Julie Brow 17 Stockton Terrace
Julie Brow 17 Stockton Terrace
Highbury South Australia
DD/MM/YYYY
Dear Case Manager,
I just want to share my story with you so you can understand my life as a mother and a carer. At 14 years of age, my son Peter started to experience problems at school even though he was a bright student and had previously enjoyed school. We encouraged him to join the scouts and at 15 years of age, this seemed to help as he started to come out of his shell a bit more. While attending a weekend camp, and with a few of his friends, Peter got so drunk that he had to go to hospital and was kept in overnight and discharged the next morning. As a family, we were shattered, confused and did not know where to turn.
Our GP referred us to a Psychologist and after 5 weeks we were finally given an appointment. Peter was diagnosed with depression and the Psychologist said that Peter should see a Psychiatrist, but Peter did not follow through on this. From the age of 15 to 20, his behaviour was difficult and unstable at times but was able to complete Year 12 and then attend University and graduate as a High School teacher. Whilst at University, Peter started self-harming by cutting his forearms, there was also one suicide attempt that we know of when he tried to swim out to sea at night. The counsellor at University encouraged Peter to see a Psychiatrist and he finally agreed, the Psychiatrist put him on anti-depressants, but his only form of treatment was adjusting his medication from time to time.
At 20 years of age, Peter moved away from home into a flat with another teacher when they started teaching in a country town in South Australia. This was when Peter started experimenting with amphetamines and other drugs on the weekends. Shortly after his 23rd birthday he arrived at our door, had lost a lot of weight and was psychotic. We called the Ambulance and the mental health team and finally Peter was admitted to hospital.
Over the next three years Peter endured a dozen psychiatric admissions (various private and public hospitals) and several drug rehab admissions. I have worked tirelessly to get him into help. Once discharged from hospital he was never offered support. He was labelled as a schizophrenic and a drug addict.
He was told he was delusional, paranoid, depressed, worthless, unmotivated and lazy. He heard voices in his head, had hallucinations, spoke in different voices. The various psychiatrists prescribed an assortment of antipsychotic medications, tranquillisers and antidepressants. These medications nearly always had horrendous side effects, which rendered him fidgety, gave him blurred vision, made it unable for him to concentrate and made him sleepy and unmotivated. He once told me that when he first used speed he felt really happy for the first time in his life. Unfortunately, it was too late once he realised how devastating the decline into drug addiction can be.
During a period between hospital admissions his ex-partner became pregnant. He felt that having a child may give him the incentive to become drug free. He cut down the usage considerably and a healthy daughter was born. Over the next twelve months, he tried so hard to be a responsible loving father to his child, finally admitting himself into a drug rehab when the going became too tough. He knew that if he did not beat his drug problems, he would lose his baby.
Adam has tried hard to get his life back on track and has had tried every avenue open to him and he only just managed to break his addiction. Now we are concerned that he is under a lot of pressure at work and his mental state has started to deteriorate.
I, my husband and the entire family are exhausted, but at the same time, we want to be involved in our sons care and treatment; sometimes he does not want to speak with us and blames us for his hospitalisations and treatment. Please keep us up to date with his welfare and we are quite prepared to come and see you at your offices.
Yours sincerely,
Julie Brow
74928-122023St John High School
Principle Jenny D. Berkeley ABN: 70 035 674 11X
17 Montpelier Court, North Adelaide, South Australia, 5006
92202014224000
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Dear Case Manager,
I write to you to express our concerns regarding one of our teachers, Peter Brow, who his mother informed us that you have recently been appointed as his case manager. Peter has been working with us for a number of years as a part time teacher in Northern Adelaide region, and is a valued member of our team.
We are well aware of his mental health issues and resultant hospitalizations, and do our best to support him. Generally, he is a competent teacher, and staff find him to be enthusiastic with his work and he is well-liked by students. We work closely with the Teacher Board of South Australia in monitoring his teaching and mental state.
I have recently been informed by one of the teachers who works with Peter, that they have become concerned about his mental state. Peter has been turning up late to school in a seemingly disheveled state. He is also easily distractible and often in labile moods ranging between tearful and irritable.
I spoke with Peter yesterday, and he denied any current issues or difficulties, although he sounded vague. I believe that he is becoming unwell again, and we are concerned about his welfare the above signs and symptoms are his usual warning signs of becoming unwell. I would like to meet with you to discuss these issues and how we can work with you to support Peter to prevent him from deteriorating and ending up in hospital again. If his mental state does deteriorate further, I will need to place him on extended leave.
Yours sincerely,
Jenny Berkeley
Peter Brow
U2/127 Port Road
Hindmarsh South Australia5007
Dear Case Manager,
I would like to cancel our appointment for Friday. I have been feeling run down and tired in the past two weeks and can only see my GP on Fridays.
As discussed with you when you last phoned, I had been feeling quite well and coping with work and weekly access visits with my daughter. My psychiatrist Dr McArthur has also been pleased with my progress.
