Dr Natasha Lalani

Windsor Family Practice

177 George St

Windsor

NSW 2756

15.10.2025

Re: Paula Hicks (DOB: 15/09/1964) NBM16692 Review and mental health assessment

Dear Dr Lalani,

Thank you for referring Paula Hicks for a PTS SOS plan under Wentworth Healthcare, for therapeutic support for ‘Major Depressive Episode’ in March 2025. I had provided previous support for Paula following a referral from Pink Finss cancer charity in June 2024.

I write to provide you with a review at the end of the referral and to request another one.

Initial Presentation

At the time of her initial consultation, Paula reported a deterioration in mental health, with feelings of hopelessness about her living situation and health. She spoke of challenges with her sub-standard rental accommodation and frustration about being on the waiting list for public housing for 15 years.

Paula spoke of her throat cancer journey and subsequent dental and swallowing issues, which were significantly impacting her ability to eat and quality of life. She had been scheduled for surgical repair of a throat ‘pocket’ to improve her swallowing, which had been scheduled and cancelled twice and for which she continues to wait. Paula has had OT exercises to strengthen her throat in the meantime, with minimal improvement.

Paula reported labile mood, ranging from low mood with feelings of hopelessness and suicidal ideation on occasions. She reported episodes of anxiety when overwhelmed or in crowded places, irritability frequently and bouts of anger with verbal aggression when very frustrated.

Paula reported social isolation and loneliness, however is challenged to socialise as she does not consider she would fit in with most social groups. She liked some parts of the Pink Finss support group, however felt emotional hearing other peoples’ stories of cancer.

Loves animals and feels more secure when she has an aggressive dog at home. Without a dog, she feels unsafe and describes hypervigilance and fear around home safety.

14/03/2025 K10 score: 47/50

Mental health history

19 - Living in Manly; was engaged; took polypharmacy overdose and wrote a suicide note; saved by a friend; denied to paramedics. Finance came home and kept me awake. He called mum and she arranged me to go to hospital; I was aggressive and violent. Angry that I was found.

Cut wrist at age 24 to prove a point that had the courage to when provoked by another person.

August 2024: Acute suicidal ideation following the death of her dog, Eve.

November 2024: Acute panic attack in car park whilst on the phone to psychiatrist due to overwhelm by too many people

Past history of DSH – cutting in high school

Admissions for detox from alcohol

Developmental history

Paula disclosed CSA at age 4 involving multiple perpetrators who used manipulative grooming behaviours.

Paula has a younger sister (8 years younger)

In her early years, she felt as though her sister had preferential treatment.

Paula lived with her grandparents a lot as a child, while her mother worked multiple jobs.

She reported limited emotional expression from family members and a yearning for validation that she was loved.

First job age 12, cleaning animals for a circus

Paula reported a history of sexual exploitation and sexual assault from the age of 14.

She stated that she ‘grew up early’ as a result and learned to be ‘tough’ to cope with adversity.

She reported past history of D/V relationships.

Entered work in sex industry and coped by using alcohol. Paula considers the transition to escort work at age 23 was directly resulting from childhood sexual assault (CSA)

Social network throughout adult life was antisocial, including social network with biker gangs.

AOD

History of poly substance and alcohol abuse

Denies current substance use and makes choices to avoid being around drug culture.

Smokes cigarettes

Supports

Paula lives at home alone with her dog Harley. She has few friends.

Pink Finss provide support for cancer related services, should Paula choose to engage with them.

Her mother, Moira McKee (0406 954 005) lives in Junee. Paula visits her a couple of times a year and finds the visits good for her mental health.

Paula lives in a rental property that is in severe disrepair. She is on the priority housing list and has been for 15 years. I have followed up with them and there is no further action possible at this time.

Medical history – from GP referral

TOP x 4 in her 20’s and 30’s

SCC tonsil and tongue; had radiotherapy 3 years ago

Subsequent swallowing issues awaiting surgery

Dental issues following radiotherapy, requiring dentures

Family history

Father died of MI age 36; Ischaemic heart disease

Mother: had breast cancer; treated with partial mastectomy.

Medication (from GP referral)

Seroquel 25mg nocte

Diazepam 5mg before bed

MSE

Appearance: Underweight Caucasian female with long hair

Behaviour: Engages well; frequently expresses irritability and frustration; cursing frequently

Affect: congruent with mood

Mood: “I’m fed up; I’ve had enough”

Thought form: Logical; sequential; no FTD

Content: Described thoughts of “not wanting to be here anymore; there’s no quality of life”; fear of dying alone from choking.

Cognition: not formally assessed.

Orientation: oriented to person place and time.

Insight: Good. Expresses regret for her life choices (AOD; sex worker) and not listening to the advice of her elders as a young person

Judgement: Good.

Update

Over the past six months, Paula has attended fortnightly to monthly consultations, which have been a combination of home visits and in clinic. At the time of her review on the 10th of October, 2025, she continues to struggle with the same challenges as per her initial consultation. She is still awaiting surgical revision of her throat, hence she has difficulty swallowing and intaking adequate nutrition, which causes her ongoing frustration with the medical system to the point of wanting to give up. I have offered to follow up on her behalf, however Paula assures me that the medical team have been in touch recently and there is nothing more I could do at this time. She lives on ensure and is underweight.

Paula is awaiting public housing, which is another cause for frustration, after 15 years wait. She has recently had contact from Wentworth Housing, requesting more information and during her last consultation, I contacted them to advocate for her urgent need for better housing. They informed me that Paula is on the priority list, however there is a shortage of properties in the Hawkesbury, and if she wanted to consider other areas, she may be allocated a property sooner. Paula has considered moving closer to her mother in Junee, however prefers to stay in the Hawkesbury. She is reluctant to move to any public housing areas with an overt drug use population due to her history and insights about her own triggers and has agreed to accept housing in older demographic estates. Her current housing is sub-standard and contra-indicated for health, with holes in walls, vermin infestation, blocked toilets etc.

Due to ongoing challenges, Paula reported that she has not experienced any improvement in mood over the past six months, however has less suicidal ideation since adopting another dog two months ago. Harley has given Paula a source of company and purpose and she is busy training him in obedience and handling.

24.20.25: K10 score: 34/50 (‘severe’ depression score; ‘mild’ anxiety score)

Formulation

61 year old single female on the DSP, living in rental accommodation and awaiting social housing, presenting with depression in background of chronic health problems associated with cancer treatment, social isolation and perceived poor quality of life.

Impression

Diagnosing is outside my scope of practice. However, you could consider:

Significant trauma history: CPTSD.

Emotional dysregulation

Anxiety

Depression

Antisocial personality traits

Plan

At the time of her review, Paula stated that she enjoys talking to me and would like to continue to access the support. Could you please contact Wentworth Healthcare and request another referral?

Their intake line: 1800 223 365

Yours sincerely,

Michelle Hookham