Risk Factor: Suicidality

Suicidality refers to thoughts, behaviors, or tendencies related to suicide, including suicidal ideation and suicide attempts.

PH-F16-3669

Update 4/29/24: Patient discharged from Inpatient on 04/19/24 to wraparound outpatient mental health services while continuing to pursue RTC options.

Patient admitted to PrairieCare Inpatient Hospital 3/19/24 from the ED following increased thoughts of suicide with a plan. Pt has had previous IP stays at PrairieCare, Mayo Clinic, Riverside and Prairie St. John’s. Pt had a previous residential stay at Gerard. RTC has been pursued and funding has been approved through Dakota County although currently pt has been declined by viable in-state options. Level 6/PRTF programming is also being explored.

Referral is currently pending at Bar None Haven. Referral also made to Acadia to explore out of state options. Referral will be made to Nexus East Bethel PRTF as CMHCM is willing to help pt switch to straight MA if Nexus is able to accept. Patient is medically ready for discharge and is pursuing an interim plan of dcing home with wrap around services while awaiting placement.

RTC (CASII LEVEL 5) (funding approved, in QI process):
-Acadia (referral sent to explore out of state options)
-Avanti (declined)
-PCR (declined)
-North Homes (declined)
-Gerard (declined)
-Northwoods (waitlist 2+ years, so not a viable option)
-Newport (Insurance not accepted, so not a viable option)
-Nexus Mille Lacs (only accepts biologically male patients, so not a viable option)

PRTF/CASII LEVEL 6
-Bar None Haven (referral pending)
-Nexus East Bethel (referral to be sent, CMHCM able to help switch to straight MA if accepted)
-Grafton (requires ID dx)
-Leo Hoffman (only accepts biologically male patients)
-Northwoods (2+ year WL)

CH-M8-3464

Update 4.18.24 – on wait list for Northwoods, admission wouldn’t be until summer. Looking for a foster family until residential.
update 4/15/24: The patient is medically stable and has been doing very well here on the unit. Has not shown aggression towards others. One minor episode of head banging when frustrated. Medications are providing therapeutic benefit.

Patient with a past history of RAD, PTSD, ODD and questionable FASD that presented to the ER with foster parents of 4.5 months for concerns of aggression, suicidal ideation, and sexually inappropriate behaviors towards others and pets. He has been in several foster/kinship homes since age 5 with significant trauma prior to this including witnessing mom overdosing on several occasions, witnessing the overdose and death of housemate, sexual abuse by bio father, homelessness, sister attempting to suffocate and strangle him on multiple occasions, and physical abuse by caretakers. He was recently found on video touching the house dog sexually and physically inappropriate and has been threatening and pushing his foster mom. Foster providers are unable to accept him back in their home.

PH-F14-3375

Update 4/12/24: Patient discharged from inpatient to home, while waiting for RTC admission.

Update 4/11/24: Patient scheduled to discharge from inpatient on 4/12/24, stepping down to outpatient supports, while waiting for RTC. Intake process is moving forward at North Homes RTC, with potential admission on 4/18 or 4/19.

Update 4/4/24: Patient has been accepted at North Homes RTC with a potential admission mid-April. Patient has now been assigned a CMHCM, waiting on screening for county funding.

Update 3/21/4: Pt is under review for acceptance at North Homes pending county funding, Waiting assigned CMHCM, parent is currently doing the intake process at the county to get a CMHCM for the Juvenile Screening.

Patient is a 14-year-old transgender male presenting at PrairieCare’s inpatient hospital. Patient presented to Sanford Bemidji Medical Center on 3/4 when parents brought them. That night while parents were away from home patient was aggressive toward sister. Family called crisis and were directed to bring to ED for evaluation. This is after a similar event last week where patient attempted to stab sister with a knife and father had to intervene.

CH-F16-3633

Patient presented to the ER with her mom for concerns of suicidal ideation though patient denies this. She has had several presentations to the ER due to aggressive behaviors and kicked out of group home for aggression towards peers and staff. She has been in and out of crisis centers and alternative housing verses being at home along with several inpatient hospitalizations.
**Full details of patient history is unknown to writer as I am not currently following her***

PH-F16-3524

Update 4/3/24- funding in place, waiting available RTC- accepted at Gerard and North Homes. Waiting to hear back from Avanti and East Bethel.

Case Description: Patient is a 16 y/o individual w/ hx MDD, GAD, ADHD, multiple previous hospitalizations, currently presenting due to SI. Patient went to foster care after discharge in previous hospitalization at PC ( october 2023) and returned to mothers home end of Dec after 1 month. Patient was hospitalized at Prairie St Johns for 1 week ( discharged 3/8) due to intrusive SI . Patient feels she was discharged earlier than she should have been because she was still struggling w/ “feeling safe”. Patient indicated that depression /anxiety and intrusive SI improved significantly in foster care. Patient indicated during the time in foster care, patient worked on her relationship w/ mother and feels it was “helpful. Patient transitioned to mothers home and feels that overall relationship has improved and does not know why depression/SI has escalated again.

