Dr Nadine Kauley and Dr Kanwal

Advanced Medical Practice

Windsor

NSW 2756

29.04.2025

Re: Naomi Brooker (DOB: 26/11/1992) Wentworth Healthcare PTS plan; Comprehensive MH Ax and review

Dear Dr Kauley and Dr Kanwal,

Thank you for referring Naomi Brooker for a Wentworth Healthcare PTS plan for psychological support for ‘depression, borderline personality disorder and possible bipolar disorder’, in May 2024. Naomi attended her first session on the 15th of April, 2024. She has attended appointments sporadically over the past year, with large gaps due to inpatient admissions. I write to provide you with a review at the end of this plan. Naomi would like to continue after discharge from her current hospital admission, which will require another referral.

Initial Presentation

At the time of her initial consultation, Naomi reported a deterioration in mental health over the prior two months. She reported low mood, suicidal ideation and had had a recent attempt to take her life. She had presented to TAC at Nepean Hospital, however there were no beds. She had also had a recent admission to Katoomba Hospital. Whilst in TAC, Naomi saw a psychiatrist, who diagnosed BPD, CPTSD and depression.

Naomi reported complex and multiple traumas throughout her life with associated challenges. Preceding this episode of care, Naomi was the victim of a workplace injury in her role as carer. She had been detained in the house of an elderly couple who had dementia and possible paranoid psychosis and had possession of a firearm. The incident brought back the impact of adverse childhood events and Naomi was experiencing ongoing trauma responses, including hypervigilance, anxiety, dissociation, compulsive house cleaning, fear of losing control and insomnia. Prior to the incident, Naomi had a high level of functioning at work and was respected by peers. Since the incident, Naomi has been unable to work and her mental health had continued to deteriorate. She stated “the incident made everything boil over.”

Simultaneously, Naomi was affected by the relationship breakdown with the father of her youngest two children in January 2024. Following separation, the father assumed custody of the children without legal orders, restricting Naomi’s access to them, causing significant distress. The older two children from a previous relationship continued to reside with Naomi. Naomi had been recovering from the relationship breakdown well until the work incident, which caused a significant setback. Naomi has attempted to gain custody of her children via legal pathways, however is overwhelmed by the processes and can’t finance lawyers.

Naomi stated she was a victim of D/V in that relationship. Naomi stated that she had been dealing with police since November 2023 regarding the physical abuse and ongoing harassment and her ex-partner was subsequently charged with grievous bodily harm (GBH) and on an AVO.

Naomi reported low mood and withdrawing from people. She felt guilty about her suicide attempt and the impact on her family. Her functioning had also declined, with social withdrawal, amotivation, anhedonia and she was struggling to take the children to school. She stated, “I’m just existing.” Naomi had accessed therapeutic support previously, however said that as soon as she starts to feel better she stops.

15.04.2024: K10 score: 35/50

Mental health history

Deliberate self-harm (DSH) when younger

2023 Admission to Katoomba Hospital

Diagnosed with CPTSD and BPD in 2024 by psychiatrist in TAC

Nightmares throughout life

July 4th 2024: Admission to Hills Clinic.

20.08.24: Presentation to Nepean Hospital

04.09.2024 – 05.09.24: Kellyville Hospital for TMS, however treatment changed on admission and Naomi discharged herself; subsequent presentation to TAC due to increased DSH and suicidality with intent.

? 25.09.24: Return to Kellyvile Hospital under a new psychiatrist, for TMS.

January 2025: Admission to SJOG for ECT

March 2025: Admission to Kellyville (3 weeks) for medication review

10.04.25: Admission to Kellyville

01.05.25: planned admission to SJOG for ECT

Current diagnosis: Major depressive disorder (DSS); CPTSD; BPD

Current psychiatrist: Dr Arly, SJOG

Current psychiatrist: Dr Heimer, Kellyville Hospital

Developmental history

Naomi is the only child to her biological parents. Her mother re-partnered and had another three children.

Her mother was 16 when she had Naomi. Naomi doesn’t remember contact with her biological father.

Naomi lived in Hobartville age 5 or 6 with mother and step-father.

Her mother and step-father separated when she was 17.

She remains in contact with her step-father and he and his wife are her main supports.

Naomi reported adverse childhood events, including neglect, sexual and physical abuse.

She recalled an “unstable childhood and wanting to be loved; I begged someone to come and take me.”

Attempting to run away from home from age 4. MGM tried to intervene, to no affect.

Went to Richmond Public School

Shalvey High School Mt Druitt

Windsor High School, finished year 11

Sexual assault in Year 7 by Year 10 student, who was charged.

Violently assaulted by female students children’s court.

