Pt is brought to the ED by law enforcement due suicidal ideations. Pt has a long standing mental health history. She Has been hospitalized innumerable amounts of times for suicidal ideations. In August alone, she was hospitalized for mental health twice. She has a case worker with social services who is supposedly working on long term placement for her. She is living at home again. In the past, it has been shown that this living situation is not ideal and she has innumerable mental health hospitalizations as she reports self harm and suicidal ideation and plans. 2 days ago, she was walking in the road hoping to get hit by a car. The sheriff was called and pt removed herself from the road and went back home with her mother. Crisis team was called again last night. Pt was outside walking and threatening self harm for 12 hours. Her CSS worker was there during this time. She threatened to hang herself with the clothes line. She finally agreed to go home and watched TV until she fell asleep. She slept until 1:30 pm today. Tonight she was at the church and took a cord and wrapped it around her neck threatening self harm. Law enforcement was contacted as she was refusing to leave the church. She was brought to the ED for evaluation.
Pt reports she doesn’t feel safe to return to home. She reports she wants to die and threatens to cut herself or overdose on medication.
Mother reports pt has a PCA that she stays with. This PCA is her cousin. The cousins father died and pt has not been able to go to stay with her for the last week. Pt has been staying at home with her mother, father and siblings.
Mother reports that this is overwhelming to her and her other children. Supposedly social services is working on long term placement for this patient.


1. Suicidal ideation

2. At risk for intentional self-harm

Patient referred observation for suicidal ideation, patient has had prior ER visit earlier this week, unable to place and patient, mother, decided to trial home with safety plan and close follow-up, unfortunately, patient presents back to ER tonight. Referred observation. Will continue to assess for placement options, consider crisis team evaluation in AM as they had recommended her present to the ER tonight. Patient had labs done on 5/22/23, did not repeat at this time as only home for 24hr otherwise has been under hospital care, will obtain if requested by facilities

15-year-old female who was recently discharged from this ER on 5/24/2023 at 1730, presents back after being home with her mom for 24 hours with actions of intentional harm, statements of hurting herself by throwing herself down a flight of stairs, stating that she will find a way to hurt herself if she is discharged back home. Crisis team had instructed her to come to the ER, not called at this time. Patient will be referred observation while assessing placement options. Patient is difficult to place due to her acuity level and also her need for long-term placement, will be in contact with her case manager tomorrow morning. She is on wait list for multiple behavioral health long-term placement options, however, these wait lists are 3 to 6 months long before her case would be reviewed. Patient is greatly triggered by her home atmosphere. Patient was released from juvenile detention on 5/19/2023, spent the night at her mom’s house but then went to a cousin’s house for 2 days before returning to her mom’s house on 5/22/2023 where she presented to the ER within 8 hours of being back home. Patient had discharge from this facility last evening to her mother’s houses there was not another option for her at that time, a safety plan had been discussed with patient and she did follow that safety plan by calling the crisis team, unfortunately returns to the ER tonight.

Placement options are limited, however, will reach out to behavioral health options for patient this evening and tomorrow, again will discuss with case manager for assistance. Consider contacting crisis team tomorrow once patient has calm down for reevaluation is finding an acute placement for this patient has proven difficult in the past several months and may need to develop a safe plan with the crisis team assistance.

Patient states that her siblings are mean to her and tell her to kill herself, due to the disruption she causes at home.