FORENSIC CLINICAL PSYCHOLOGY Dr Nicola Gillespie Highly Specialist Clinical Psychologist Belfast Trust
Dec 19, 2015
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