I want to discuss with you about appealing my Community Treatment Order as I have been doing so well. I have been taking my medications regularly as is evident by my mental state and coping with work. I do feel that I could have my medication reduced as I am still experiencing problems dullness to my thinking, sometimes I feel as if I am moving through treacle.
No NO nOI am fed-up with people controlling my life, my family interfere and push me into hospital, I am restricted in my work and these tablets poison me.
Speed has been the only thing to to energise me and free my thinking Why do people keep telling me what to do
I can be free without the poison you peddle
I need to find a new life away from those that spy on me I am in a fog bog log
You are controlled by satan and his secret ally jesus Death might be my freedom
Spies whispering in my homebetraying seductive They have stolen my baby
my reason
my thoughts
Goodbye Peter Brow
Green Acre Specialist Suites
Joshua J. McArthur, M.B.B.S., FRANZCP
895985284480002nd Floor, 221b Beaumont Street, Norwood, South Australia, 5067
DD/MM/YYYY
Dear Case Manager,
Re:
Peter Brow
DOB: 08/05/1981
Peter has been a patient of mine for the past 3 years. During this time his mental illness has been quite fragile and he has had 4 admissions in both private and public mental health units. In part the brittle nature of his illness was contributed to by his previous amphetamine abuse. A detox admission with DASSA a couple of years ago was a changing point in his life and he seems to have been drug free since then.
Peter was admitted to Woodbridge House in February this year for a 4 week admission with a relapse of his Schizophrenia Disorder, which appears to have been in the context of the Department of Family Services contacting him about concerns they had about the welfare of his daughter. Whilst in hospital he had a change in his medications due to long-standing side- effects. With this change in medications, his paranoia settled quite quickly and he became more stable in his mood and prior to discharge was able to spend more time with his daughter again.
Given the fragile nature of his illness, I reluctantly agreed to a successful application by the treating team for a 12-month Community Treatment Order (CTO). You would have received a discharge summary from Woodbridge House in relation to this.
Historically his warning signs of relapse are generally as follows with later signs of increasing un-wellness:-Increased labile mood tearfulness to irritability
Distractedness, increased confusion, increase in paranoid conversation
Personal hygiene/ADLs deteriorate unable to work
Appears to be responding to internal stimuli auditory hallucinations
Conversation becomes more bleak, themes of hopelessness and helplessness and self- loathing
Self-harm by cutting and/or overdose of medications
Later symptoms have often been associated with amphetamine abuse
I have seen Peter every 4 weeks since discharge. Whilst initially upset about the CTO, he has come to accept it with some reluctance. His mental state has been quite stable, and he appears to have more control over his life currently than in the past 7 years. Given this I reduced his Quetiapine dose by ceasing his PRN dose of 50 mgs BD.
He has continued to work part time at the St John High school and has a good relationship with the staff and students there.
Green Acre Specialist Suites
Joshua J. McArthur, M.B.B.S., FRANZCP
895985284480002nd Floor, 221b Beaumont Street, Norwood, South Australia, 5067
At our last appointment, I felt that he was starting to show subtle signs of relapse, outwardly he appeared stable, was well groomed and mostly attentive and chatty. Towards the end of the appointment he was more fidgety and appeared more distracted and had some difficulty answering and following questions he put this down to working late at night on teaching materials needed for the new curriculum in the past week. We did discuss an increase in medication, but he was very reluctant and wanted to see how he would cope. I am due to see him again towards the end of August this year.
Current Medication Regime:
Sodium Valproate 500 mgs Mane, 1,000 mgs Nocte, Sodium Valproate level 5/6/2016 = 417 (n 300-600)
Quetiapine 100 mgs Mane, 300mgs Nocte
(Quetiapine 50 mgs BD PRN to max 100mgs daily - Ceased 5/6/2016)
I would like to be kept up to date with Peters progress and your support and management. Please do not hesitate to contact me at my consulting suites if you have any questions or need further information.
Yours sincerely,
Joshua J. McArthur
Joshua J. McArthur, M.B.B.S., FRANZCP
The New RAH CLINICAL RECORD UR DETAILS 123456789-0
BrowPeter127 Port Road Hindmarsh
SA 5007 DOB: DD/MM/YYYY
DATE/TIME NOTE: ALL ENTRIES MUST HAVE SIGNATURE & DESIGNATION RECORDED
DD/MM/YYYY Peter is a 37 yr old man referred to ED by his Case Manager after being found in semiconscious state at his unit likely related to ingestion of prescribed medications and multiple stab wounds to his abdomen.
Transported to ED via SAAS. Referred for MH assessment by admitting Medical Registrar.
Time: On review, Peter was laying on a barouche, in a semi-conscious state and his movements ranged from very restless to being quite still. Able to answer some of my questions about recent events. Admits to taking almost two weeks worth of prescribed medications Sodium Valproate and Quetiapine with high intent and plan to kill self, had also stabbed himself in the abdomen with a small kitchen knife. Peter stated that he has been feeling down in mood, paranoid about psychiatrist, case manager and others who are controlling his life. At times his mood was very distressed and difficult for him to relate information, at other times he was falling asleep.
