Bad Thoughts

So a month or so ago together with my Psychiatrist I made the decision to increase my anti-depressants. It was a relatively new medication anyway, I had only been on a low dose for a couple of months. But I was still really struggling with getting enough sleep, both quality and quantity, due to my 'night-time anxiety' and also my nightmares often waking me up and making me fearful to go back to sleep. Also because of feelings and thoughts I was having. Even though I have a diagnosis of 'Depressive Dis-order' for me it has always been something that I suffer from as a magnification of outside events. So, if things are difficult, for example events beyond my control 'happening to me' or I am getting triggered alot about my trauma then I can get very down and overwhelmed. But for me Depression has never been something that has affected me when everything in my life is balanced and going well. It seems as though (and most Treatment Providers that have known me have said) that Depression for me is similar to Anxiety, another symptom of my PTSD (Post-traumatic Stress Disorder). I know it might seem difficult to believe after alot I have written in this blog, but most people have only ever got to see the 'happy' Danielle, with only a very few that have seen me 'not well' or not doing-so-good.
So part of the feelings that I was struggling with a few weeks ago, was alot of suicidal thoughts. It was becoming a daily occurrence, and that was scaring me... luckily I have some skills to put into play when I start feeling this way, but it doesn't always make the thoughts totally go away. The biggest thing I know Is Too Just Hold On - Everything Changes Eventually, including the way I feel & if I am still here holding on when it changes then I'll get the chance to see that.

I don't know why these thoughts come sometimes and not others. There are a variety of emotions attached... shame, fear, anger, disgust...
Probably thanks to the increase in medication a few weeks ago it's been a few weeks since I started feeling this way.
But then yesterday it started. I spent about an hour last night trying to ring Lifeline but it just kept going to the recorded message that they didn't have anyone available and to phone back. It was almost midnight and I had tried phoning a couple of different people earlier, a family member and someone else. They didn't answer, I am not sure if they saw my number and didn't want to talk to me or not.

I found out last week that if you have a Review lodged with ACC over an issue, you can't take any Legal Action regarding it, it's one or the other. And neither is guaranteed obviously.
I have one thing now with ACC that I first put an Application through for in October 2008, it is still in review now, it's been almost 2 years and still no idea when it will be sorted.
And now I have to try and decide about trying to get a review on their bullshit decision regarding my treatment. Which mean that the small amount of treatment I've had and paid for by borrowing money left, right and center (thinking of course this will get sorted out and the ACC subsidised portion would be able to be paid back) is just forgotten about if I try for the review 'option', or going the Legal way, selling more stuff (clothes and book... bbq... tv) to be able to stand up for myself, and say, that's not ok how you've treated me.

At the beginning of this year I thought of a friend who had been involved (she had cancer) when patients, mainly women I think, were campaigning and asking for Herceptim to be provided or subsidised for the treatment of breast cancer. I actually knew two women who were diagnosed withen 24hours of each other, they subsequently went on to attend alot of their treatment together. BUT at the time, One of them had insurance, and One of them didn't. 'Had-insurance-woman' had her Heceptim paid for by the insurance company, she spent alot of time at home resting, eating Organic Food, playing video games, and watching movies. 'UN-Insured Woman' was constantly on the go, I think working still, she had alot of support but had to go far as fund-raising to get the treatment she needed to save her life. Thankfully through in part due to same brave Women standing up and speaking out, I believe that funding has changed somewhat, and the 'un-insured' are able to access this treatment.

But that's how it felt at the beginning of this year, I felt like I was standing in the eye of a hurricane watching everything tumble and spin around me, dangerous and out of control... and I thought this is how women must have felt when the were diagnosed with breast cancer and they new that they couldn't afford the treatment.

Just because PTSD is not something you can put under a microscope, it doesn't mean it isn't real. It's real for me and I hate what happened to me SO MUCH, and I wish I couldn't remember things that I can... and I wish my therapy would've been able to finish.

I've got know idea if the above will make sense, it either will or I'll look totally pathetic. I don't know any answers right now.

Off The Couch (Quote)

Here is an excerpt from Kyle MacDonald's Latest Blog Post 'Off The Couch'

"Most damning, and most encouraging for the future of Sensitive Claims, is the findings of the legal opinion commissioned by the Review panel which found that the interpretation of the legislation and common law used by ACC to justify these changes (the “aw schucks we can’t do anything, it’s the law” argument) was just plain wrong:


“Thus, while the Court provides some support for the principle that a DSM-IV diagnosis is one authoritative means of establishing “mental injury”, it is stretching the decision beyond its capacity to argue that it supports a legal principle that a DSM-IV diagnosis is the only means of establishing “mental injury.”


