Patient sent to Cambridge medical center ED due to aggression and numerous ED visits from Bar None. Bar None discharging the patient.
Risk Factor: Suicidality
Suicidality refers to thoughts, behaviors, or tendencies related to suicide, including suicidal ideation and suicide attempts.
PH-F12-5010
12 year old, history of trauma with subsequent depression and anxiety ADHD and anxiety. Multiple treatment interventions at PHP. Patient reports that depression has been worsening over the last several months and has becoming more difficult to manage. Patient reports ongoing suicidal ideation and difficulty thinking about anything in the future that would be of benefit. Patient reports ongoing mood disorder low mood low energy reports difficulty with school reports anxiety.
R
PH-F15-5000
Previously diagnosed with depression, anxiety, PTSD . Numerous admissions to psychiatric hospitals and Emergency Departments because of suicidal ideation, suicide attempts and self-injury. History of CPS, county mental health case managers and crisis services. Plan to jump off a bridge. Self injury has included cutting, scratching, burning and head banging.
MFIUP-M13-4967
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
CH-M16-4938
Patient presented to the ER via EMS on 12/4/24 after an intentional overdose of chlorpheniramine maleate 4 mg / dextromethorphan hydrobromide 30 mg pills in an attempt to get high. He required PICU admission for anticholinergic toxicity and treatment with Precedex related to agitation and history of aggression with anticholinergic toxicity. He has had multiple ER visits for substance use. He was previously admitted here for inpatient psychiatric hospitalization from 11/7-11/15 and was discharged with plans to attend outpatient SUD treatment in Wisconsin. as he was not willing to participate in residential treatment. This is at least his 6th intentional overdose in attempts to get high and his 5th hospital admission requiring PICU admission. He is currently under the emergency guardianship of Mille Lacs County related to a CHIPS petition as he has been abandoned by his mom who moved to Wisconsin. He is also currently on probation with Mille Lacs County. He has not previously been successful with past SUD treatment or inpatient psychiatric hospitalizations. Has very poor insight and follow through- though is able to express his desire for sobriety.
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.
MHF-F16-4834
Kiddo came to us on 11/7 from East Bethel PRTF. East Bethel has discharged reporting they are unable to meet his needs based on his ongoing SI and behaviors. They are completing a referral to CABHH. Has a long history of SI. There is currently no County involvement. Aunt is working on setting up CMH services, but County has reported they don’t have any placement options. Our team will be requesting County look at approval for out of state options once they are open due to limited options in MN for this level of care.
PH-F17-4728
Patient is needing an out-of-home, secure, placement, due to ongoing, chronic, safety concerns, that are unable to be managed at home. Patient is recommended to attend Residential Treatment or enter into a supportive living environment.
Patient has a significant psychiatric history including:
Psychiatric hospitalizations
-Mayo Clinic Generose 08/2019
-PrairieCare 10/29-11/11/2022
-PrairieCare 08/30-9/7/2023
-Mayo Clinic Generose 09/2023
-PrairieCare 11/8-11/20/2023
-Mayo Clinic Generose 12/2023
-Mayo Clinic Generose 04/2024
-PrairieCare 06/25-7/11/2024
-PrairieCare 07/25-8/14/2024
Residential Treatment:
-North Homes for a 35-day evaluation
-Gerard 08/2020-06/2021
-Gerard 12/2022-06/2023
Day Treatment:
-Fernbrook Family Center
Partial Hospitalization:
-Mayo Clinic November 2021, June 2022; Prairie St. John’s February 2022 and July 2022
-PrairieCare Rochester 11/16-12/21/2022
-PrairieCare Rochester 09/11-9/15/2023
-PrairieCare Rochester 09/19-10/11/2023
History of self-harm by cutting (recently daily), with one prior reported suicide attempt (by overdose, 6/2024), who re-presents to PrairieCare inpatient due to safety concerns related to self-harm by cutting, with increasing suicidal ideation and intention, with an inability to contract for safety, in the context of stressors related to school re-starting.
EHS-F16-4792
Patient is a 16-year-old girl with history of mental illness who was brought to the emergency department from port group home where she has been residing for about 5 days. Patient states that she was in juvenile detention immediately prior to going to the group home. Patient has been prescribed psychotropic medicines in the past, but is not currently using any medications. Recommendation from probation officer and county social worker is juvenile detention center or psychiatric inpatient hospitalization pending long term psych placement. However, LE states they can’t bring her to JDC as she has no charges that would make that appropriate at this time without order from probation. Pt has been aggressive, verbally and physically while in the ED. She has eloped on multiple occasions and has attempted to harm herself.
PH-F8-4701
Recommendation is for QRTP or PRTF – either could potentially meet the needs of this patient and limited treatment centers available due to patient’s age. Patient is currently in psychiatric inpatient hospitalization.
Patient is an 8-year-old female. Patient presented to inpatient from the ED due to increase in unsafe and risk-taking behaviors. This is her fourth inpatient hospitalization; one in 2022 and three in 2024. Patient has attended day treatment twice and participated in outpatient psychotherapy and medication management.
Discharge Plan:
PRTF/QRTP: (county funding approved for QRTP)
– Grafton (declined due to not meeting criteria)
– Northwood (referrals submitted 9/9, on waitlist 9/23 – awaiting update on admission timelines)
– Gerard (unable to accept due to age)
– Avanti (unable to accept due to age)
– Bar None Haven (unable to accept due to age)
– North Homes (unable to accept due to age)
– Heartland Girls Ranch (unable to accept due to age
Continue with following outside providers:
– Therapy/Therapist: Solutions Behavioral Healthcare Professionals
– Primary Care Provider: Sanford Health
– Medication Management: Solutions Behavioral Healthcare Professionals
– Case Management: Solutions Behavioral Healthcare Professionals
– Occupational Therapy: Beyond Boundaries Therapy and Wellness