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Correctional Healthcare Article

Lorry Schoenly, PhD, RN, CCHP Correctional Healthcare
with Lorry Schoenly, PhD, RN, CCHP

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He's faking it: How to spot inmates' invented illnesses

How do you respond appropriately to keep questionable illness from becoming a career stopper?

An inmate in segregation calls out for help. He is having trouble breathing. The corrections officers and even the nurse on duty think he’s faking and do not respond. Not long after, he is dead on arrival at the local hospital. Now everyone’s job is on the chopping block.

Faking illness, also called malingering, is a real issue in your corrections work life. How do you respond appropriately to keep it from becoming a career stopper?

What is malingering?
Malingering is the intentional production of false or over-exaggerated medical or mental health symptoms.

Motivations for malingering in the corrections setting are many. The table at the bottom of this article categorizes frequent motivations for malingering as either legal or environmental. The legal objective might be to obtain an improved sentence, while an environmental objective might be to improve the incarceration experience for the individual. No matter what the reason is for malingering, your response to the situation can be tricky and it will require great care.

Actions to take
Inmates’ feigned medical or mental health illness puts an additional strain on operations and budgets. Although the true extent of the condition in corrections is unknown, there have been estimates that as many as 20% of mental health problems exhibited in jails and prisons are malingering.

Due to the high degree of malingering in corrections and the nature of the inmate population, it is understandable that many officers and healthcare staff members become jaded or cynical when confronted with health requests. Maintaining objectivity in the face of potential malingering is ever important. COs and health staff can work together to foil would-be malingerers, but focus is needed. These tips will reduce your risk of missing actual health conditions or being taken in by inmates seeking secondary gain.

 - Follow-through on medical requests: Allow healthcare staff to evaluate the condition. One of the greatest risks to your career is missing an actual medical condition because you consider it a ‘fake’, as the example above describes. Initiate standard action for a medical situation and document thoroughly.

 - Team up with medical staff: Even if you don’t have a medical background (and all the better if you do!), your observations will be very helpful in differentiating real and feigned illness. Study how the inmate acts when not around health staff. This can help to establish incongruities and inconsistencies in their symptoms – a hallmark of malingering.

 - Don’t be too helpful: …to the inmate. Malingerers can learn and adjust their symptoms based on your response or feedback. Do not point out discrepancies to the inmate. Keep your information for confidential communication with the healthcare staff.

 - Get to the bottom of it: Time spent discovering and treating the real issue, whether it turns out to be actual or feigned, is time well-spent. Go the extra mile to document and follow-up.

There are many advantages to taking action on both actual and ‘faked’ healthcare requests. Establishing a management environment where officers and healthcare staff work together to treat medical and mental health concerns while rooting out malingering speaks volumes to your inmate population. Trust that you will ‘do the right thing’ in a true medical situation and that you will not tolerate manipulation for gain will, over time, reduce tensions and unnecessary costs.

What has been your experience with inmates faking illness? Leave a comment here or on the CorrectionsNation Forum string on this topic.

Motivations for Inmate Malingering


- Avoid Criminal Responsibility

- Reduce or alter sentencing

- Obtain benefits (such as SSI) upon release

- Transfer to a better location (hospital, infirmary, mental health unit)

- Receive lighter work duty

- Obtain contraband for black market (narcotics, psychotropics)

- Obtain perks (better shoes, lower bunk)

About the author

Dr. Schoenly has been a nurse for 30 years and is currently specializing in correctional healthcare. She is an author and educator seeking to improve patient safety and professional nursing practice behind bars. Her web-presence, Correctional Nurse, provides information and support to those working in correctional health care. Her books, Essentials of Correctional Nursing and The Correctional Health Care Patient Safety Handbook are available in print and digital on amazon.

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