Furthermore they go on to roundly criticize the change in application of the definition of causality that has resulted in so many claims being declined:


“As a result, ACC will have to exercise considerable care in declining claims on the basis that the sexual abuse was not the exclusive or sole cause of the mental injury; or that the claimant came from a dysfunctional childhood background and that the sexual abuse was part of that context, and it is therefore not possible to assign a causal link between the sexual abuse and the current mental injury… …Because very little in the experience of life has an exclusive or single cause, it is unrealistic, and seems unduly restrictive and unfair in the context of multiple causes of a claimant’s mental injury, for it to be a requirement that the claimant prove on the balance of probabilities that the sexual abuse constitutes the sole or exclusive cause of the claimant’s mental injury. This seems especially so in the context of childhood sexual abuse, where there is a high likelihood of a generally dysfunctional environment, of which the sexual abuse forms a significant part. It is well established in common law cases of causation that exclusive causation is not required to be proved, and that often a “material contribution” to the injury or a showing of “substantial cause” is sufficient to establish the causal nexus.”


These findings are game changing. They open up the process for a return to a structure that more closely resembles the previous structure than anything else, including counselors once again being able to assess their own clients:


“there seems to be nothing in the legislation ... which would restrict ACC from accepting a clinician without a DSM-IV qualification, as having the necessary clinical training and expertise to provide expert advice on the existence or otherwise of ‘clinically significant behavioural, cognitive, or psychological dysfunction.’”


And:


“It will be important that the Massey Guidelines principles of safety, client focus, and the therapeutic relationship are considered when developing the assessment process. The assessors should themselves be experts who have worked with sexual abuse victims. There will need to be a sufficient workforce so that clients can be assessed without undue delay.”



Implementation is now the name of the game. And ACC are consulting with representatives of the sector now, myself included. The devil will be in the detail, as they say, but at least we now have a document that we can hold ACC accountable to. And that is thanks to all of you, providers and survivors, who put so much work into your submissions. If you haven’t already read the Review Panel report, I suggest you do. It is very validating of all our hard work.


Overall I have struggled throughout this process to know whether all of this madness has been the result of outright incompetence from ACC, or malicious intent. The latter seems evident in stories such as those highlighted in the recent Sunday Star Times expose of the possible involvement of Dr. Felicity Goodyear Smith; the former, namely incompetence, is the tune the review panel plays.

I think I’ve reached the point now where I don’t really care either way. ACC owes New Zealand an apology regardless, and sorry may very well go a long way towards earning back the trust of a very angry and disillusioned sector.

They certainly owe an apology to all those who have suffered, still suffer and some who may have even lost their life, as a direct result of this ill-informed and incompetent little “experiment.”"

Kyle MacDonald is an enlightened soul, who has campaigned tirelessly for victim's rights of fair-care and healing - and he's quite clever too! So you know what, Kyle, you have played a intergral part in shining the light on the truth over this last year, so Bravo! to you, and good on you through all this madness for staying solution focused. You can find his blog by clicking HERE.

Band-Aid Medication

It's just starting to rain, fat & heavy drops. The sky is grey and the wind is howling through the trees outside my window.

So on Thursday last week I realised that I would run out of 2 of my medications in a couple of days, Saturday to be precise. And it's rather important to be precise when it comes to medication for the mentally ill (like me I guess). So I rung one of my treatment provider's, and spoke to the Receptionist and spelt out the names of the Meds, and explained that they would need to be faxed, not posted, because I would need to pick them up either tomorrow or the next day (which was either Friday or Saturday then). My chemist is closed on a Sunday you see, which is fine, there is one across the road that is open 7 days, but they arn't as nice. And for someone like me, who gets the 'High-user Healthcare Card' 2 weeks into the year... and as well some who is well, extra sensitive sometimes, it's nice to have a nice Pharmacist. So I then gave them the Chemist's name, address and fax number (even though I knew it was already in my file somewhere, it's nice to be helpful); And then before I got off the phone, just said again how I only had 2 days worth left (cause I'm an anxious, insecure mess most of the time these days, I may as well be honest).

