Mental Health Collaboration HubTrauma and Stressor Related Disorders are a group of psychiatric diagnoses that result from exposure to traumatic or stressful events, such as acute stress disorder and adjustment disorders.
History of present problem: pt endorsed SI and having thoughts/plan to slit his wrists with a knife, which he has access to at his dad’s house, and endorsed self harm via cutting in recent past. Pt reports feeling isolated due to lack of consistent phone connection.
**Aggression is verbal and throwing objects (no contact)
**MnCHOICES Assessment referral made
**Psychiatry scheduled at BHSI – Brooklyn Center
Pt is adopted, Pts parents signed a voluntary out of home agreement with Rice County, Pt has not been home in approximately 3yrs. Numerous failed placements due to aggression. There has been zero movement in regard to placement options. Patient is very aggressive and has been so on the psychiatric unit. Pt presents with all the symptoms of RAD
The patient presented to HCMC emergency department on 11/13/24 with police after running away from home. He is still currently in HCMCs emergency department. He was found on a metro transit bus where he became agitated, fighting and fleeing from officers, making suicidal comments. When in the emergency department the patient significantly agitated, pacing room, yelling. He began destroying hospital property and was physically restrained by security and placed in pediatric violent restraints. He repeatedly shouted, “just kill me” and threatening harm to self and staff. He has been angry and agitated about his situation at home. When he doesn’t get his way with his mother, he acts out, runs away from home, and he places himself in danger as he is impulsive and does things that place himself at risk. The patient was given sedatives for the agitation and heightened state on two different occasions so far.
Presented to the emergency department at HCMC on 11/9/24 for suicidal ideation. The patient ran away from home two hours prior to arrival at the ED. He was encountered by police and was very upset, refusing to go home because he did not like it there. Made suicidal comments, prompting PD to bring patient to the ED. Patient currently is adamantly denying any suicidal attempts this evening. He endorses self-harming in the past by punching himself in the head, no self-harm tonight. He reports that he feels safe at home, but that he does not want to be there because it is boring.
He was at an inpatient psychiatric from 9/6/24-9/24/24, which was his first inpatient hospitalization. The patient was brought in by ambulance from school after an aggressive outburst. Patient was verbalizing suicidal thoughts. He was aggressive in school and required ketamine and restraints during transport. Patient presenting with episodic episodes of dysregulation of such magnitude that he requires multiple psychotropic medications as well as physical restraints to calm him down for his safety and that of others.
The patient is a 13 year-old female with a history of ADHD, inattentive type, anxiety, depression, sexual abuse, suicidal ideation, and self-injurious behaviors that presented to the ER following an intentional overdose in an attempt to end her life. She has had 2 previous inpatient hospitalizations. Patient has a complicated home life with several CPS reports and basically does the caretaking for her younger siblings. Patient has several tattoos given to her by her mother and sister and mother is unwell as well and frequently struggles with suicide attempts and self-harm. Sounds like a significant sexual abuse history within the entire family that may still be occurring. The patient is at risk for sexual exploitation given increased sexuality.
Pursuing QRTP – patient is currently in psychiatric inpatient hospitalization.
Patient is a 15-year-old male. He presented to inpatient via ED due to increased SI and SIB. He has three historical inpatient hospitalizations, has done DBT and outpatient psychotherapy services, and most recently was at Newport RTC – although was discharged early due to aggression and property destruction.
From an acute psychiatric standpoint, youth is safe to discharge form inpatient care and receive services in the community prior to admission to QRTP. He has made significant progress on treatment goals during hospitalization.
Discharge Plan:
Referrals sent to the following residentials:
– Omegon Ascend (Reviewing, no current waitlist)
– Nexus Gerard (Reviewing, waitlist about a week)
– Nexus Mille Lacs (Reviewing, Current waitlist 2 months)
– North Homes (Declined d/t hx of aggression towards others)
– Northwood (Received, 6-9 month waitlist)
– PrairieCare Residential (Reviewing, 2-3 week waitlist)
Alternative Placement through Wright County:
-Wright County unable to identify alternative placement as of 9/24/24
Plan to bridge until residential:
PrairieCare PHP at MOB (unable to pursue establishing care at this time due to pt continuing to be hospitalized)
Continue with established outpatient providers:
Individual Therapist- Bridging Hope Buffalo
Medication Management- LifeSpan Mental Health Monticello
PCP- HealthPartners Elk River
CMHCM- Wright County
Neuropsych Testing- Clary Clinic St. Cloud
17 y/o male with MDD with psychotic features, neurodevelopmental disorder, intellectual disability. He recently discharged from CABHS. Waiting for MSCOCS placement hopefully will be admitted on 10/2. There concern of excessive irritability, agitation, disorganized thoughts, delusions, history of auditory or visual hallucinations, history of self injury and impulsive behaviors leaving to being in dangerous situations.
Pt came to our ED on 9/6 following a verbal altercation with foster parent. Foster parent is refusing to let kiddo return. County has custody, limited parental involvement. Was supposed to begin Fairview’s PHP program 9/10 however is unable to being in the ED, should be able to begin that program once placement is found. County is currently searching for shelter/other foster care options and screening for MH group home placements.
Patient endorses homicidal ideation towards his sibling. Increasing behaviors at home. PHP (Clara’s House) attempted and will be discharged with recommendation of high level of care (residential). Patient has significant trauma after extensive physical abuse from biological mother and likely operates at a much younger age. Patient was removed from his mother’s custody by Ramsey County CPS in May 2024. Aunt is foster care provider.
Update: Discharging today 6/20 to hotel crisis respite
Came to the ED this time on 6/9, after refusing to do chores and punching a wall and tree. Dad is refusing to pick up. Was previously in our ED 5/4-5/18 and 5/25-5/28, returned home with Dad both of those times. Case Manager is looking for waiver paid placement, and has been for over a month. Had interview with potential provider 6/12- they are potentially going to do a variance for him to live in adult home if accepted (he’s 3 months from 18). At baseline has some auditory hallucinations, ongoing aggression- primarily verbal, occasionally property, along with some suicidal ideation.
Recommendation is for Level 5 Residential Treatment; patient is currently inpatient.
Patient presented to inpatient from the ED due to an increase in SI and risky behaviors. Patient has had two previous psychiatric inpatient hospitalization, has attempted PHP, and engaged in outpatient mental health services.
Discharge Plan:
RTC: (JST Thursday 5/30 at 1030 to approve funding for RTC)
Avanti (ACCEPTED – opening 6/11, pending county funding support)
Gerard (referral sent & received – under review, tentative openings August)
North Homes (referral resent & received – under review)
PCR (accepted – insurance OON, county unable to support county contract for funding)
PRTF:
Grafton (referral sent & received – under review)
DHS PRTF eligibility (approved 5/13)
CMHCM: Sherburne County
Continue with established outpatient providers:
-Individual Therapy: Nystrom & Associates
-Family Therapy: Nystrom & Associates
-Medication Management: Allina Health Clinic Cambridge