Malingering

This last week, an inmate saw me in the corridor and told me he's been falling out of his upper bunk due to his new psyc med dose. He wants a bottom bunk restriction. I told him to write me (on a request slip) and I'd talk to him later about it.

Several inmates have been thinking of reasons why they need this bottom bunk now and/or a 1st floor cell. I can think of one good reason why they might. Prison is not airconditioned. The only way you get a fan is if you have money (someone sends it to you from the outside). If you're indigent, you're just hot. Heat travels up, right? A bunk on the 3rd row, even a top bunk, in this heat, with no air circulation is more than uncomfortable. So I've been fielding lots of "reasons" why they need me to move them.

I got a call that the inmate I mentioned above was been seen as an emergency in the infirmary area and security needed me there asap. They were photographing huge bruises on his body. He got the bruises from falls off his top bunk - due to his psyc meds. I authorized his bottom bunk - a little late, huh?

To treat? Or not to treat?

So yesterday, a colleague in Mental Health Services (MHS) and I were discussing malingering. Some of the stories I get, reasons for needing on the psyc caseload or needing medicine or whatever - well, some are so bad and lacking in imagination I want to say, "hey, go work on your act. I'm here all week." Others are VERY good at manipulating. I do believe we have some of the world's best actors in prison. Think about it. They've been manipulating parents, teachers, "marks," probation officers, judges, prison guards, you name it -- all their lives. And what they didn't know about manipulation and game playing before, they learned in prison.

We in MHS have real challenges every day. Do I diagnose an inmate based on the symptoms with which he is presenting? And even if I do request free world records, can I believe that he didn't manipulate that provider into a diagnosis? So if I err on the side of caution and give him the diagnosis and meds, here's what I'm risking: He can be procuring the drugs to sell or drug another inmate (for easier assault), he can be trying to get a diagnosis from me so that he can qualify for SSI when he gets out, he can be wanting what he sees as extra privileges for being on my caseload, or he could just want a good reason to come to the air-conditioned infirmary on a regular basis. And if I diagnosis him as malingering, will he not get the attention his mental illness needs? Will he hurt himself or someone else as a result? Will what he sees as callousness prevent him from seeking MHS again?

I've spoken to colleagues who've been doing this a lot longer than I have and they tell me there's no easy answer. We all make mistakes.