All places have frequent fliers. We have a set of vacationers too. It is frustrating from a taxpayers point of view. It costs $800.00 a day to just be admitted to a bed on our unit. If you want meds, labs, consults, treatments--all extra charges. It really burns me up if I think of it like that.
So, I try to think of it in a different way. I look at it like I know the patient so admitting them won't be hard. I know what to expect from them, they know what to expect from me. I always think that it could be much much worse and I imagine having to admit my worst patient. The frequent flyer fills a bed so if the worst patient tried to get in, she would have to be admitted elsewhere. So I use all my psych skills on myself--imagery, rational emotive therapy. Guess that stuff really does work.
Some of our more familiar clients are blunt with me and tell me, they are here to rest after coke binge, being kicked out, no money left, need a break from the hubby etc. I try to think of them like family. You don't have to like them, just let them stay for a few days til they are on their feet then off with them. We are family to some of these people. We have been the only caring and almost mentally healthy people they know. When you have been kicked out, where do you go? These people have no one else.
I firmly believe in tough love so a lot of this clashes with my own personal beliefs. I believe in personal responsibility. I also believe that I would make myself sick if I let it get to me all the time. I don't try to do a lot of therapy with the ones that don't come there for that reason. I do the basic review of meds, side effects and mood/hallucination checks. Lots of times, I don't even sit down for these interactions. That leaves me time for the ones that are craving to be heard. You don't get much satisfaction from fakers but when you feel you have made a small difference in someone's life just by listening to them, it really makes me feel like I have done a good job and that validates my choice of careers.