Dr Z Parvez

Advanced Medical Practice

Windsor

NSW 2756

22.09.2025

Re: Julie Fink (DOB: 07.02.1971) Review

Dear Dr Parvez,

Thank you for re-referring Julie Fink for a Wentworth Healthcare’s MHNIP plan in September, 2025. I write to provide you with a review. Julie requests privacy with the contents of our sessions, hence my report is an overview and brief update.

Initial Presentation

Julie was initially referred to see me under the Wentworth Healthcare SOS program following a presentation to Nepean Hospital/TAC in December 2020. At that time, she reported low mood and suicidal ideation. She was prescribed medication and discharged home for follow up with the Access Team.

At the time of her initial appointment she reported a long history of suicidal ideation and a recent deterioration in mood over the previous few months. Julie reported that she had struggled since separating from her ex-partner 10 years prior.

See previous correspondence for more information and comprehensive MH Ax, prepared for Dr Ruby Thabakulasingam in 2022.

Update

Over the last six months, Julie has attended weekly to fortnightly consultations, with a general improvement in engagement and trust, enabling her to open up a bit more about challenging life / adverse childhood events. At times, this has caused heightened emotions and unhelpful coping strategies, which she has been able to better manage than in the past. Triggers for psychological distress have included relationship stressors between family members; work stress; chronic shoulder pain (right); youngest child’s reluctance to engage in school or complete assessment tasks; and loss of contact with a close friend. Some of these stressors have caused unwanted memories of adverse events in her life, including domestic violence and childhood trauma. These episodes can be intense for Julie, however her resilience is improving gradually and she is able to manage more often without going into extreme emotional dysregulation.

Julie continues to struggle with low mood and chronic suicidality, at times finding it difficult to see a reason to live. Parenting her children has been a focus for the past three decades, giving her a sense of purpose and have been a protective factor against negative thoughts. Her youngest of four children, is approaching 18 and the end of his schooling, which is a key milestone for Julie. We have been exploring different ways to find purpose post-dependent-children and to reframe the belief that she is no longer needed. This has included considering the positives of freedom from responsibilities of full-time parenting, and being able to pursue her own interests, such as travel and reconnecting with culture and country.

Julie’s risk of self-harm/suicidal ideation requires ongoing monitoring. She is having weekly consultations at the moment, whilst navigating the changes in lifestyle with her youngest finishing school and turning 18. Although she has chronic suicidal ideation, she was able to give a guarantee of safety at her last consultation and requested a renewal of her MHNIPs plan for the next twelve months.

Supports

Julie lives in social housing with her two youngest children. Her two older children live with their partners and children. Julie has contact with her grandchildren on occasions.

Julie is on Centrelink Job Seeker and has part-time employment as a driver.

MSE

Appearance: 54 year-old woman of Aboriginal descent.

Behaviour: Varies between engaging well to withdrawn at times

Mood: Low mood

Affect: Varies from restricted affect to warm, with good eye contact and rapport

Thought form: logical; sequential.

Speech: normal rate, rhythm and quiet tone.

Content: Chronic suicidal ideation

Cognition: Julie reports poor literacy skills, however can read and write. She is able to comprehend and process complex questions.

Perception: No apparent alteration in perception

Orientation: oriented to time, place and person

Insight: Developing.

Judgement: Chronic suicidal ideation, however has continued to seek help and has not acted on the thoughts recently.

Formulation

54-year-old woman of Aboriginal descent, living in social housing with her youngest 2 adult children, working part-time and on Centrelink benefits, continuing to struggle with low mood and chronic suicidal ideation in background of multiple biopsychosocial stressors and past history of trauma.

Impression

Consider: Depression; Complex trauma; PTSD; Borderline personality disorder

Plan

Continue weekly to fortnightly therapeutic intervention or as needed.

Trauma informed care.

Monitor mental/emotional state.

Risk assessment as needed.

Care coordination as needed.

Strict care with confidentiality.

Regards,

Michelle Hookham