So late Friday morning I walked up to the Chemist and no scripts had come through for me. That was okay, you know it's actually not all about me, and things don't always happen instantaneously, I had a chat with one of the girls in there about the storm that was meant to be hitting over the weekend. I left saying that I would just come back tomorrow and get it.

So Saturday, the Chemist shuts at 2pm I think, so I have to make sure I get there before that if I am going. And I am, or I was... so I go up, and they don't have any fax scripts for me. Now luckily I know that there is a pretty good chance that I can explain the situation and they may choose to give me enough medication to see me through until Monday. So now I need to start explaining, wondering whether or not 'it's ok', whether I sound like a lying drug seeker, or a person who has run out of their med's and the treatment provider forgot to send the fax. My chest gets very tight. The Pharmacist listens, and then gives me 2 days worth and say's 'See you Monday then'. I walk home, tears streaming down my cheeks from I don't know what, feeling stupid somehow that I can't understand or describe.

So then Monday comes, yesterday. And I am not going to risk ACTUALLY going into the chemist unless that script is there... because it will just be too overwhelming... and then I think that if it will be remembered and faxed, it probably won't happen early in the day, so I wait until 3pm and then phone the chemist and ask if there has been a script come through. No.
Crap.

I've had about 45mins sleep in the last 48hrs and my head is a bit spastic. I rang the chemist today at lunchtime and they still didn't have a fax, and I don't think it's very safe for me to go another 24hours... so I tentatively phone the Receptionist, explain the situation, and ask for the Treatment Provider to phone. That was a few hours ago. So an hour ago I rang the chemist... still nothing... only a couple of hours till closing, starting to panic. I just phoned back and the Receptionist said she just faxed it through.... I asked if there was a message or did they say they were going to call... she didn't think so.

I'm not angry at anyone. All my Treatment Provider's are wonderful people, who time and again have shown compassion and patience towards me, but who are also human, are busy, and surprise surprise - it's not all about me, I know that.

I'm just feeling down about trying to manage a problem with medication that needs more than just the band-aid that med's provide. Sometimes a band-aid is a good thing so healing can have a chance to happen... just feel frustrated with what has happened with my healing.

I have a mental illness, I am clean and in recovery from addiction, but am reliant on meds. I have trust and faith that in my Treatment Provider's, but there are more side-effects to meds than just the physical I guess is what I am trying to say.

Gotta wrap up warm and head out to the chemist now. Molly has been limping lately when it is cold (she was run over about 3 1/2 years ago and her back knee was re-built)... so will leave her at home even though I feel a bit safer when I go out and she is with me - not that she'd probably know how to even do anything to anyone if they tried to hurt me, she is such a wuss!

Hope everyone out there (in my computer) is doing okay, is keeping warm and safe in these trying times.

Nick Smith doesn't bother to answer Annette King re: ACC Sensitive Claims Disaster

An extract from:
Questions and Answers - 14 September 2010
Tuesday, 14 September 2010, 5:28 pm
Press Release: Office of the Clerk
http://www.scoop.co.nz/stories/PA1009/S00215/questions-and-answers-14-september-2010.htm

Accident Compensation Corporation—Performance

4. Hon ANNETTE KING (Deputy Leader—Labour) to the Minister for ACC: Is he satisfied with the performance of ACC?

Hon Dr NICK SMITH (Minister for ACC): Generally, yes, I am very satisfied. The Accident Compensation Corporation (ACC) has made huge progress in reversing years of huge deficits, and has markedly improved rehabilitation rates. The one area that I am not satisfied with is sensitive claims, which make up 0.2 percent of claims. That is why I instigated an independent clinical review of ACC’s processes, and I am pleased with the way that ACC has responded to the clinical panel’s recommendations.

Hon Annette King: What discussions, if any, has he had with ACC in light of the fact that there has been a drop of around 6,250 people getting elective surgery funded through the scheme since he became the Minister, and that, on the current track, that drop could reach 10,000 people by December; and is he concerned about the impact this huge reduction is having on injured New Zealanders?

Hon Dr NICK SMITH: In respect of elective surgery, it is true that under the previous Government ACC was funding elective surgery that was not injury-related, and that is why ACC is properly meeting its requirements. The drop in the number of claims in that area is way over the increases in elective surgery that my colleague Tony Ryall has provided for under Vote Health.

Hon Annette King: Has he received correspondence from orthopaedic surgeons like the correspondence that I have here in my hand, which states that 80 percent of patients with shoulder injuries are being refused surgery because of changes made by ACC since he became the Minister, and that when those patients do win on review 4 to 6 months after the accident, they have irreparable damage to their shoulders because of the delay?

