Mental Health Collaboration Hub
Presented to the ED in the evening, 9/18/24, with her parents after she ran away from school on Tuesday and made suicidal statements to a friend on Monday stating “I’m going to kill myself” which was relayed back to her parents. She also told another peer on Monday that she plans to run away. When she did run away the following day, Mom reports that she was missing for two hours before they found her and there were no known precipitating factors leading to this. Patient tells writer that she “doesn’t know” where she went on Tuesday and “I was walking towards home apparently.” Writer asked about why she is expressing confusion/poor memory of the event and if she was using any drugs/alcohol. She looked at writer, shrugged, then did not answer further. Throughout evaluation, patient is vague, intermittently evasive, and at times mute with writer. She presents with an incongruent and at times inappropriate affect and vacillates from a younger child-like presentation to a more adolescent presentation. She lacks insight into her parents’ concerns and demonstrates poor insight and poor judgement related to her personal safety. She is not willing or able to participate in reflection about why her parents/other adults are having significant concerns for her overall wellbeing, mental health and safety. When asked if she thinks she can maintain safety in the community/at home and also agree to not run away, she will not answer writer.
Area(s) of Risk: suicidal ideation, elopement, inability to care for self
Level of Risk: High for elopement and safety chronically for past few months which has been demonstrated repeatedly by running away and making unsafe choices such as getting in a stranger’s car and making pornographic videos of herself. Level of risk for SI statements is fluctuating and it is noted that pt does not have hx of suicide attempts.
Intent to Act: No
Referrals made to adolescent child psychiatric hospitals however no openings. Patient calm, cooperative and not having sx or bx thus appropriate to dc back home as of 9/20 however parents declining to have her discharge to home.
Child Protection involved as well as patient’s mental health case manager.
Risk Factor: Suicidality
Suicidality refers to thoughts, behaviors, or tendencies related to suicide, including suicidal ideation and suicide attempts.
PH-M17-4298
Patient admitted to inpatient hospital following attempted overdose. Prior to hospitalization pt had resided at home with parents since February 2024. Prior to this pt had 18 month stay at Gerard RTC. Pt also had previous stay at North Homes RTC.
Discharge Plan:
RTC
-PCR (referral sent)
-Gerard (referral sent)
-North Homes (referral sent)
-Village Ranch (declined in February due to behaviors, flight risk, animal cruelty)
-Mille Lacs (referral sent)
-Bar None Shelter Plus (need county referral/funding, CMHCM not supporting)
-Leo Hoffman (referral in progress)
Group Home
-CMCHCM assisting with referrals although pt would need to pursue CADI funding prior to county funding
-MnChoices Assessment through Hennepin County for CADI Waiver (request made, scheduling 6 months out, can expedite if placement is found)
Continue with established outpatient providers:
Individual Therapist: Scott Nielson with Melissa Anderson and Associates
Primary Care Provider: Riverwood in MacGregor
Prescriber/Medication Management: Janet Larson with Riverwood Clinic
CMHCM: Alissa Boser with Aitken County (218-838-2405)
Probation Officer: Jacob Leondhardt with Aitkin County (218-927-7231)
PH-M15-4148
Recommendation is for level 5 residential treatment.
Patient arrived at inpatient from ED due to an increase in suicidal ideation with plan. Patient’s legal guardian is Goodhue County. He currently lives with a foster family. This is his 5th psychiatric inpatient hospitalization. He has done PC PHP 3 times, receives outpatient mental health services, and did CIBS program.
Discharge Plan:
RTC: (will need county funding)
-Gerard (Referral sent)
-North Homes (Referral sent)
-Nexus Mille Lacs (Referral sent)
Referred for Trauma informed therapy and CTSS.
Continue with established outpatient providers:
CMHCM: Fernbrook Family Center
PCP/Medication Management: Allina Health
Guardian Ad Litem: Goodhue County
County Guardian: Goodhue County
PH-F17-4082
Recommendation is for CD residential treatment. Patient is currently inpatient.
17 year old female admitted from the ED. Pt was having increased panic attacks and engaging in self-injurious behaviors by hitting themselves. Patient has been having suicidal ideations. Patient has been using marijuana as a coping strategy. Patient has a history of numerous psychiatric hospitalizations. At this time mother feels the patient can not return home as the family has been staying at a motel.
Pt insured by BCBS PMAP and Medicaid.
Pt has the following outpatient supports:
Individual therapy
Psychiatry/medication management
Primary care
AH-F16-4271
Adopted at birth with in utero meth exposure. Several inpatient, residential and outpatient avenues explored both instate and out of state. Patient is declined or asked to leave to due aggression to peers. Juvenile system has discharged back to mental health. Engages in self harm, significant aggression, stealing and fraud, fire setting, etc.
PH-M14-4228
Recommendation is level 5 QRTP, patient is currently inpatient.
