Dr Padma Kaluarachchi

Conrad Road Family Practice

45 Conrad Road

Kellyville Ridge

NSW 2155

10.03.2025

Re: Elizabeth Ann Myra Tierney (DOB: 17.09.1963) MHNIPs 3-month Review

Dear Dr Kaluarachchi,

Thank you for re-referring Elizabeth Tierney to the Mental Health Nurse Incentive Program with Wentworth Healthcare. I write to provide you with an update and review. Her MHNIP plan is currently due for renewal, which is explained at the end of this report.

Initial presentation

Elizabeth was first referred to see me in May, 2019. At the time of her initial presentation, she reported psychosocial stressors, in particular the traumatic death of her mother in a motor vehicle accident 3 ½ years prior. She was subsequently diagnosed with anxiety, depression and PTSD and has not been able to work since. She reported difficulty sleeping, low appetite, weight loss and was ruminating about the traumatic event and had frequent flashbacks about the accident.

Elizabeth had previously worked as a school music teacher and loved her work and engagement with the children. Losing this joy in her life had further impacted emotional wellbeing, sense of purpose and routine. Elizabeth has no family support system, since she is an only child and all her elder family members have passed away. Once an active long-standing member of the community, she had become withdrawn and socially isolated. She expressed feelings of worthlessness and disappointment with herself for not being able to ‘bounce back.’

Physical health

Elizabeth has a comorbidity of physical health problems, including diabetes, asthma, chronic upper respiratory infections, high cholesterol, dental health issues, heartburn and has been seeing an immunologist for unexplained compromised immune system. She is a heavy smoker, even though she detests the habit and would like to change it. Over the past four years, her physical health has deteriorated significantly, with recurring infections (dental and URTI predominantly) requiring continual courses of antibiotics, viral illnesses and frequent GIT disturbances including chronic nausea and diarrhoea. She is under the care of multiple specialists, including respiratory, endochrinologist and immunologist. Elizabeth had a period of time where she had monthly Ig infusions, however she struggled with the side effects. I attended an appointment at Westmead Hospital with Elizabeth with her Professor of immunology to discuss her treatment and side effects at that time and it was agreed that since she continued to have recurrent infections whilst on the infusions, the benefits versus the side effects were considered and it was agreed for Elizabeth to take a break. Should she need to re-commence Ig infusions, Elizabeth would like to consider the option to learn to self-administer at home, with my support.

Elizabeth has recently found out that she requires eye surgery or is likely to go blind in her left eye. This has caused significant distress, particularly as she doesn’t have the finances available to pay for private care and the public waiting list is approximately one year. I understand that both yourself and Elizabeth’s optometrist are trying to get her prioritised on the list. We have also been exploring alternative pathways to fund the surgery, should she require to go under Medicare.

Update

Over the past year, Elizabeth has continued with weekly to fortnightly consultations. Unfortunately, because of acute exacerbations of physical health problems, including frequent upper respiratory tract infections/ influenzas/gastro, she has requested phone consultations on many occasions. Elizabeth states that both in-person and phone consultations help her to cope with adversity and to feel better, and she consistently reports improvement in wellbeing by the end of each session.

The key challenge for Elizabeth during this period has been her deterioration in physical health, which significantly affects her mental health. Impactful symptoms increase her anxiety about health and contribute to low mood. At times she becomes highly distressed, crying and struggling to feel optimistic about her future. It seems that every time she starts to move forward and re-engage with life, her health prevents it.

One of the positive impacts on her emotional wellbeing has been taking in a rescue dog, Ella. Her cousin Geoffrey has also moved onto her property. He has end-stage chronic health conditions himself, however they manage to support each other with their medical appointments and she finds it comforting to have him nearby.

Despite the challenges, overall I would say that Elizabeth has developed more resilience. When she has setbacks, she recovers more quickly and the impacts to her mental health are less severe. She is also more easily able to talk about her parents, with positive early life experiences, indicating that she is processing her bereavement and is less impacted by the PTSD following her mother’s MVA.

Supports

Elizabeth is now on the DSP, however she continues to struggle with financial stressors.

Geoffrey is her key support.

She has a cousin who recently moved to QLD who provides support when needed.

See previous correspondence for previous reviews and mental health assessments.

17.07.2023 K10: 35/50

30.10.2023 K10: 30/50

10.03.2025: K10: 35/50 (deterioration following news about eye surgery)

Formulation

61 year old retired music teacher on the DSP, living in her own home in Windsor, suffering with major depression and PTSD in background of witnessing the death of her mother in an MVA. She has comorbidity of chronic/complex medical issues, which significantly impact her mental health and emotional wellbeing.

Plan

Continue weekly to fortnightly sessions.

Care coordination as required.

Encourage Elizabeth to increase social engagement.

Ongoing psychoeducation; Ongoing health education as needed – diet, smoking, exercise, healthy lifestyle.

Dr Kaluarachchi, Elizabeth needs a new MHNIP referral. Could you please contact the intake team on

1800 223 365 at your soonest convenience?

Thanks so much.

Regards,

Michelle Hookham