Transforensic psychiatry: Addressing inpatient aggression in the "gray zone" between general and forensic psychiatric care.

Abstract

A minority of psychiatric patients are unfit for general psychiatric care due to offensive behavior that renders them at risk of coming into contact with the criminal justice system. In the absence of criminal proceedings, these patients find themselves in the "gray zone" between general and forensic psychiatric care. To accommodate these patients, we established a "transforensic" ward. Instead of applying forensic treatment elements reactively (as part of a criminal sentence, after an offense has been committed), we applied it preventively (so as to avert offending behavior and resultant criminal sentences). Psychometric psychopathology and violence risk assessment scores were substantially lower at discharge than at admission (Cohen's ds=-0.3 to -0.6). These results offer ground for cautious optimism about the efficacy of transforensic care in serving as a safety net for psychiatric patients who are found to be unfit for general psychiatric care on account of their aggressive behavior.