Risk Factor: Aggression (highly acute/risk to others)

Highly acute aggression refers to aggressive behaviors that pose a significant risk to the safety of others.

MFIUP-M14-6668

Pt presented to ED with family after FBI visited family after an anonymous tip that patient was having SI and HI regarding a mass shooting in the context of worsening depression and anxiety. Pt acknowledged recent homicidal ideation as a means to justify ending his own life. Initially pt denied creating a written plan, denies attempts to get a gun or have possession of a gun, or thought of a specific school or time he would do this, though, he now states he identified two elementary schools as potential targets. During past assessments he has acknowledged reasons for not going forth with this shooting – like the attempt would fail and he would be in a worse situation and he does not want to actually hurt people. Similarly, suicidal thoughts are present with thoughts of shooting himself, but does not have intent or obtained means to act on it. Although these are moderate-high risk thoughts, patient is able to keep self and others safe while in the hospital at this time. Aspects of his clinical history that put pt at risk for progressing to future violence include pre-occupation with prior shooters, nihilistic beliefs, and time spent in a potentially radicalizing online community. Additionally, mom reported partner had a gun in the home and patient + step-brother was looking around the house for this gun. The leading drivers of current SI and HI seem to be significant anxiety and co-morbid depression. Has experienced significant neglect and sexual abuse that have impacted his current mood and outlook as well.

AH-M6-6272

Behavioral dysregulation in the context of Familial Foster Home, and in care of respite provider. Breaking items in the home environment. Suicidal behaviors “wrapping items around his head”. CPS involved. Working towards residential placement.

CH8SCH-M10-6113

Presented from partial hospitalization program (Clara’s House) for worsening aggression and self-harm. Has had in-home skills worker and outpatient providers. Was referred to Clara’s House for worsening non suicidal self-injurious behaviors. Recommended residential treatment due to attempting all lower levels of care.

MCR-M9-5609

He has been in foster care since he was removed from home in 10/2022 due to physical abuse. He was in foster care with a family and was relatively stable until the past few months, when the foster father died and since then there has been an increase in behaviors. He is unable to return to that foster home. He has very low cognitive functioning, reported to be around a 3 year old, and he was attending school only a few hours per day. He was on a lot of medications and psychiatry has optimized them during his time here.

HCMCH-F13-5634

13-year-old female with a history of autism spectrum disorder, oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), major depressive disorder (MDD), and traumatic brain injury (TBI).

On 4/23/25 according to EMS, the patient had an argument with her mother around 5:00 PM today and subsequently left the home abruptly.
This is her second time boarding in APS; she was admitted two weeks ago and remained for two weeks while in-home services were being arranged. She was discharged but returned due to elopement and aggressive behavior toward her mother.

During her previous admission, she was referred to CABHH but placed on the waiting list. She has also been referred to Beacon for respite care and has been on the waiting list at Grafton for over a year.

CH-M13-5196

Patient presented to the ER after an unprovoked stabbing of a sibling in the middle of the night requiring emergency surgery and then proceeded outside in the cold without weather appropriate clothing. Patient has chronic aggressive behaviors towards caretakers and other children.

CH-F14-4594

Patient presented to the Emergency Trauma Center at St. Cloud Hosptial with aunt. Patient presented after being on run from NW Passages in Wisconsin. During times of elopement, patient is known to spend time at the home of a person known for drugs and trafficking. Patient has a county mental health case manager that is working to make referrals for appropriate levels of care. Patient has a history of aggression towards their aunt. Patient does not have any contact with biological father as he is incarcerated and limited contact with biological mother. Parental rights have not been terminated, but patient’s aunt has physical and legal custody. Patient is very vulnerable and has no insight into the unsafe nature of his behaviors.

PH-M15-4994

Psychiatric history of autism spectrum disorder, anxiety, and ADHD, with no prior psychiatric hospitalizations, with no prior reported self-harm, with no prior reported suicide attempts, who presents to PrairieCare due to safety concerns after patient jumped out of his window to run away(he hurt his leg, and was found semi-hypothermic in water) due to anxiety about an upcoming court case regarding him lighting his house on fire with his family inside last month.

SL8SHOD-F15-4879

Pt has has multiple psychiatric hospitalizations, is aggressive often, and very unpredictable in her behaviors. She was in an ED for about a month, and was placed at Northwoods residential treatment. She was engaging in self harm. and making threats to jump out of a window. Pt assaulted police who came to remove her from the facility for psychiatric care. Northwoods does not feel that they can keep her or the other patients safe there, so they are not willing to accept her back.