Dr Rory Webb

Kurrajong Village Medical Centre

Shop 1, 66 Old Bells Line of Rd

Kurrajong

NSW 2758

18.02.2024

Re: Dolores Craig (DOB: 05.11.1963) MHNIPS review

Dear Dr Webb,

Thank you for re-referring Delores for a Wentworth Healthcare MHNIPs plan in May 2024. I write to provide you with a review. The plan is still current and not yet due for renewal.

Initial Presentation

Delores Craig was initially referred to me by her GP in November, 2019 for psychological support for complex post-traumatic stress disorder (CPTSD), generalised anxiety disorder and depression, associated with multiple biopsychosocial stressors.

Delores reported a ten-year history of not coping with everyday life, due to impacts of traumatic life events. She reported high anxiety and panic about everyday functioning, including situations that require engaging with the community, seeking employment, managing activities of daily living and meeting financial obligations. She stated:

“Anxious thoughts become overwhelming to the point where I just freeze and then can’t go outside.” Delores frequently has dissociative episodes and withdraws from people and becomes socially isolated, which contributes further to low mood. She stated that when anxious thoughts “all come crashing in, I have dark thoughts about not wanting to be here.” She reported suicidal ideation and thinks about ways to end her life when emotions become overwhelming. She frequently reported states of terror, with high levels of fear, out of proportion to the trigger, associated with the PTSD. At these times, she experienced agitation, shaking throughout her body, followed by periods of fatigue that lasts for days. Nightmares and flashbacks were impacting sleep, further affecting functional capacity.

The 2020 – 2022 Hawkesbury bushfires and flooding events were more recent triggers for anxiety, with further activation of PTSD, because of the association with other traumatic life events involving the death of loved ones in a house fire. Delores has experienced an additional reminder of past trauma associated with the registered missing person, and previous partner.

Mental health history

2024: Diagnosed with CPTSD by Dr Ruby Thavakulasingam (possibly other diagnoses, however I have not seen the report)

2016: Diagnosed with anxiety and depression.

2017: Diagnosed with anxiety and PTSD. Delores stated that the PTSD stemmed back to the disappearance of her partner in 1989 (who has never been found and whom Del continues to have nightmares about his disappearance).

Update
In July 2024, I accompanied Delores to see Dr Ruby Thavakulasingam for a mental health assessment for her DSP application. It was challenging for Delores to talk about her mental health history with a new person, however she felt very supported by Dr Ruby. You will have received her report, confirming a diagnosis of CPTSD, and possibly other diagnoses.

In September, 2024, Delores suffered a setback in mental health following the suicide of her brother, with whom Delores had a complicated history. It brought up memories of childhood trauma and the family background of domestic violence. His burial was delayed and there was disagreement between family members around his end of life care, which was overwhelming for Del. The traumatic memories triggered emotional distress over the next few months. Through counselling, Del found peace in her decision to farewell her brother in her own way. She was also able to process the complex emotions and flashbacks that she had been trying to suppress.

In December, Del was advised that her DSP application had been accepted. This has been a significant step in Del’s emotional recovery. The relief from pressure and financial stress is tangible and Del has been able to see a more positive future for herself since that time.

At the time of her last consultation on the 24th of January, Del reported feeling more at peace. She stated “there are still sad days, but I’m accepting that these will come and go.” She had been re-evaluating old patterns, clearing out unwanted belongings and felt much better to start the year with a fresh focus. She had made the decision to go camping up North (Hat Head) and had readied to do so. She had made the decision to follow her own truth and path and was feeling very optimistic. This was apparent in her presentation. Her affect was bright and reactive and in the best state of emotional wellbeing I have seen her in.

MSE

At the time of her review on the 10th of April, 2024, Delores was relatively stable. She described her mood as “fluctuating”, with periods of low mood where she isolates and doesn’t want to leave the house, and other times where she spends time with her family and feels very uplifted. Her affect is congruent with mood and she feels comfortable with me to express whatever emotions are coming up each time. She engages well in all sessions, though has difficulty sitting for long periods, because of her back pain. She frequently gets up and moves around to get comfortable. She continues to experience suicidal ideation in the background, with no plan or intent. It’s more the thoughts that when things get tough, it would be easier not to be here. There is no evidence of psychotic phenomena and thought form is logical and sequential. Speech can be pressured at times. Del has good insight about the underlying causes of her anxiety and demonstrates good judgement in seeking help when needed, although there can be a tendency to withdraw and avoid contact when not coping.

K10 scores over this period:

22.04.2024: 35/50 22.11.24: 33/50

Functioning and Supports

Delores is lives alone in a private rental property in Kurrajong.

She is now on the DSP

Delores has 3 children: Paloma: 27 (next of kin), Son, Beau: 31, Stien: 35

She has a few friends, who are supportive.

Formulation:

61 year old woman presenting with anxiety, depression and CPTSD in background of complex psychosocial stressors, including childhood trauma and recent suicide of her brother, seeking therapeutic support to reduce symptoms, improve her functioning and get her life back on track.

Impression:

CPTSD

Anxiety

Complex grief

Plan

Monthly consultations, or as needed.

Care coordination as required.

Work towards discharge.

Yours sincerely,

Michelle Hookham