Discharge Plan: RTC (county funding approved for RTC)
-Avanti (Referral done, waiting to hear back)
-Gerard (Referral done, Accepted)
-North Homes (Referral done, Accepted, currently on waitlist, openings anticipated in June)

PRTF:
-Nexus East Bethel (Referral in progress)

Existing outpatient providers:
-CMHCM at Sherburne County
-Individual therapy Main Street Family Services-Elk River (Appt scheduled 3/27)
-Family therapy at Main Street Family Services-Elk River
-Primary care at Stellis Health-Monticello
-Psychiatry s at Nystrom & Associates
-In-home skills

HCMCECC-M13-3482

**Contact department: HCMC Acute Psychiatric Services (APS) 612-873-9300

13 y.o. male boarding in ED. Brought in by adoptive mother after running away from home 3 times. Multiple suspensions from school (including currently) for fighting. Mother unwilling to bring patient home. Physically assaulted mother after he was brought back home. Went to Uncle’s house and left via window. Has been making passive comments indicating suicidal ideation and not having any sense of danger- getting into cars with strangers. Significant increase in challenges since he began going through puberty about 6 months back.
Copied from ED note:

“Collateral from mother and family:
Foster mother took in his sister first, took him as well at 16 months old. States that when he first came to live with her he would eat out of the trash, and from bowls on the floor like a dog. Took several months to correct this. Patient was then returned to his paternal grandmother in chicago, but was only there for two months. Foster system asked mother to adopt him and keep him with his sister. Some school issues, briefly on IEP. Mother was kindergarten teacher.
In the past 6 months, since hitting puberty and undergoing a growth spurt, patients behaviors have been worsening. In Nov of 23 patient attempted to start a fire in his bedroom. He has been in a plethora of fights at school. Is currently suspended. Believes that everyone hates him. Since January he has been making comments to family about ending his life. Reportedly had knife in his room at one point. 3x running away from home. 1st time was not far and he came home quickly. 2nd he made his way from north Minneapolis to S St. Paul, and was with a complete stranger for approximately 9 hours. Family reports that patient refuses to speak about this time. Was acting strangely after he returned. 3rd was yesterday after he became angry and physically assaulted mother. Was found by police (allegedly engaging in burglary?) Was brought to uncles house per request of mother, as he had been quite belligerent with her earlier. Patient normally behaves well with uncles, but today he waited until he was unsupervised and climbed out of a ground floor window to run away again.”

Not appropriate for inpatient pediatric medical floor. Boarding in HCMC Emergency Department. HCMC Acute Psychiatric Services do not feel patient needs an inpatient psychiatric admission. Family and NEXXUS advocate not comfortable with discharge unless plan for significantly increased outpatient support. No formal diagnoses. Has been completely compliant and appropriately behaved since presenting to the ED 32+ hours prior.

MCR-M14-3272

Comes from shelter placement (Von Wald) due to aggression. Has probation with court on 3/14/24. Voluntarily placed with Rice County by family due to safety concerns. The CASII score is 6 with strong recommendation for wilderness residential programming, as he has been through a few ‘traditional’ residential programs, so he has some buy-in for wilderness type residential. Looking for shelter vs group home as waiting for residential programming. Parents hesitant to look at out-of-state programs.

ADYC-M14-1768

Update: 1/19/24 Pt. still looking for placement.

15-year-old male looking for a group home and residential program. Children’s Mental Health Case Manager has tried everything, and doors are being shut. Client has a physical aggression, verbal aggression, history of PTSD and sexual abuse. Client has experienced abuse from biological father who is in still in the home, and sexual assault that happened possibility of more than one with an older cousin sister. Client mother is giving up on hope on trying to help her child. Client is struggling at home, school, and community. Children’s Mental Health Case Manager has been trying everything to find a placement for him. He’s been going in and out of the ER like every two months now. Children’s Mental Health Case Manager still trying to offer support the way she can by being there every hospital stay, seeing client like twice a month, and having mom keep her on speed dial to talk to client.

Because of experiences, client is chemical dependent on marijuana, perks, and opioids.

AH-F15-2953

Presented to the ED for suicidal ideation. Boarded in the ED and attempts were made to safety plan with family but family refused to take patient home. Pt has an extensive history of running away, threatening others, suicidal ideation and there have been concerns (not proven) about patient taking advantage of vulnerable peers and children. Patient was admitted to ANW in early 2023 for 68 days. RTC was recommended but patient was declined from programs in MN and nationwide. Family was resistant to taking patient home but eventually patient discharged home.