Hon Dr NICK SMITH: Yes, I have received some correspondence from orthopaedic surgeons, and I have met with them. We have a panel—[Interruption] Well, I might get to it, if members take the time to listen. The Government and ACC have ensured that those who are eligible for accident compensation actually get it. When we look at the cases that have been reviewed, we see that under the National Government there has been no change from the position under the previous Government in the number of decisions being overturned. In fact, approximately 80 percent of those decisions are being supported through that review process.

Michael Woodhouse: How has ACC responded to the Canterbury earthquake, and has he been satisfied with that performance?

Hon Dr NICK SMITH: The corporation has responded very effectively to the Canterbury earthquake. There have been 830 claims lodged for injuries associated with the earthquake, and they are being effectively managed, despite two of the scheme’s three offices in the region being closed for the first week of the civil emergency. The corporation quickly made contact with all 550 serious injury claimants to ensure their well-being over the course of the last week. ACC has deferred collection of accident compensation levies from Canterbury businesses, because they are under pressure. I also note that ACC has made 20 of its staff available to assist the Earthquake Commission, which is under huge pressure with regard to case management. I think that is the sort of cooperation we would want from Government agencies when we face a catastrophe the size of Canterbury’s earthquake.

Hon Annette King: Is he aware that the New Zealand Orthopaedic Association has reviewed the criteria that ACC experts are using to assess shoulder surgery since he became the Minister, and has found that they are grossly simplified and do not take account of the loss of function at the time of the accident; and will he ensure that ACC listens to the association’s advice? After all, they are the real experts.

Hon Dr NICK SMITH: I certainly accept that orthopaedic surgeons have a very real interest in their patients, but we should not be naive; they also have a very real interest in the fact that ACC pays far more generously for surgery than Vote Health does. It is my view that we need to ensure that decisions about orthopaedic surgery are made by the clinicians, not politicians.

Michael Woodhouse: Mr Speaker—

Hon Annette King: Good Lord!

Michael Woodhouse: I have never been called that.

Mr SPEAKER: I do not think that was at all necessary.

Michael Woodhouse: What is the recent performance of ACC in respect of rehabilitation, and is he satisfied with this performance?

Hon Dr NICK SMITH: ACC’s improved performance in rehabilitation rates has been absolutely outstanding. In fact, despite significant declines in 2005, 2006, 2007, and 2008, over the last year there has been a 3 percent improvement in rehabilitation rates, which means that thousands of New Zealanders are back at work earlier than they would have been under the previous Government. I am surprised that members opposite are so opposed to effective rehabilitation. Those improved rehabilitation rates are one of the reasons that the scheme, rather than losing $2.4 billion in the last full year in which Labour was in office, is now in far more robust financial shape.

Hon Annette King: Has he seen the announcement from the National Foundation for the Deaf 4 days ago that ACC has also got wrong the criteria for workplace hearing injuries, and in light of the fact that it took over a year of clinical and public pressure before the Minister and ACC admitted that the had got wrong the criteria for sensitive claims for sexual abuse, will he listen to their clinicians before any more damage is done to those people who have been denied help?

Hon Dr NICK SMITH: I have met with the Deaf Association and with the key associations with expertise in audiology. The key element that those organisations accept, which is the Government’s position, is that age is not an accident, and that it is not right that accident compensation pick up the cost of the very substantive bill associated with age-related hearing loss. That is not the function of the scheme

Sigh... I was just speaking with someone and saying that I had finally managed to finish reading the CLINICAL REVIEW OF THE ACC SENSITIVE CLAIMS CLINICAL PATHWAY Report and that I was blown away by the thoroughness of the Panel and the Document. BUT I then said that given my experiences of the last year (or even just the last month!) that I still feel gun shy when it comes to trusting ACC.
So on that note, was disappointed to see that when Annette King gave Nick Smith the opportunity to speak about the Report, Changes, and Healing that needs to happen to do with ACC Sensitive Claims, that as far as I can see he did not attempt to even make mention in his reply.
It feels like a good analogy of Nick Smith's attitude towards Sensitive Claims, not even worth a mention apparently. Shame on you Nick, BUT IT'S NEVER TO LATE TO SAY SORRY AND BEGIN TO MAKE AMENDS - CHANGE MAY BE HARD NICK, BUT IT WON'T BE HARDER THAN WHAT ACC SENSITIVE CLAIMANTS HAVE BEEN THROUGH...

