Dr Gunjan Singh (regular GP)

Crestwood Family Practice

Suite 3, 21–31 Lexington Drive

Bella Vista, NSW 2153

07.10.2025

Re: David Best (DOB: 11.03.1968) Extended MHNIP plan review

Dear Dr Singh,

Thank you for referring David Best under Wentworth Healthcare’s MHNIP in September 2024, for psychological support for low mood, anxiety and PTSD. He has attended fortnightly consultations since that time, and I write to provide you with a review and to request a new referral.

David had previous Wentworth Healthcare referrals to see me between January, 2021 and May, 2022 and again in early 2024.

Initial presentation

At the time of his initial consultation under this plan, Dave reported a deterioration in mental health following multiple biopsychosocial stressors, including complications of a right ankle injury from a MVA in January, 2023; right shoulder injury; unsatisfactory resolution of a workplace injury/workers compensation claim; significant deterioration in mobility; loss of employment opportunities and a relationship breakdown with his children.

At that time, he described his mood as “very low” and expressed thoughts of wanting to give up. He stated “I have nothing worth living for; I feel useless; it’s just battle after battle; I have no support; people are running daggers into me; I’m half the person I was; my friends didn’t even visit me in hospital” He reported suicidal ideation, with thoughts to cut his throat. He stated “6 weeks ago, I had had enough; I was crying and had no more fight left in me.” David stated “I have had several "breakdowns", where these thoughts intensified, however his dog, Ghost is a protective factor and he stated "I couldn't do that to her." Dave expressed the feeling of being a victim in many situations, to the point where he felt cursed. He reported low self-worth and hopelessness about his recovery and of ever finding a meaningful purpose in his life with the added impairments stemming from the accident.

29.03.24 K10: 40/50 – very high level of psychological distress

Dave experienced a significant relapse in mental health in November 2024 following the death of his 19 year old son, Craig, to suicide.

(see previous correspondence for more information)

Mental health history (brief summary)

David has a background history of adverse childhood events/childhood sexual assault (ACE/CSA).

He was diagnosed with anxiety and depression in 2011.

Dave was further diagnosed with CPTSD, following exposure to multiple traumatic events whilst engaged as a fire fighter, including being first responder to MVAs in the line of duty, in addition to ACE.

Physical health

January, 2023: MBA; Dave sustained a right grade 3 open tri-malleolar ankle fracture,

December 2023: internal infection in right ankle requiring IV antibiotics and prolonged courses of oral antibiotics throughout 2024 and 2025

Progressive post-traumatic arthritis to the ankle joint and chronic pain

Left shoulder surgery August, 2024

Diabetes

High cholesterol Lipitor.

LFTs high

2020: Cancer of the salivary glands and lymph on his right jaw surgical excision.

August 2025: reported chest pain, currently being investigate; Dave has had a 48 hour halter monitor and is awaiting analysis.

Supports

Dave lives alone with his dog in a rental property in Windsor. He has a property in Tenterfield, NSW and plans to move there in the near future. He has been spending more time there and reports it has a positive impact on his mood.

On the disability support pension (DSP).

Dave has two good friends locally and one friend in Tamworth, Northern NSW.

Update

At the time of writing this report, Dave has been struggling with grief and bereavement following the death of his son, Craig (suicide) a year ago. The anniversary of his death is November 19th and as this day comes nearer, Craig is front and centre of his thoughts and feelings. At times, Dave reflects on the events leading up to Craig’s death; of the complex challenges he had and the impact of life events contributing to his action. However, over time, there is less focus on seeking blame or self-recrimination and more time on connecting with Chloe (his daughter) for mutual support. Dave reports that antidepressant medication has helped his mood. He has joined a suicide bereavement support group in Richmond, and is getting solace through shared experience with other people. He also spoke at a mental health awareness event, sharing his story to encourage others to seek out support when struggling. He is finding purpose through advocacy and using his lived experience to help others. The following excerpt from his notes illustrates the fluctuation in mood:

I went to cemetery on Sunday; cared for Craig’s grave; to celebrate father's day.

Felt ok

Back on emotional roller coaster, which I know is normal

Yesterday was a tough day, not sure why

Something triggered it; disbelief that he's gone

It could be the car, as Craig loved going out in it

It started coming on Wednesday evening; unsure why

Yesterday in a bit of a hole; stayed at home and played with the dog. Did chores around the house.

Tried not to dwell on it too much

Found one of Craig’s school photos from grade 5; who would have thought a few years later you wouldn't be here.

I don't fight it anymore; I just let it ride out. I’m just existing.

Over the past six months, Dave has been able to take on voluntary training work, coaching young people to be safer drivers, which he has found rewarding. Unfortunately, misunderstandings have caused him to step back from this role, which he has handled very well.

Physical health challenges have been the other significant contributor to Dave’s mental health, however he reported an improvement in accepting the injuries instead of trying to work and function as per prior to the MBA. Chronic pain and swelling in his right foot and shoulder have settled following the reintroduction of antibiotic treatment, which has had a very positive affect on Dave’s wellbeing. Should the right shoulder not settle soon, Dave plans to speak with the orthopaedic surgeon as to whether further surgery is necessary.

13.12.24 K10 score: 46/50 (deterioration in psychological wellbeing associated with Craig’s death)

12.09.25 K10 score: 40/50 (anxiety score: severe; Depression score: severe)

Formulation

57 year old unemployed man, living alone in rental property, with a history of CPTSD, presenting with anxiety and depression, in background of complex psychosocial stressors, including work-related trauma, adverse childhood events and recently bereaved by suicide.

Impression

Grief and loss

Trauma disorder

Low mood

Plan

Continue fortnightly consultations.

Monitor mood and mental health.

Therapeutic intervention as needed.

Dr Singh, could you please ring the intake line at the NBM PHN and request another MHNIP for Dave?

Intake line: 1800 223 365

Yours sincerely,

Michelle Hookham