Dr Therese Roberts

Kellyville Village Medical Centre

Shop 10, 90 Wrights Rd

Kellyville

NSW 2155

23/05/2025

Re: Julie McGrath (DOB: 13.10.1965) Review at end of plan

Dear Dr Roberts,

Thank you for referring Mrs Julie McGrath to see me in February, 2024, under Wentworth Healthcare’s (WHL) PTS program, for ‘complex trauma reaction and depression’. I write to provide you with a review and to let you know that her plan has been extended by the WHL, so no action is required from you at this time.

Please refer to previous correspondence for a comprehensive mental health assessment.

Initial Presentation

At the time of her initial appointment in February 2024, Julie stated that she didn’t like talking about her life, however, was able to begin sharing her challenges stemming from a 10-year history of domestic violence by her ex-husband (see below for more information), who she described as “extremely violent, aggressive and manipulative.”

Julie was the victim of domestic violence between the years of 2003 to 2013. The relationship with her husband broke down in 2005, however the alleged coercive control, intimidation, obsessive stalking, and verbal threats continued until 2013. Prior to the D/V, Julie had an active social life, was confident and enjoyed her work. However, through prolonged exposure to D/V, she reported feeling “degraded”, loss of self-confidence, self-esteem, and supports, and has come to realise that she had been in “survival mode” since then, with frequent episodes of fight/flight activation.

The adverse events associated with the D/V include legal proceedings and losing custody of her second child for four years, all of which have had an ongoing impact on Julie. She continues to struggle with anxiety, worsening depressive mood and reliving past traumatic events. This contributes to mood instability. Julie stated “I get cranky really quickly; I get upset easily; I don’t have patience or tolerance; I try to avoid conflict; I worry about my response; I lash out and am always hypervigilant; always on guard; fear of ex finding me; I’m always scanning the environment for threat or danger.”

Julie has experienced other stressors more recently. Her mother passed away in October 2018 and Julie had been living with her as her primary carer during the final states of her terminal illness. Subsequently, Julie felt lost, as she went from full-time carer to “having nothing to do.” Two years later, her father passed away, further compounding her grief and loss. This was triggering for Julie, as she felt unable to protect her daughter from harm. Further, Julie’s car was involved in a MVA in February, 2024 and her car insurance claim has been unresolved since, causing ongoing stress.

Physical health:

Awaiting eye surgery;

Myocardial infarction in 2018 and insertion of pacemaker. Pace maker is working well, however has had episodes of bradycardia and had to see cardiologist. No abnormalities detected in medical investigations.

Has Type 2 diabetes

Review at end of plan.

Over the past six months, Julie has been navigating her DSP application, which has caused frustration and increased anxiety. The main issue holding up the process is the requirement for a formal diagnosis by a psychiatrist or psychologist, and her application is timing out. She now has an appointment with a Dokotela psychiatrist - thank you for referring her and apologies for the confusion trying to establish her referral pathway, which will now be covered by WHL.

Julie had a family reunion in Kiama in April this year. Prior to the event, she presented with increased anxiety, feeling unsure about conversations that may arise about her past relationship. The reunion went very well and Julie experienced improved mood following the event.

Overall, Julie reported feeling able to cope better with her emotions, with some improvement in functioning. She describes her mood as "Normal. I've been ok." She reported that she continues to feel negative towards people, which she has come to understand better as difficulty trusting people due to the significant breaches of trust in her previous relationship. This continues to result in avoiding social situations, however she is enjoying spending time with her grandkids and is involved their lives.

Julie continues to need the TV on for background noise to stop ruminations in order to sleep.

16.08.24 K10 score: 27/50 (was 37/50 at her initial consultation)

14/05/25 K10 score: 31/50

Functioning and Supports

Julie lives in rental accommodation with her youngest daughter, Kimberley (21).

Julie is currently on Centrelink benefits – Job Seeker, with medical exemption, however work is not realistic at this time, and both yourself and Centrelink have recommended that she apply for the DSP, which she is in the process of doing. I have written a report to support her application, which I have enclosed for you reference.

MSE

Appearance: Caucasian woman

Behaviour: Good eye contact; at times guarded to talk about traumatic life events

Speech: normal rate, tone and volume

Thought form: Logical, sequential.

Affect: congruent with mood. Reactive; weeping and showing anguish when talking of traumatic events

Mood: “I’ve been ok; better than I was”

Content: as stated above.

Perception: no apparent alteration in perception.

Insight/judgement: Julie is becoming more aware of the impact of trauma on her emotional wellbeing and overprotectiveness of her youngest daughter.

Formulation:

58 year old Caucasian female, living in rental accommodation with her 21 year-old daughter, presenting with CPTSD, anxiety and low mood in background of a D/V relationship with her ex-husband. Currently showing signs of improvement in her recovery.

Impression:

Complex PTSD.

Plan

Julie would like to continue to see me and reports it helpful to speak about her challenges. Her plan has been extended by WHL, so there is no further action for you at this time.

Yours sincerely,

Michelle Hookham