IOP Case Study

QUESTION

female that was referred to IOP by her guidance counselor for self-harming and suicidal statements.  patient reports that she told her friend today at school she wanted to die and she self-harmed last night as well. She reports that she cut herself last night after an argument with her mom because it made her “feel better.” She does admit that she had made suicidal statements about a month ago which got her into this program but now she realizes that people are not taking her seriously. She reports that she plans to go home and overdose on her mother’s over-the-counter sleeping medication. The patient states “if they try to stop me, I will try something else.” She tells you that she just feels “exhausted” and cannot imagine living anymore. She states that since starting therapy three days ago, she goes home and cries every night and states she feels “hopeless.” Sleep has reportedly been excessive stating that when she is not in group, she is sleeping or feeling like she needs to sleep. Her appetite is reportedly also decreased stating she believes she has lost about 10 lbs over the past week.

Pink Slip criteria

1. Represents a substantial risk of physical harm to self as manifested by evidence of threats of, or attempts at, suicide or serious self-inflicted bodily harm.
2. Represents a substantial risk of physical harm to others as manifested by evidence of recent homicidal or other violent behavior, evidence of recent threats that place another in reasonable fear of violent behavior   and serious physical harm, or other evidence of present dangerousness.
3. Represents a substantial and immediate risk of serious physical impairment or injury to self as manifested by Evidence that the person is unable to provide for and is not providing for the person’s basic physical needs because of the person’s mental illness and that appropriate provision for those needs cannot be made immediately available in the community; or
4. Would benefit from treatment in a hospital for his mental illness and needs such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of others or himself.

Questions? 

Please identify which criteria of the pink slip (3-day court ordered involuntary admission) does the patient meets for inpatient admission (choose 1-4).

1. Write out the statement of belief about why you believe an adolescent should be pink slipped and admitted to the hospital.

ANSWER

The patient in this case presents with concerning symptoms and statements that indicate a significant risk of self-harm and suicidal ideation. Based on the information provided, the patient meets the criteria for a pink slip (court-ordered involuntary admission) for inpatient admission. Specifically, the patient meets criterion 1, which states that the individual represents a substantial risk of physical harm to themselves as manifested by evidence of threats of, or attempts at, suicide or serious self-inflicted bodily harm.

The patient’s history of self-harming behaviors, recent statements about wanting to die, and the intention to overdose on medication are clear indicators of a high risk for self-harm. Additionally, the patient’s statement that she will try something else if someone tries to stop her further highlights the urgency and seriousness of her situation. The patient’s feelings of exhaustion, hopelessness, excessive sleeping, decreased appetite, and weight loss further support the need for immediate intervention and hospitalization.

Considering the patient’s current state and the potential risks she poses to herself, it is crucial to prioritize her safety and well-being. Inpatient admission will provide a structured and supervised environment where she can receive intensive psychiatric care, including close monitoring, therapy, and medication management. By being admitted to the hospital, the patient will have immediate access to mental health professionals who can assess her condition, develop a comprehensive treatment plan, and closely monitor her for any changes or worsening of symptoms.

In this case, the statement of belief for the pink slip would emphasize the urgent need for inpatient admission to ensure the safety and well-being of the adolescent. The patient’s self-harming behaviors, suicidal ideation, recent statements about wanting to die, and specific plans to overdose on medication demonstrate a significant risk of physical harm to herself. The lack of perceived support and feelings of hopelessness further exacerbate her vulnerability. Inpatient admission is necessary to provide a secure and structured environment where the patient can receive immediate and comprehensive mental health care, with the goal of stabilizing her condition, addressing her suicidal ideation, and developing a long-term safety plan. The primary focus of hospitalization would be to ensure the patient’s safety, provide therapeutic interventions, monitor her mental state, and engage her in a collaborative treatment process.

It is important to note that the decision to pink slip an individual and admit them to the hospital is a serious and complex decision that requires careful evaluation by mental health professionals. The purpose of the pink slip is to prioritize the safety and well-being of the individual and provide them with the necessary support and interventions to address their mental health needs.