Upset that someone had found him, still has ongoing thoughts of dying. At times reluctant to answer questions.
Peter is well known to MH services, multiple admissions in past few years with relapse of Schizophrenia with psychotic features and self-harming behaviours. Currently on a CTO until April next year, case managed by local MH team and has a private psychiatrist. Collateral information from Case Manager indicates that Peter was doing well until recently when he started to relapse had not voiced suicidal ideation when last seen. Missed last weeks appointment Case Manager had decided to follow-up more frequent contact. Case Manager has forwarded some letters by mother, employer, psychiatrist and Peter which prompted todays home-visit. Family informed of admission to ED by Case Manager.
Neurovegative Features:
Sleep: Little sleep in recent days, initial insomnia and frequent waking. Appetite: Poor
Energy: Fluctuating from very little to difficulty sitting Motivation: Low, pre-occupied, affected by energy levels Concentration: variable, fluctuating from poor to good
Thoughts: Paranoid themes about being controlled, low self-esteem and self-worth, suicidal thoughts for several days. Overwhelmed and currently sees little future.
Current Treatment:
Sodium Valproate 500mgs Mane, 1,000 mgs Nocte Quetiapine 100mgs Mane, 300mgs Nocte
Ventolin PRN Social Situation:
Lives with his young Daughter in a Unit in Hindmarsh with one dog. Part time High school teacher
Regular contact with family Few friends or hobbies
Past Psychiatric History:
Contact with MH services since 15
Multiple admissions to public and private MH units Currently seeing Psychiatrist Dr McArthur
Case managed by local Community MH team under CTO until April next year
Various diagnoses: Schizophrenia, anxiety and depression
Comorbid Alcohol & IV drug dependence
Various pharmacological treatments over the years, previous psychology input.
Past Medical History:
History of overdoses and self-harm by cutting when much younger Asthma
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The New RAH CLINICAL RECORD UR DETAILS - 123456789-0
BrowPeter127 Port Road Hindmarsh
SA 5007DOB 08/05/1981
DATE/TIME NOTE: ALL ENTRIES MUST HAVE SIGNATURE & DESIGNATION RECORDED
DD/MM/YYYY
Time: Substance Use:
Alcohol: Occasional use only social use for 2 years
Illicit: Tried Marijuana use many years ago Nil use for several years;IV amphetamine use occasionally Nil use since November last year post detox admission with DASSA. OTC: Nil regular use of analgesics or herbal preparations.
Risk Assessment:
Static: Previous self-harm events in past. Past alcohol, IV drug use. Dynamic: Current overdose with high intent.
Self: Current and past ingestions, self-harm, current high intent.
Others: Nil
Functioning: Good until recent weeks. Support: Good, very supportive family
Engagement: Erratic in past, very good in recent months until past two weeks.
Overall Risk: Current high intent ingestion with relapse of illness, fluctuating mood, paranoid features. Likely potential to abscond based on past history.
Mental State Examination:
A: Dishevelled looking man, average height, thin build, hospital gown, short blondish hair. Scars on L) lower arm, one tattoo on upper Left arm.
B: Sleepy to restless movements, fluctuating engagement and level of consciousness.
C: Broken rate, tired tone, free flowing to hesitant and reluctance. Voicing paranoid thoughts at times. A: Drowsy but elements of fluctuating mood tearful and distressed at times.
P: May be responding to internal stimuli but fluctuating conscious state makes this unclear. C: Drowsy, difficult to currently assess.
I: Poor.
J: Currently impaired.
R: Currently limited level of rapport.
Impression:
37 yr old man referred to ED by Community MH team post high intent ingestion of Sodium Valproate and Quetiapine. Likely consequence of relapse of Schizophrenia Disorder evidence of early warning signs of relapse in recent weeks letters from employer, psychiatrist and self. Currently fluctuating level of consciousness makes a fuller assessment difficult; Currently waiting for a transfer to a medical bed for further observation and treatment. One to one nursing care due to high level of risk.
Based on past history and current presentation with likely fluctuation in mood and potential impulsive behaviour, high level of risk, I have detained Peter on an ITO - Level 1.
Recommendations:
Nurse special 1 to 1 on medical ward when transferred from ED.
Cardiology review due to potential cardiac side-effects of Quetiapine ingestion arranged with Medical Registrar.
Review by Psychiatrist re ITO in morning have contacted Consultation Liaison team about this.
Oral or IM Olanzapine 5-10 mgs PRN for agitation try to avoid where possible as may impact level of consciousness related to sedative effects of Sodium Valproate and Quetiapine.
Concerns re management can be directed to duty Psychiatric Registrar.
Psychiatric admission once medically stable
John Higgs John Higgs
MH Nurse Practitioner - ED MHT - Authorised Health Professional
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