Dr Michelle Li

Bligh Park Family Practice

Shop 10/6 Colonial Drive

Bligh Park

NSW 2756

25.02.2025

Re: Selena Glover (DOB: 10.08.1977) NBM6310 MHNIP, Review

Dear Dr Li,

Thank you for referring Selena for a MHNIP plan under Wentworth Healthcare, for therapeutic support for major depressive disorder, PTSD and grief. I write to provide you with a review.

Selena had her first appointment on the 17th of August, 2022. Since the time of her last review a year ago, Selena has attended fortnightly to monthly consultations and has made significant progress with her recovery.

Please see previous correspondence for a comprehensive mental health assessment.

Initial Presentation

At the time of her initial presentation in August, 2022, Selena reported a history of deterioration of her depression and suicidal ideation following the sudden and unexpected death of her husband in May 2022. He had collapsed in the bathroom, blocking the door and preventing Selena from providing emergency first aid. This has added to her grief, since she feels guilty and has recurrent thoughts that if she had been able to get to him, he may have survived.

Selena and Adrian had been married for 15 years. Selena reported an unhappy childhood and stated that after meeting him, her life improved and she found happiness, companionship and support. She is struggling to want to live without him and is scared that her life may go back to the unhappiness she knew prior to Adrian.

Selena works in a childcare centre and loves her work. She reported that her mood is better when she is immersed in work, however plummets at the weekend, since these were the times she and Adrian spent together.

15.08.22 K10 score: 35/50

Update

Selena has attended fortnightly to monthly consultations over the last year. During this time, she has experienced several challenges, including the anniversary of Adrian’s death and the first anniversary of her mother’s death, the death of her Aunty Sharon, and the financial settlement of her mother’s estate (April 2024). On the whole she has coped very well and has made significant progress over this time.

There were a couple of times where Selena had setbacks in her mental health. Anniversary times are always difficult reminders of grief and loss for her, however with each year that passes, Selena is managing better. The complex family dynamics triggered other setbacks, bringing up negative thoughts about her self-worth and belonging. Selena made the choice to distance herself from her siblings, which has proved to be of benefit to her emotional wellbeing. She feels more autonomous within herself, has become more independent and empowered to confidently make her own choices.

The most significant of such choices commenced in May 2024, when Selena decided to pursue becoming a foster parent. Over the rest of the year and early into 2025, she attended the DCJ training and assessment interviews and is currently awaiting the outcome. This has given Selena a focus and sense of positivity and purpose about her future. She and Adrian had always wanted a family but had been unable to, so it feels like a milestone for her to have the possibility of becoming a foster parent.

In November, 2024, Selena stepped up in her work role to director of the pre-school whilst her manager is on maternity leave. Initially anxious about taking on the role, she has settled into the increased responsibility with ease and is thriving on the challenge.

Over the past year, Selena has been able to take a couple of breaks - to her friend’s property in Taree and on short cruises with friends. Initially it was emotionally difficult for her to experience joy whilst grieving, however the cruise in December 2024 she enjoyed immensely and is currently gearing up for a trip to New Zealand with a friend. This demonstrates progress in Selena’s social recovery; she is engaging more with people outside her family, leaving the house more often and enjoying the experiences more. She has also travelled to Melbourne each December to assist with Adrian’s memorial scholarship at his (late) sporting club.

At Selena’s review in February, 2025 improvement in mental health was evident in her demeanour. She was smiling and laughing more, and when speaking of her life’s challenges arise, she expressed that she is coping better and recovers more quickly.

13.12.24 K10 score: 26/50

Physical health

On the 22nd of January, 2025, Selena reported feeling unwell. She felt nauseous and had a visible hand tremor. Her BSL was 5.5mmol, although she had only eaten a banana for breakfast and her appointment was at 4pm. She considered it might be caused by a decrease in her Effexor dose from 225mg to 150mg.

On the 22nd of February, 2025, Selena reported feeling unwell over the Valentine’s Day weekend. She reported extreme drowsiness for 24 hours, which she considered to be of emotional origin. She informed me that her BSL had been 2.2 mmol. I provided education about nutrition and blood sugar stability and the risk of hypoglycaemic episodes. She assured me that she will discuss it further with you at her next consultation.

Other medical conditions

11 year history of hypertension.

Continues to struggle with hypertension, despite having commenced on anti-hypertensive medication. After a recent increase in blood pressure, Selena’s GP changed her medication, however she experienced side-effects of nausea.

Has a history of diabetes, however managed with exercise and diet.

Hypertension/diabetes-related eye pathology, requiring injections (not macular degeneration), diagnosed in June, 2023. This was very distressing for Selena.

Medication

TBC

AOD

1 glass of alcohol per day.

Supports

Siblings; friends in Melbourne.

MSE

Appearance: Caucasian female, dressed in work uniform. Good attention to hygiene and grooming.

Behaviour: engaged well; good eye contact, easy rapport.

Affect: Reactive. Congruent with mood. Laughing and smiling

Mood: “I’m feeling a lot better.”

Thought form: Logical; sequential; no FTD

Content: as stated above

Cognition: not formally assessed.

Orientation: oriented to person place and time.

Insight: Good. Is aware of the impact of childhood trauma and recent grief on mental health.

Judgement: Good. Coped really well with the challenges.

Formulation

47 year old Caucasian female, working in child care and living in private rental, presenting with resolving major depression, PTSD and grief following the sudden death of her husband in 2022; in background of complex psychosocial issues, including childhood trauma.

Impression

Grief and loss; Major depression; PTSD. Recovering and doing really well.

Plan

Monthly consultations sessions for psychotherapeutic intervention.

Monitor mood

Focus on self-care and diabetes management

Dr Li, Selena’s MHNIP plan is due for renewal. She would like to continue for another year, as she finds the support an essential part of her recovery process. Could you please contact Wentworth Healthcare’s intake line on: 1800 223 365 to request a further plan?

Thanks and regards,

Michelle Hookham