Risk Factor: Self harm

This term refers to instances of isolated, non-repetitive aggressive behavior, such as a single incident of physical aggression or verbal aggression.

MHF-M17-1182

Pt is presented to the ED via EMS. Pt resides at a residential treatment facility, where he has been for the past three months. While at the group home, pt reports he became upset by hallucinations and began banging his head. Pt states that he wanted to harm himself and possibly end his life. Pt has hx of baseline S/I and threats of suicide. Pt reports hx of physical and sexual abuse (does not provide further details.) Pt has hx of Borderline Personality Disorder, DMDD, PTSD, GAD and Unspecified Psychosis.

MHF-F18-995

Patient is presented to the ED by EMS from an RTC facility. Patient assaulted another resident and staff members, and attempted to elope from the facility. Patient is under guardianship of Martin County, and is considered a vulnerable adult. Patient has a significant history of abuse, and suicidal ideation. Patient is supposed to follow a low sugar and fat diet due to pancreatitis.

MCR-F12-255

12 year old with trauma history, in-utero cocaine exposure, long history of behavioral outbursts with adoptive parents, participating in CIBS since November and moved to Phase 2 at Gerard in early January, but struggled and was sent to the ED within 48 hours due to severe outburst at Gerard. Appears to have mild autism spectrum disorder (difficulty with transitions, sensory sensitivity, communication struggles), and likely PTSD related to attempted kidnapping and multiple sexual assaults spring 2022. Has started Vyvanse, Prazosin, and Fluoxetine while boarding, and she has had much less extreme behavioral outbursts, has not needed IM or restraint in weeks. Oppositional, but generally can be verbally redirected. Outbursts tend to be tied to her difficulty with flexibility – eg when meals or medications arrive at slightly different times, or one nurse implements different TV rules than another – will start swearing, sometimes escalating to head-banging, but generally is able to calm on her own when given space (intervening/talking/etc once she is starting to dysregulate tends to escalate rather than de-escalate her). Has loving parents and want her in their home, but fear they cannot keep her safe right now. Regarding running – hasn’t tried to elope from peds floor. Sometimes ran from school or home when upset, walks around neighborhood and comes back. Issues at school have been more blowing up and headbanging. Update as of 4/11 still in ED

MHF-F16-1094

Patient is presenting to the ED via EMS for suicidal statements and self-harm. Patient returned to her group home from school, and entered the bathroom to self-harm with a paperclip. Patient was told the group home would have to remove some of her possessions, so patient left the home. Patient threatened staff, and threatened to jump off of a bridge. Patient has been inpatient for mental health, at least six times, and has had many ED encounters (6 times in the past month) for similar symptom presentation in the past.

MHF-F37-787

Patient presents to ED via EMS for aggressive behaviors and agitation at her foster home. Patient has diagnosis of MDD, GAD, and Intellectual Delay. Foster caregivers report that the patient has had increased agitation over the past 4-5 days, is throwing things, crying most of the day, trying to run away from the setting multiple times a day, is uncooperative, destroying property, hitting caregivers in the face and stomach, and is now trying to self-harm by dumping a dresser over on herself. Patient does have contact with her birth mother but there are apparently issues with that, and foster care believes that birth mother is influencing the patient to act out so mom can get custody returned to her.

C8SM8SP-F14-893

Pt’s parents recently lost custody. Patient was residing at Brittney’s Place and engaged in SIB by cutting superficially. Pt was evaluated and cleared for discharge however Brittney’s Place with not take Pt back.

C8SM8SP-F14-885

Patient has previous mental health history and does not want to return home to live with her parents. Patient makes efforts to elope from their care and will escalate her behaviors to ensure she does not return home. Patient has grabbed the steering wheel from mom in an effort elope from the car.

MCR-M16-378

16 year old, county ward, who has been at Gerard Academy for 1.5 months and had escalating SI in the context of conflict with peers at Gerard and then ultimately learning that father’s parental rights were terminated. Long previous history of neglect and possible abuse, multiple family members with substance use disorders. At Gerard was leaving the facility and finding sharps to potentially harm himself with. Initially was recommended for inpatient psychiatric care, but declined by all facilities due to history of aggression or behavioral issues in those facilities previously. Eventually acute SI resolved while boarding in the ED, but as plans have been made to work on return to Gerard, he has repeatedly stated he does not want to go back there and will hurt himself or others if he does. His case manager reports that similar statements have arisen repeatedly in the past as placement facilties start to challenge him and seem to serve the function of avoiding difficult emotions. Currently trying to work with Gerard staff and case manager to help him safety plan for a return to Gerard.