Recommendation 11 of 'Clinical Review of the ACC Sensitive Claims Clinical Pathway' Report

The highly anticipated Report from the Panel for 'CLINICAL REVIEW OF THE ACC SENSITIVE CLAIMS CLINICAL PATHWAY' was released yesterday. I haven't as yet read the whole document, I spent about 15 minutes reading it yesterday and was sitting on the couch crying so hard I had to stop, I think in light of and on top of the 'decision' and 'treatment' I've received it was all a bit much. Anything to do with ACC now increases my anxiety and triggers feelings of fear and hopelessness.
But saying that, what I have read so far is EXTREMELY HOPEFUL. It seems as if the Panel have done a wonderful job, and there is much more of a chance now of victims of Sexual Abuse and Rape being able to access the care they need in the future. And in my situation at the moment I am trying to think that writing this blog and going to speak in front of the Panel, and being open with my situation publicly in the Sunday Star Times, even if I am not going to get the care I need, at least it was worth it if it means that future Survivors wanting to get help to help themselves will never have to suffer the indignities and difficulties that I've been put through by ACC.
In light of my blog's purpose, to document openly MY experiences with ACC I'm posting a large portion of my DATA (Diagnostic & Treatment Assessment Report) which I attended at the end of October. After a 2 minute phone call from my Case Manager (Selena Domingaz) at ACC to tell me that I only had 5 remaining sessions of subsidised therapy, and me collapsing when I was out; my wonderful Therapist then got on the case & worked out they'd suddenly 'decided' I'd never had a DATA so they were going to stop my care. My Therapist (recognising the urgency perhaps) went to great lengths to set up a DATA with an ACC Authorised Treatment Provider very quickly.
When reading this keep in mind this from the recent Report:

" Recommendation 11
That a proportion of claimants may be required to undergo an assessment for cover from an assessor who is not their treatment provider before a decision about cover is taken or to review ongoing therapy. These assessors should themselves be experts who have worked with sexual abuse victims and, wherever possible and desired by the client, the client’s usual treatment provider should also be involved in the formal assessment process and in determining appropriate treatment goals and plans."

Page 1


Pages 2-4 contain some quite historic personal information about my actual attacks, so I will list the headings of what is covered on the missing pages:
- Method of Addressing Referral
- Post Traumatic Stress Disorder
- Re experiencing the trauma
- Avoidance of Stimuli Associated with the Trauma
- Increased Arousal Symptoms
- Depression
- Past Mental Health History
- Medication
- Family History
- Relationship History
- Mental Status
- Formulation

Page 5


Page 6


Page 7


Page 8


Page 9


Page 10



Hopefully it is all readable! Can someone please let me know? It is really important to me that it is, so if it isn't I will amend this post and ensure it is.

Out of a WHOLE 10 pages there is only 1 SENTENCE referring to 'Segar House' as POSSIBLE extra ON TOP OF and SUPERVISED by the Therapist I was seeing. Yeah, that's right, the 'Highly Qualified and Experienced ACC Assessor' recommended in October 2009 that I remain attending sessions with my therapist then. But of course that is NOT what ACC decided or actioned :(

This is just one of many pieces of Clinical Evidence showing that ACC's actions and decisions around my Sensitive Claim, Care and Treatment decisions over the last 11 months, and up to and including the most recent Letter, have been at best a series of terribly damaging mistakes, and at worst, something I can't fully describe but what feels at times like being treated like 'something to be gotten rid of' through calculated manipulation. It's left me physically, mentally, emotionally and financially broken. Because of me scrambling to try and pay lawyer's fee's & attempting to try and finance the care I need over this time, I am now for the first time in my life up to my neck in debt and that I can't see my way out of. I now can't afford to even get a bus to therapy and back, let alone get my dog the medical (vet) care she needs or pay my rates.
The nightmares are worse than ever.

The Latest with My ACC In-Sensitive Claim

In case it isn't possible to read the scanned copy of letter:

"31 August 2010
Danielle Martin
**********
**********
**********
****

Dear Ms Martin

We're sorry, we can't fund any further treatment
Ms Danielle Martin DOB:**/**/****

Your treatment provider ***** ***** has applied to ACC on your behalf for help with the cost of your treatment. Decisions regarding treatment requests are made on an individual basis and after careful consideration of the information we hold, we're sorry to say your application has not been approved.

