FORENSIC CLINICAL

PSYCHOLOGY

Dr Nicola GillespieHighly Specialist Clinical PsychologistBelfast Trust

Overview The roles of Clinical Psychologists in

Forensic settings

My (former) role in particular

Where

Who – the clients, the MDT

The role

Best Parts

Questions

Forensic Clinical Psychology

BPS (2006a) core competencies for clinical psychologists: Commitment to reducing psychological distress

and enhancing and promoting psychological well-being through the systematic application of knowledge derived from psychological theory and evidence.

Forensic psychology covers legal and criminological psychology. This is concerned with the understanding,

assessment and treatment of criminal behaviour.

Forensic Clinical Psychology

Seeks to combine both Alleviation of distress Enhancement of skills Reduce future offending risk Protect the public

Roles Reports to court Expert Witness (court, media) Consultation (police, court, PBNI) Profiling (not so much if at all in NI) Prison service Training Offending behaviour work Mental health problems CFMHTs ‘Forensic’/ high-risk work in other settings

(mental health inpatient, community) Evidence base – books/ articles/ research Secure hospitals

Low, medium, high

My Role

Specialist Clinical Psychologist Regional Medium Secure Unit 1st step – understand the system.. Procedural and Relational security Ascertain psychological needs of patients/ system Try to meet the needs!

Where – the Service

Regional Medium Secure Unit Belfast 34-beds, 3 wards Referrals from Prison, PICUs, LSUs,

HSUs, recall from community Preadmission assessments in those

locations

Who – The Clients

Up to 29 males, up to 5 females

Age 18+ Detained/TDOs Severe mental health

difficulties (psychosis) Risk to the public – offending/

violence

Clinical Presentations Trauma History Psychosis Mood disturbance Brain injury Learning disability PDD/ASD ADHD Addiction/Substance misuse

issues Personality disorder Psychopathy (DSPD)

Offending Wide range, e.g. Violence

Murder Assault Spousal assault Sexual violence

Stalking Organised crime Theft Fraud Drug dealing Arson

Who – The Multidisciplinary Team

5 MDTs Psychiatry Nursing Social Work Occupational Therapy Clinical Psychology User and Carer Advocates

The Role of Clinical Psychology

Engagement Number 1

Assessment (incl. preadmission) General clinical Risk assessment Neuropsychological Intellectual Personality attributes PTSD Psychosis Malingering & deception

Formulation Telling the story of mental health/ risk

Predisposing Precipitating/ Triggers Perpetuating/ Maintaining Protective

Collaborative

Intervention targets Enhance strength/ protective factors Reduce or manage risk factors

Re-evaluate/ reformulate

Therapy Individual Group

Issues Trust Shame Stigma Fear Misunderstanding in

MDT Safety Location

Consultation Indirect intervention

Formulation Behaviour plans Function of dangerous behaviour

Self harm Violence towards others Substance use

Staff support/ reflective practice Impact of clients, the work, environment

Training E.g. psychological models/ interventions

Meetings Case Conference PQC Reviews Discharge planning Service development/ review Tribunals Parole Commission

Supervision Trainee clinical psychologists Assistant psychologists Other professionals

Research/ Service Evaluation E.g. recent studies – Childhood trauma is

associated with risk of violence Low levels of social support associated with

trauma history and negative beliefs about self

Sharing Psychological Research/ Theory

Formulation Individual approach Training

Best parts of the job Chance to contribute something different Opportunity for long-term therapy in a safe

place – really getting to know the clients Can do the work that isn’t possible in other

settings Working with other disciplines to enhance

recovery Instilling hope – client, team, self Lots of variety Get to visit other locations, e.g. prison, other

MSUs Challenging It’s never dull!

Questions