Patient is a 14 y/o male w/ hx of depression, anxiety, ADHD, conduct disorder, ptsd , FSIQ 77, currently presenting due to ongoing mood/behavioral dysregulation resulting in hospitalization after aggression w/ mother and boyfriend. Biologically, there is a genetic predisposition for depression, anxiety, substance use. Patient w/ a long hx of impulsive/aggressive behaviors (runs away frequently, physically/verbally aggressive w/ authority figures, ect). Patient is a poor historian per outpatient psychiatrist and parents which impacts ability to know how he is actually doing. At this time, outpatient psychiatrist recommended RTC, and patient is on the wait list.
Patient has previously engaged in PHP, IT, CMHCM, and Intensive outpatient services
RTC
– Northwoods (referral submitted by CMHCM, year long waitlist 6/27)
– Gerard (referral submitted by CMHCM, under review 6/27)
PRTF
– Grafton (referral submitted 6.26)
PH-F13-4223
Recommendation is for level 5 QRTP, patient is currently inpatient.
Patient admitted on 5.29 to inpatient hospital. Patient has had 3 prior inpatient hospitalizations at Abbott Northwestern Hospital. January 2022, July 2023 and August 2023 her mother estimated. She also has participated in partial program. Patient had no incidents of aggression towards peers or staff. Referring information described her as needing to be on 1:1 staffing, due to aggression on the unit, however this was prior to the last inpatient hospitalization, in which no incidents of aggression were reported. The initial statement of ‘no incidents of aggression” was reported by the patient herself. Patient does have a history of psychiatric hospitalizations, day treatment, skills groups and individual therapy. Patient does not have a history of eating disorder treatment. Patient does have formal mental health history, including formal psychiatric evaluations, engagement in therapy, psychotropic medication trials and psychiatric hospitalizations.
Residential Treatment (referrals submitted 6/24, pending county funding)
– Avanti
– North Homes
– Nexus Gerard
PH-F14-4234
6/4/24 admission note: Patient is a 14-year-old female admitted to PrairieCare for suicidal ideation and self-injurious behaviors. Patient was recently discharged from a 45-days residential program. 2 days post discharge patient began threatening to kill her mom and reported SI with plan to jump in front of a car. Pt has a history of recurrent major depression SI, and SIB.
Discharge Plan:
SMRT-Hennepin County (7/8)
PRTF/QRTP – Level 6:
-Grafton (declined due to current milieu at facility)
-Nexus East Bethel (unable to refer due to insurance)
-Leo A Hoffman (unable to refer due to males only)
-Bar None Haven (SW to send referral once consent obtained)
-Northwood (SW to send referral once consent obtained)
-The Youth Village in Tennessee (guardian pursuing)
-Acadia Healthcare (SW to send referral once consent obtained)
Current Providers-
Therapy- Paula Ocampo at Lake Country Associates
EMDR therapy-Tiffany Rundquist, Sanford Health Bemidji
Pediatric Neurology- Dr. Ilgarli, Essentia Health
Psychiatry- Daniel Janiczak, MD and Kayla Scheneit, MD- Sandford Bemidji
CMHCM- Erika Kjellberg, Hubbard County
CTSS- Megan Berg, Hubbard County
EMPATH at Bemidji Sanford 2 times/week
PH-F15-4188
Recommendation is for level 6 RTC/PRTF – patient is currently inpatient.
15-year-old Female from RTC level 5. Patient admitted to inpatient after struggling with self-regulation after recent inpatient discharge. Patient has had 5 inpatient hopsitalizations since March 2024 with attempts at individual therapy, PHP, RTC (elopment), and In alignment with CMHCM, seeking RTC level of care. Referrals have been sent to Nexus East Bethel, Bar None Haven
Patient insured by Medicaid.
Pt has the following outpatient supports:
CMHCM
PH-F16-4145
Recommendation is for dual diagnosis residential programming (ASAM 3.5)
Patient arrived at Inpatient from ED due to increased suicidal ideation. This is his 5th psychiatric inpatient hospitalization in the past few years. He has done RTC through Northwest Passages, PC PHP, and began programming at Options day tx before it closed. He does have a history of aggression towards school peers although aggression has not been a concern while in programming or hospitalized.
Discharge Plan:
Dual Diagnosis RTC:
Dual Diagnosis RTC:
-Newport (patient declined due to impulsivity and aggression concerns)
-MHealth Fairview, Maplewood (declined due to acuity of MH and aggression)
-Hazelden (in network benefits approved – initial phone screen complete, awaiting decision for setting up next assessment)
-Wings (pt declined due to physical aggression in previous six months)
-Rogers BH (Referral sent – guardian to complete phone screening and then pt screening will be scheduled)
-Lakeside Academy (Christian based program – patient declines referral due to this)
-Bar None Omegon (unable to refer – only accepts biological males)
-Anthony Louis Center (unable to refer – will not accept those needing dimension 3 ratings or above)
