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Integrating Forensically and Civilly Committed Adult Inpatients in a Treatment Mall Program at a State Hospital

With the exception of Dr. Geller, all authors are affiliated with Dorothea Dix Hospital, Raleigh, North Carolina. Dr. Geller is with the Department of Psychiatry, University of Massachusetts Medical School, Worcester. Send correspondence to Mr. Webster, Dorothea Dix Hospital, 3601 Mail Service Center, Raleigh, NC 27699-3601 (e-mail: steve.webster{at}ncmail.net).

OBJECTIVE: This brief report presents outcome data from a 350-bed state psychiatric hospital that integrated its adult forensically and civilly committed inpatient populations within one rehabilitative program. METHODS: Dorothea Dix Hospital, located in Raleigh, North Carolina, used the "treatment mall" model to offer all of its resources to all adult patients in a centralized setting. Program participation of 100 patients from two long-term civil units was compared with program participation of 94 patients from the hospital's medium- and maximum-security forensic units. RESULTS: The forensic patients were significantly less likely to refuse to join or to leave a group, and they were better engaged in their treatment. The use of restrictive interventions and the incidence of assault were minimal for both groups. CONCLUSIONS: The experience at Dorothea Dix Hospital suggests that integrating these populations in rehabilitative programming is not only fiscally responsible but also clinically promising, with no evidence of greater disruptiveness attributable to forensic patients.

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