With increasing numbers of patients presenting at our nation’s already oversubscribed emergency departments (EDs) for mental healthcare, the Psychiatric Times recently posed a pointed question : Just how many patients have real psychiatric illness? It’s not rhetorical. Recent research suggests that up to 20% of psychiatric ED patients are “strongly or definitely” suspected of malingering, deliberately feigning or exaggerating symptoms, while suspicion exists for roughly one-third of all visits.

That’s a staggering proportion, and the trend appears to be rising. This shift brings with it a tangled web of clinical, operational, and ethical challenges that affect not only providers but also the patients most in need of timely, effective care.

The human and operational toll

When malin

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