Worked in candy store in teens and became the manager during school years

Asked to leave home at age 17 (by her mother); followed by a period of sleeping rough

Met 1st partner and “life changed for better”.

Birth of children to first partner:

Age 21: Lucas

Age 23: Nate

Birth of children to second partner:

Age 25: Abbigail

Age 29: Theodore

Family history

Mother: AOD issues

Brother: type 1 diabetes

AOD

Experimented with substance use in teens and early adulthood

Medication (March 2025, as per Naomi’s information)

Nortriptyline

Clonidine for nightmares

‘Thyroid medication’

Physical health

Termination of pregnancy November 2023 (new relationship and partner didn’t want a child).

Hypothyroidism

Increased weight

Supports

Naomi has 4 children: Lucas 10yo (Dx with ASD and ADHD) and Nate 8yo with first partner; Abigail 6yo and Theo 2yo (has global developmental delay) with second partner. The younger two lived with their paternal grandparents.

Sister, Chloe (0431 053 488), lives in Glenmore Park and her step-father and his wife are key supports.

On Centrelink benefits – single parent and Family Tax Benefit

Update

At the commencement of the plan, Naomi attended regular weekly to fortnightly consultations, with initial positive effect on mood. She was on sick leave from work, and trying to return to work, however flashbacks of her being detained caused increased anxiety and panic every time she had to visit a new client’s home. She continued to struggle with domestic chores, with lack of motivation to cook and clean. She had periods of difficulty getting out of bed and getting the children to school.

A romantic disappointment in May further impacted Naomi’s mood, with feelings of sadness and disappointment. Not having all her children continued to be an ongoing source of distress. She had a resurgence of suicidal ideation, with thoughts to drive over a cliff, however her children were protective factors.

In May, 2024, Naomi took out private health insurance for a planned mental health admission.

During the first half of 2024, Naomi reported periods of coping well, and implemented strategies we had explored to support her recovery. She began cooking and taking care of her appearance, however the slightest stress caused setbacks in her emotional wellbeing. She stated that it felt good to talk about everything, as her coping strategy had been to bottle up her emotions.

DSH as a negative coping strategy recommenced towards the end of May 2024, including cutting, binging on alcohol and a deterioration in self-care. This was triggered by a relationship breakup of a 6month relationship (and father of TOP), causing feelings of low mood and low self-worth, for example, “I’m not enough”. Naomi explored negative core beliefs and their origin, with good insights about the behavioural patterns associated with the thoughts.

In June, 2024, Naomi’s employment was terminated as she had been unable to return to work due to her mental health challenges. This contributed to her feeling that she had “failed everything”, further impacting her mood.

From the 4th of July, Naomi had a series of inpatient admissions (see mental health history above). The children were cared for by her mother during these times.

30th of August: court for legal matter with ex-partner. Ex-partner pleaded guilty of GBH and placed on AVO with no contact. Naomi was supported by the Women’s Cottage with these legal matters.

Around that time, Naomi reflected that she had been looking outside for a solution to her mental health issues but it hadn’t worked. She stated “I feel so lost; I have no work; I avoid everyone; I’m stuck in a cycle; I don’t know who I am anymore. 10 months ago, I was strong and knew what I wanted. Now I don’t; I had so much fight to get my kids back, now I can’t see past what’s happening now.” She considered the trigger was being detained by the psychotic client. She reported feeling “sad, disappointed and tired; a hole in my chest and it’s empty. I’m withdrawn and avoid company.”

Naomi had a break in psychological support with myself for the next six months. I next saw her again on the 31st of March, 2025. At that time, she reported increased anxiety after leaving hospital, with shortness of breath and chest tightness. She stated that the ECT had improved her mood, but was disappointed she wasn’t feeling even better. She was feeling motivated to get her life back on track and had made an appointment with Relationships Australia for mediation with the children’s paternal grandparents, with the view to restoring custody. She planned to focus on her mothering duties, domestics and self-care, with a plan to get fit. Unfortunately, Naomi didn’t have discharge medication and at the time of the appointment, had not had medication for three weeks. Naomi stated that she felt institutionalised and didn’t want to return to hospital, as each admission she finds it more difficult to leave. We talked about early warning signs of relapse and early intervention strategies to prevent relapse.

I have since been informed that Naomi is currently in Kellyville Hospital with a planned transfer to SJOG for another course of ECT on the 1st of May, 2025.

MSE: unable to assess

Plan

Naomi’s Wentworth Healthcare referral has now been closed. Naomi stated that she would like to continue to see me as she finds it helpful. I will leave it with you to discuss with her. Should you agree, could you please call the intake line on: 1800 223 365 and request a new plan?

Naomi informed me that she requires a medical certificate for her Centrelink benefits, however this may have been resolved by the social worker in the hospital.

Regards,

Michelle Hookham