The TOMM is the test of malingered memory. It will not help in the situation you mentioned.
There are specific tests depending on what type of illness the person feigns. For example if the person is faking psychotic symptoms, you would use the SIRS (Structured Interview of Reported Symptoms). If they are feigning memory problems, you would use the TOMM (Test of Malingered Memory). Since the SIRS is a rather lengthy and cumbersome a shorter test is the M-FAST (Miller Forensic Assessment of Symptoms Test™
Though the M-FAST is not as accurate and in depth as the SIRS. In fact for that reason, some only use it as a screening test.
There is also what is called the Atypical Presentation Scale which is included in the Georgia Court Competency Test which helps to detect malingered psychosis in a court setting.
Here's an example of one question.
-There are charges against you. Do you confuses these charges with charges on your credit card?
Pretty much no psychotic person would answer yes. A malingerer would answer yes because they don't understand how true mental illness works and will want to appear as sick as possible.
When someone answers one question that's highly unlikely in a mentally ill person, that creates a measurable statistical chance they are malingering. These tests are to the point where they give enough questions where in several cases, one can tell if the person is malingering with well over 90% certainty. If you want to be even more certain, you can administer multiple tools--to make sure you're well past the well over the 90% cut off.
How does this apply to the pesky ER situation? Unfortunately in most cases hardly at all because you don't have the time in that environment to do the proper testing.
I discussed this with a doctor who headed a panel at the last AAPL convention on manipulative patients who attack staff in a psychiatric unit, yet are not severely mentally ill (the police usually refuse to do anything even though in these cases it's really an antisocial person who was brought to the psychiatry unit when he should've been put in jail). He answered in that situation, if you suspect it, all you can write down is that you suspect it and recommend the inpatient doctor do the formal testing. You should not play hardball unless you are extremely confident you can discharge this person safely (and there's usually no objective way to tell.) Then if the inpatient doctor did enough formal testing, he could then come up with an accurate diagnosis. Then if the malingering patient showed up to the ER again, now the ER psychiatrist could have a better handle on the situation because there would be documented testing of malingering that would well stand up in court.
However, you and I know that's usually not how it works. ER doctors don't know they should document in this way. They'll dx a severe mental illness (even if they're suspicious the person is malingering) and admit the person. Then it goes to an inpatient doctor who often times will not do malingering testing. Then the person will show up to the ER again in a few days weeks and claim to be suicidal again. A different ER psychiatrist will probably be on duty, then the person gets admitted again because 2 other doctors wrote down the person was mentally ill and suicidal--and now the vicious revolving door has begun....
(Which I saw on a daily basis in residency and it became a pet peeve.)
