Background <p>Comprehensive studies on chronic forensic psychiatric inpatients in Türkiye are limited. This study focuses specifically on long-term hospitalized patients, highlighting prolonged hospitalizations and high rates of homicide and recidivism, and examines the connection between substance use and violent crimes. Given Türkiye’s unique sociocultural and legal context, the study offers a valuable foundation for future comparative research.</p> Results <p>The cohort included 169 patients (mean age = 45.3 years; 92.3% male). Most were single (72.2%), unemployed (69.2%), and had low educational attainment, with 38.5% completing only primary school. Schizophrenia and other psychotic disorders predominated, with an average illness duration of 20 years; 43.8% had a family history of psychiatric illness. Alcohol or substance use was reported in 47.3% of patients and was strongly associated with violent crimes. The recidivism rate was 56.8%, with homicide (33.1%) and assault (29.0%) being the most common offenses. Hospitalization durations were notably long, reflecting the chronic nature of this population.</p> Conclusions <p>Prolonged hospitalizations suggest a need to reassess clinical and forensic-ethical approaches. High rates of homicide and assault indicate significant public safety risks, while the 56.8% recidivism rate points to deficiencies in rehabilitation and follow-up systems. The association between substance use and violent crimes further underscores the need for integrated addiction treatment within forensic psychiatric services. Overall, this study provides a comprehensive dataset on Türkiye’s chronic forensic psychiatric population, contributing to both national and international literature and highlighting areas for improvement in clinical intervention, rehabilitation, and policy development.</p>