The characteristics of patients admitted to a forensic psychiatric intensive care unit (FPICU) in Belgium

Background: Psychiatric intensive care units (PICUs) are increasingly recognised
as essential components of forensic care for managing patients who are difficult
to treat in conventional units. Despite this, there is limited research on the
psychiatric and violence risk profiles of these patients, particularly in forensic
settings.
Aim: To identify the characteristics of patients admitted to a forensic PICU
(FPICU) in Belgium.
Method: A comparative analysis conducted between 2016 and 2022 on a cohort
of 344 patients; 176 FPICU admissions and 168 forensic cases not admitted to
the FPICU (NFPICU). Demographic, clinical and criminological profiles were
assessed using the PCL-R, VRAG and HCR-20 tools.
Results: As expected, FPICU patients demonstrated complex diagnostic
profiles, including higher rates of substance use (52.8%), psychotic disorders
(55.1%), and antisocial personality disorders with psychopathy (25.0%).
Comorbid mental disorders were prevalent (69.9%), exacerbating their elevated
risk of violence as assessed by the HCR-20 and VRAG. They were also more
frequently involved in non-sexual violent (56.5%) and non-violent offences
(68.7%). Coercive measures, including involuntary treatments (65.9%), seclusion
(91.5%), and restraint (43.8%), were more commonly employed for FPICU
patients.
Conclusion: Patients admitted to the FPICU present complex psychiatric and
criminological profiles, with high levels of comorbidity and violence risk.
Specialised care strategies should be implemented in secure environments that
emphasise therapeutic relationships to reduce restrictions, manage disruptivebehaviours, and enhance treatment adherence. The implementation of the
Forensic High and Intensive Care model, as developed in German-speaking
countries, could support the reintegration of these patients into standard care
units.