Why we can't approve your application
We're unable to approve your application because the available information suggests that while treatment may be recommended for your current condition, that condition is not related to the injury you sustained on 05/10/2000.

ACC believes you currently require treatment that would be best met at Segar House. The programme at Segar House will provide you with a safe and therapeutic environment that is targeted to your current presentation. The level of treatment required would not be ment in one on one counselling sessions and therefore treatment through Segar House is more appropriate at this time. This has been discussed extensively with your treating psychiatrist Dr ***** and counsellor ***** *****. A referral was to be made by Dr ***** through the DHB to Segar House for more intensive therapeutic treatment, which ACC understands you have declined.

ACC is mandated to provide and fund treatment that is appropriate and necessary and at the quality required for the purposes of restoring your health to the maximum extent practicable. Until treatment at Segar House is successfully completed, ACC is not able to provide any further treatment for your covered mental injuries of Depressive Disorder and PTSD.

What happens now
We've written to your ***** ***** with our decision and we suggest that you discuss your treatment needs with them. If you have further written medical information in support of this application we may be able to reconsider our decision.

We're happy to answer your questions
Please call us on 0800 101 996 if you would like to talk about this decision. We'll be happy to answer any questions, if you have any concerns, work with you to resolve these.

If you're still not happy, the enclosed information sheet, Working Together, tells you about the different options we offer, including independent reviews. For reviews, you need to apply in writing within 3 months of our decision. Later applications may be accepted if factors ourside your control stopped you from applying in time.

Yours sincerely
Michelle Wogan
Case Manager
Telephone: 0800 735566"

A REPORT FROM MY PSYCHATRIST, THE 'DR' REFERRED TO IN THE LETTER FROM ONE OF MY LAST ACC SUBSIDISED SESSIONS:

"02 Dec 2009

Ms Selena Dominguez
Case Manager, ACC
via email

cc:
Dr * ******

Dear Selena

Re: Ms Danielle Martin
**********
**********
**********

Danielle was seen today for review. Please find following, details of the consultation, and please note myt recommendations re ongoing therapy, and request for approval of a small number of follow-up sychiatric reviews over the coming 6-9 months.

Date of session: 2 December 2009
Session type: Psychiatric
Goals for session: Review progress and plan

Updated History
Danielle has come through the stress of the need to terminate with her therapist, in terms of no suicidal thinking for the past week and no further self-harming behaviour. However she cannot contemplate having to engage with another therapist, and having prior to this felt she was making significant progress finally and could start to have hope for the future, is now feeling that the "rug has been pulled from under her yet again...", and is struggling to retain hope that she will recover over time.

Danielle remains needing large doses of hypnosedatives to get at least a minimal nights sleep (3-4 hrs), and with nightly re-experiencing of past rape via very distressing nightmares. She is aware that when she is ready/able to cope with it, that EMDR treatment does at least offer the chance of relief of these more acute PTSD symptoms.

A long session was spent today processing a range of issues related to the recent events incl the ACC/funding issues, reviewing current treatment, and also me giving my recommendations re "where to from here" in terms of what is ideal separate from any funding constraints. My recommendations, based on consideration of Danielle's issues and my understanding of her developed over the months I have known her, and developed with condieration of her own wishes but certainly not based on what she wants, are:

i) That 4-8 weekly psychiatric overview continue for at least the next 6-9 mths, and that we look to progress a trial of stopping **********(medication) and commencing **********(medication).

ii) That Danielle has made progress in therapy since her psychiatric conditions were better treated, and that disrupting this therapy in her case is not in my opinion in her best interests currently - that the present therapy arrangements should continue.

iii) That I will communicate my opinion as above to Danielle's ACC case manager.

iv) That we review her readiness to engage in a period of EMDR over time with a view to successfully undetaking this treatment at some point within the next 6-9 mths.

v) That supporting Danielle towards greater independance is key to her ongoing recovery; she has made steady progress in this regard over the past 12 months.

Medications
02-Dec-2009 ********** 37.5Mg Modified Release Cap
SIGS : use to reduce and stop ********** QTY: 30

02-Dec-2009 ********** 75Mg Modified Release Cap
SIGS : 1 nocte QTY: 30

02-Dec-2009 ********** 5Mg Tab
SIGS : 1-2 nocte QTY: 45

02-Dec-2009 ********** 7.5Mg Tab
SIGS : 1-2 nocte QTY: 45


Yours sincerely


Dr ***** *****"

Just a girl, drowning ♥