appointment she reported a long history of suicidal ideation and a recent deterioration in mood over the past few months. Julie reported that she had struggled since separating from her ex-partner 10 years previously. She was unsure of any triggers for this recent deterioration.

See previous correspondence for more information and comprehensive MH Ax, prepared for Dr Ruby Thabakulasingam in 2022.

Update

Over the past year, Julie has attended weekly to fortnightly consultations. Her level of engagement has varied, however, there has been an improvement in trust over the year, enabling Julie to talk about challenging life / adverse childhood events. At times, this has caused heightened emotions and unhelpful coping strategies, such as self-harming behaviours. However, she has been able to manage and recover a little better than in the past, showing some improvement. She has also gained insight about how adverse events have affected her.

Julie continues to struggle with low mood and chronic suicidality, at times finding it difficult to see a reason to live. Her children leaving home has contributed, since parenting has been Julie’s key focus over the past three decades. Her son is a protective factor, since he is still at home and school and Julie has voiced wanting to live to see him through school. Her youngest daughter has also recently moved back home.

Other stressors over the past year include relationship stressors between family members; work stress and pressure from the job agency affiliated with Centrelink.

Julie has had some physical health challenges, including a frozen left shoulder, for which she has had a cortisone injection recently. Initially she thought there had been no change, however over the weekend she reported some pain free days. She has been recommended surgery for this, but is unsure she wants to take that pathway. Julie has referred to another medical issue requiring surgery, but prefers not to disclose the nature of the issue to me.

Julie’s appetite has improved a little, from last year where she was eating one small meal a day. She reports more regular meals now and has regained the weight she had lost.

MSE

Appearance: 54 year-old woman of Aboriginal descent.

Behaviour: Reluctant to engage at times

Mood: “I’ve had enough.” Low mood

Affect: Flat

Thought form: logical; sequential.

Speech: normal rate, rhythm and quiet tone.

Content: as stated above.

Cognition: Julie reports poor literacy skills, however can read and write. She is able to comprehend and process complex questions.

Perception: No apparent alteration in perception

Orientation: oriented to time, place and person

Insight: Developing.

Judgement: Chronic suicidal ideation, however has continued to seek help and has not acted on the thoughts recently

Formulation

54 year old woman of Aboriginal descent, living in department of housing accommodation with her youngest 2 children (teenager and young adult), working part-time and on Centrelink benefits, continuing to struggle with low mood and chronic suicidal ideation in background of multiple biopsychosocial stressors and past history of trauma.

Impression

Consider: Complex trauma; PTSD; Borderline personality disorder

Plan

Continue weekly to fortnightly therapeutic intervention or as needed.

Trauma informed care.

Monitor mental/emotional state.

Risk assessment as needed.

Care coordination as needed.

Strict care with confidentiality.

Regards,

Michelle Hookham