Is My Patient Faking It?
Lorry Schoenly | Correctional Nurse
Unfortunately, correctional nurses must be wary of a variety of motives behind inmate-patients seeking medical or mental health treatment. Malingering is defined as the intentional falsification or exaggeration of symptoms for external motives or secondary gain. There is a high incidence of malingering in jails and prisons. A reported 20% of mental illness in corrections is malingering.
Reasons to Fake Illness
There are many reasons an inmate may fake a mental or medical condition. The first that usually comes to mind is to procure drugs. Separated from preferred mood enhancers such as alcohol or barbiturates, inmates seek other avenues of relief. Seroquel (Suzie-Q) is an example of a current favorite that may be sought through feigning mental illness or psychosis.
However, in the prison system secondary gain can include other, more benign desires such as special creams, lotions, or supplements. One prison system I worked in had a problem with overuse of nutritional supplements (such as Ensure). It was discovered that it brought a high price on the facility black market as bodybuilders thought it would help them bulk up.
Illness can also bring desirable housing locations or work release. Trips to hospital or specialists provide avenues for escape attempts or a chance for a ‘vacation’.
Some inmates may exaggerate symptoms because they think they will not get attention in the system unless they are in severe distress. A true medical condition exists but not as intense as it is being portrayed.
A Nurse’s Best Response
A good principle to follow is to “Trust no one but give everyone the benefit of the doubt”. This is key to maintaining the right level of professional objectivity, writes Melissa Caldwell, PhD, in an article for the Society of Correctional Physicians. Here are some tips to help you maintain objectivity in the face of potential malingering:
• Do a complete nursing assessment. Do not disregard any medical complaint as faking. Always respond.
• Thoroughly document all objective and subjective data. Repeated questioning now or later may reveal inconsistencies or validate findings.
• Review prior documentation and history for comparison or evidence of drug-seeking behaviors.
• Portray empathy. You do, in fact, want to get to the bottom of the issue and provide correct treatment.
• Avoid giving clues that will make them a better malingerer.
• Err on the side of safety. Provide a period of observation (such as in the infirmary or holding area).
• Always question yourself. After 3 false ‘chest pain’ complaints – this could be the real one.
Remember, determining malingering is not a nursing function. Assessment, referral or treatment based on protocol are nursing actions. As in the game of baseball – play your position.
Why It‘s Important
Getting to the bottom of potential malingering is important in order to eliminate the waste of valuable resources and time that could be more effectively used elsewhere. Correctional nurses can help eliminate inmate malingering by taking careful histories and assessments, documenting responses for comparisons over time, and collaborating with medical and mental health staff to develop appropriate interventions.