Dr Padma Kaluarachchi

Conrad Road Family Practice

45 Conrad Road

Kellyville Ridge

NSW 2155

31.10.2025

Re: Elizabeth Ann Myra Tierney (DOB: 17.09.1963) MHNIPs Review

Dear Dr Kaluarachchi,

Thank you for re-referring Elizabeth Tierney to the Mental Health Nurse Incentive Program with Wentworth Healthcare in April, 2025. I write to provide you with a review. Her MHNIP plan is current and you are not required to take any action at this time.

Initial presentation

Elizabeth was first referred to see me in May, 2019. At the time of her initial presentation, she reported psychosocial stressors, in particular the traumatic death of her mother in a motor vehicle accident 3 ½ years prior. She was subsequently diagnosed with anxiety, depression and PTSD and has not been able to work since. She reported difficulty sleeping, low appetite, weight loss and was ruminating about the traumatic event and had frequent flashbacks about the accident.

Elizabeth had previously worked as a school music teacher and loved her work and engagement with the children. Losing this joy in her life had further impacted emotional wellbeing, sense of purpose and routine. Elizabeth has a limited family support system, since she is an only child and all her immediate elder family members have passed away. She has some cousins and distant relatives and her cousin Jeffrey lives close by, albeit he also has complex physical health issues. Once an active long-standing member of the community, Elizabeth has reduced her engagement with activities and become socially isolated. She expressed feelings of worthlessness and disappointment with herself for not being able to ‘bounce back.’

Ella is her rescue dog, who gives her enormous pleasure, company and fulfilment.

Physical health

Elizabeth has a comorbidity of physical health problems, including diabetes, asthma, chronic upper respiratory infections, high cholesterol, dental health issues, heartburn and has been seeing an immunologist for an unexplained compromised immune system. She is a heavy smoker, even though she detests the habit and would like to quit. Over the past six years, Elizabeth’s physical health has deteriorated significantly, with recurring infections (dental and URTI predominantly), requiring continual courses of antibiotics, viral illnesses and frequent GIT disturbances including nausea and diarrhoea. She is under the care of multiple specialists, including respiratory, endocrinologist and immunologist. Elizabeth has had a two-year break from monthly Ig infusions (to support her immune function), due to side effects. However, due to chronic infections and deterioration in immune function, she needs to re-commence Ig infusions and is currently meeting with the Professor of Immunology to explore self-administer at home.

Elizabeth had right eye surgery in April 2025 which was very successful. She recovered well and enjoys good vision in that eye. She returns to the surgeon in Feb to assess left eye. She was hoping to transfer her place on the waiting list for public healthcare for the surgery, due to the cost whilst living on the DSP, however due to changes in hospital administration, she is unsure if this is now possible.

Elizabeth’s current health challenges include:

Sleep apnoea. She has a CPAP machine, however is avoiding using it due to claustrophobia. I have asked her to bring the machine to appointments so that we can explore graded exposure therapy around use

Weight gain. Elizabeth recognises increased weight is attributed to not exercising enough and hereditary factors. She denies excessive food intake.

Smoking. I sourced a quit smoking book for Elizabeth that has worked for a clients, however she is awaiting Jeffrey to finish reading it so that she can start. She is aware that she may be subconsciously avoiding the book.

Insomnia. Elizabeth reports disrupted sleep and feeling tired. She is aware that the CPAP machine may improve her quality of sleep, however has to overcome the hurdle to start using it.

Chronic URTI’s.

Her physical health is significantly better in the summer, with noticeable decrease in URTI.

Mental health update

PTSD symptoms are much better. Elizabeth was recently triggered to traumatic memories of her mother’s death following a recent motor vehicle accident outside her home. However, she was able to manage the intrusive thoughts over the following few weeks without having a major relapse in mental health.

Elizabeth continues to make progress in her mental health recovery, with PTSD symptoms significantly improved and healthy coping strategies in place. However, she remains challenged by her tendency to prioritise Jeffrey's needs over her own self-care, particularly regarding smoking cessation and sleep apnoea management. She is experiencing meaningful internal changes and growth, developing greater self-awareness about her avoidance patterns and beginning to recognise her life achievements. The therapeutic relationship remains strong and supportive of her continued progress and she would like to continue seeing me. She stated:

“I know I’ve come a long way, but still have a long way to go. I still don’t feel like my old self; my coping skills are not what they were…I’m still not how I was. I realise that age and losing people can’t let you be that person. I feel disappointed with myself. I just hope there’s more improvement for a better future life.”.

Elizabeth continues to manage her ADLs, albeit limits her social engagement to Jeffrey, the occasional contact with old friends and family and medical appointments. She has started to consider her future and realises she will need to re-locate at some point to a house that is more manageable. She has explored retirement villages, and put her name down on waiting lists at three facilities, however is not ready to live in an ‘old people’s village.’

Supports

Elizabeth is now on the DSP, however she continues to struggle with financial stressors.

Jeffrey is her key support, although he has serious chronic health issues.

17.07.2023 K10: 35/50

30.10.2023 K10: 30/50

10.03.2025: K10: 35/50 (deterioration following news about eye surgery)

13.10.2025: K10 27/50 - improvement

Formulation

62-year-old retired music teacher on the DSP, living in her own home in Windsor, suffering with major depression and PTSD in background of witnessing the death of her mother in an MVA. She has comorbidity of chronic/complex medical issues, which significantly impact her mental health and emotional wellbeing.

Plan

Continue weekly to fortnightly sessions.

Care coordination as required.

Encourage Elizabeth to increase social engagement.

Ongoing psychoeducation; Ongoing health education as needed – diet, smoking, exercise, healthy lifestyle.

Regards,

Michelle Hookham