Dr Toby Taleb Nasr

135 Metella Road

Toongabie

NSW 2146

07.10.2025

Re: Lawrence Attard (DOB: 21.11.1964), Summary of care, review and update

Dear Dr Taleb Nasr,

Thank you for referring Lawrence for a Wentworth Healthcare’s MHNIP’s program in August, 2024 for psychological support for anxiety, depression and suicidal ideation in background of childhood sexual assault. This referral follows a series of Wentworth Healthcare referrals dating back to February, 2019. I write to provide you with a review.

See previous correspondence (March 2025) for a summary of presentations and care since 2019.

Initial presentation

At the time of his initial consultation with me in February 2019, Lawrence reported deterioration in mental health and chronic suicidal thoughts, in background of legal matters arising regarding his being a victim of childhood sexual assault (CSA). He had a history of two previous attempts to end his life, with the previous attempt being in 2017. He had a further deterioration in November of 2019, associated with additional stressors pertaining to the pending legal matters and also financial pressures whilst off work to recover from shoulder surgery.

Medical issues

Medical issues as stated in GP referral letter, including spinal compression injuries, pelvic fractures following MVA in 2017, Low testosterone, NIDD, hypertension and hypothyroidism.

2017: motorcycle accident

May 2021: Bilateral knee replacements

May 2025: pilonidal sinus requiring surgery

2025: dental issues; requiring tooth implant

Workcover claim ongoing

Awaiting surgery for hip replacement, elbow replacement, pilonidal sinus

Orthopaedic surgeon has recommended medical retirement, however Lawrence is conflicted about that

Hearing loss; wears hearing aids

Mental health

2017: suicide attempt in background of legal matters associated with CSA

2019: anxiety and depression

Weekly to monthly psychological therapeutic support with myself since 2019.

26th October 2022: suicide attempt in background of adverse court outcome acute admission to Orange Hospital.

Medication

TBC

Support

Lawrence lives at home with his wife, Esther.

Lawrence has four adult children and several grandchildren

Works part-time as a plumber.

Centrelink benefits to subsidise income.

MSE

Appearance – Middle aged man of Maltese descent, dressed in work clothes; good attention to hygiene and grooming.

Behaviour: Comfortable in consultations. Easy rapport. Good eye contact.

Describes mood as “I’m OK; a bit better; still up and down.”

Affect – Brighter; reactive; able to laugh and joke

Content – as reported; denies active suicidal ideation, plan or intent.

Thought form: logical; sequential.

Perception: denies alteration in.

Oriented to time, place and person.

Cognition: not formally assessed; no obvious loss of function.

Insight: Understanding patterns associated with negative core beliefs is an ongoing psychotherapeutic piece of work

Judgement: Good. Is aware of emotional challenges and actively taking steps to seek help and manage his emotions.

Update

Lawrence has presented with labile mood over the past 6 months, with direct correlation to multiple life stressors, including financial stress, relationship challenges, medical issues and a complaint to Council about a neighbour’s property management impacting water drainage on his property.

Ongoing medical issues have been a predominant source of distress for Lawrence, since the recommendation is for him to medically retire. Lawrence’s mental health improves when he is occupied and deteriorates when he is unable to contribute to supporting his family. Financial stress then becomes overwhelming and he struggles to find a way forward or to consider a happy secure retirement. A work-cover claim is in process and is covering the cost of physical health issues, however the finalisation of an outcome is pending and contributes to uncertainty and anxiety at times.

Decreased capacity for employment has resulted in Lawrence being more home based, spending more time with Esther and their grandchildren, which increases relationship stress. Despite being multi-skilled, Lawrence struggles to consider other opportunities for work at this time, however is starting to consider options.

When low in mood, Lawrence sleeps a lot more during the day and has difficulty getting out of bed. He also reports difficulty sleeping at night due to rumination of negative thoughts. He questions his worth and purpose to living, however denies current suicidal intent or plan. His K10 score of 23/50 shows an improvement in mood, with the depression score being ‘moderate’ and the anxiety scale being ‘sub-clinical’.

02.05.22 K10 score: 33/50

11.11.22 K10 score: 45/50

03.05.23 K10 score: 21/50

13.12.23 K10 score: 32/50

12.06.24 K10 score: 21/50

19.02.25 K10 score: 30/50

17.09.25 K10 score: 23/50

Formulation

60 year old male of Maltese descent, presenting with anxiety, depression and suicidal ideation in context of multiple biopsychosocial stressors and in background of childhood trauma.

Impression

Victim of CSA complex trauma with associated feelings of poor self-worth impacting his ability to trust in the love of others and belief in himself, compounded with shame of being exposed publicly and constant reminder of trauma through current legal pursuit of the perpetrator of abuse. These underlying factors contribute to chronic low mood and suicidal ideation, which further impact his functioning, in conjunction with several physical health conditions, reducing his capacity to work and fulfil his potential.

Relatively stable at the moment.

Plan

Dr Nasr, could you please contact NBM PHN to request another MHNIPs plan? Lawrence has requested ongoing support, since his ongoing medical issues are impacting his mental health.

The WHL intake line is: 1800 223 365

Regards,

Michelle Hookham