Dr Mirthula Balasuthanthira and Dr Suprity Chowdhury

Windsor Family Practice

177 George St

Windsor

NSW 2756

13.05.2025

Re: Adam Lavender (DOB: 25/01/1973) PTS MHCP review

Dear Dr Balasuthanthira and Dr Chowdhury,

Thank you for referring Adam Lavender for a Wentworth Healthcare PTS plan for psychological support for ‘depression and drug abuse disorder’ in September, 2024 and again in May, 2025. Adam attended his first session on the 25th of September, 2025. He engaged well and was able to open up about the challenges impacting his mood and mental health. I write to provide you with a review at the end of his treatment and commencement of his second PTS plan.

Initial Presentation

At the time of his first consultation, Adam reported complex psychosocial stressors including homelessness, substance use disorder, unemployment, literacy issues, State debt due to unpaid fines and complex family system challenges. He was living in a tent with his partner, Rachel and on Centrelink, Job Seeker, benefits.

Adam reported low mood, with irritability and stated "I’m not myself lately", which he attributed to substance use. He disclosed a history of methamphetamine daily use over a long period of time and considered he needed it to function. We discussed substance use and options for care and Adam agreed to consider an inpatient admission to the Nepean Detox Unit. We tried to contact the admissions office twice during his initial consultation, however, were not able to connect. The phone number given to Adam to try again the following day.

Adam presented with poor hygiene and was malodorous, which he attributed to homelessness and apologised. He engaged well in the session, keen to access support. He reported low mood and affect was congruent, with downcast eyes and head posture. During the mental state examination, Adam reported possible auditory hallucinations, stating: “people yelling out smart remarks such as ‘dick head; poof; paedophile’.” He stated that they are not voices; that he hears it from a distance. He also hears "Bartholomew" which is the name his father had wanted to give him. Adam stated that people rummage through his tent when he is sleeping and that he can hear people at the Bowling Club saying they had been through his tent. This could be paranoid thoughts, but I was unable to verify without a corroborative history. Adam demonstrated disorganised thoughts, which has continued over the course of his referral, with multiple missed appointments and losing his mobile phone on many occasions, making contact difficult.

Initial K10: 31/50

Supports

Rachel, partner of 10 years, lives with Adam in the tent.

Adam’s mother, Leslie, lives in Bowen Mountain and is a key support.

Daughter, Chloe from previous relationship is 25 and has just had a baby boy.

Son, Jack from previous relationship, is 22 and currently incarcerated.

Younger son, Tyler, to current partner (8yo) was removed by FaCS at birth and has been in foster care since. Adam and Rachel have access visits with him.

Adam is seeking social housing and is on the waiting list with Wentworth Housing.

Mental health history

Adam reported previous diagnoses of anxiety, depression and schizophrenia, however this needs to be confirmed as it was not documented in the GP referral.

Developmental history

Born in Parramatta Women’s Hospital.

Grown up in the Hawkesbury – Bowen Mountain.

His mother worked in the city and his father was a builder.

Adam has an older sister, Cilla.

His mother had another relationship, which “broke up the family”; Leslie had two boys in the second relationship. His father re-partnered and had a boy and girl

Adam reported a history of absenteeism during school and ‘being naughty’. He went to a Steiner School in Yarrumundi, leaving in Year 10. He reported difficulty with literacy and didn’t learn to read or write.

After school, Adam went into fencing then turfing and today works occasionally in roofing.

Adam met Tammy at age 23 and they were together for 21 years. They had two children, Chloe and Jack. They worked and lived on the Central Coast for a few years, before returning to the Hawkesbury.

Adam has been in a relationship with Rachel for the past 10 years.

Legal

On parole for trespassing for 1 year.

Work Development Order (WDO) for unpaid fines, with the agreement to seek mental health support on a fortnightly basis.

Physical health

Chronic dental infection

Inguinal hernia repair ? 2023

Update

Since the initial referral, Adam aimed to attend fortnightly to monthly appointments. Unfortunately, due to his general disorganisation and lack of phone access for appointment reminders, he missed multiple sessions. At times of missed appointments, if I was unable to get hold of Adam, I contacted his mother, Leslie. She encouraged him to attend. However, she also had to manage her level of input, as concern for Adam often overwhelmed her, to her own detriment.

Adam continues to struggle with homelessness, with difficulty accessing priority with Wentworth Housing. We had planned to navigate this together, however due to missed appointments, this did not eventuate. To improve his personal hygiene, I facilitated access to showers and provided clean clothes at the Old Hawkesbury Hospital, which had a positive effect on Adam’s mood.

Adam’s partner, Rachel, had a medical emergency in March, 2025, which led to a period of increased anxiety for Adam. She has since been discharged from hospital, has been stabilised on methadone, and is making a gradual recovery.

At the time of his last appointment, on the 12th of May, 2025, Adam reported feeling low in mood (K10 was 33/50). He spoke about the stressors/frustrations in his life, including: Rachel's agoraphobia and getting her out of the tent/hotel to attend appointments and get her methadone; his son being in jail; difficulty securing social housing. He stated that he hadn't used methamphetamine in a week and was struggling from lack of quality of drugs to give him the effect needed to function, according to his perception. I provided education about substance use and withdrawal, and hope for recovery if he was able to continue with abstinence. We discussed again the option to attend detox, however he declined at that time.

Plan

I spoke with Adam about his treatment plan and missed appointments yesterday, including my willingness to assist him, providing he commits to the treatment plan as per his WDO. Should he miss further sessions, unfortunately, I will need to close his referral.

Thank you for the re-referral, Dr Chowdhury. This has enable an additional 5 sessions for Adam, which have mostly been used. Should he continue to want to see me and to attend his scheduled appointments, Adam will need an additional referral via Wentworth Healthcare. I would recommend either a flood plan or extended plan going forward.

Regards,

Michelle Hookham