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Stop Hospitalization Manipulation

Dan Thorne • Jun 01, 2022

In some behavioral health outpatient agencies, the foster family, and residential agencies, up to 50% of all hospitalizations are the result of a youth manipulating the situation. 

Clients can say they engage in risky behavior to get hospitalized.

When your agency’s youths are being hospitalized, is it a case of hospitalization manipulation?


In child and family agencies, it is not uncommon for youths to have thoughts of harming themselves or others. When the thoughts turn to plans, the next step is to evaluate the youth’s need for inpatient psychiatric hospitalization. Just to stabilize the youth and keep them safe.


But what if youths are using hospitalization as a place to run away from life and escape for a while?


Hospitalization by manipulation occurs more often than most agencies recognize. In some behavioral health outpatient agencies, the foster family, and residential agencies, up to 50% of all hospitalizations are the result of a youth manipulating the situation.


Here’s an example:


At an agency in the Los Angeles area, a twelve-year-old girl was at school. We’ll call her Carrie to protect her confidentiality. She attended her classes without any problems. But around her 4th school period, she instead went to the school nurse.  She stated she was very upset. She planned to buy a bottle of pills and swallow the whole bottle. 


The nurse called the local Mental Health Emergency Team. A social worker evaluated her and determined she needed an involuntary hold. Into the hospital, she went for seven days. 


Two months later she repeated the same event at school.


When the agency’s department manager talked to Carrie’s therapist about this case, they looked at the antecedents to her behavior. Turns out she avoided going to her Math class and instead went to the nurse. Why? Because she didn’t like math and didn’t want to take the test scheduled that day.


A seven-day hospitalization at a cost of probably $15,000. All due to a Math test.


It’s common for youths to use suicidal or homicidal thoughts as a mechanism to avoid problems. At home, the school, or in the community. Family disputes. Abuse or violence. Or their own inability to manage stress.


And why not? At the hospital, they get meds. A cushy schedule. Avoid the pressure of life. Plenty of attention. A reprieve from life.


Many youths do face personal hardships in their daily lives. These exacerbate their symptoms and lead to behavioral and emotional problems. But they may be able to avoid hospitalization. 


This requires the agency and therapist to do a review of all hospitalizations, the triggers, and antecedents that lead to the youth’s true or fictitious reason for inpatient care. 


What does the youth avoid? Trouble at home? A test? Bullying? A girlfriend’s rejection? Or abuse?


What need does hospitalization fulfill for them? Safety? Stress management? Socializing with their hospital buddies?


Youths, like adults, do things with good intentions. It’s self-preservation.  But their actions are misguided at times. Knowing the purpose, and the function helps develop strategies to intervene.


In Carrie’s case, a Math tutor helped her stop being hospitalized.  Resolved her fear of Math. 

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