FORENSIC
CLINICAL
PSYCHOLOGY
Dr Nicola Gillespie
Highly Specialist Clinical
Psychologist
Belfast Trust
Overview
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The roles of Clinical Psychologists in
Forensic settings
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My (former) role in particular
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Where
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Who – the clients, the MDT
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The role
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Best Parts
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Questions
Forensic Clinical Psychology
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BPS (2006a) core competencies for clinical
psychologists:
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Commitment to reducing psychological distress
and enhancing and promoting psychological wellbeing through the systematic application of
knowledge derived from psychological theory and
evidence.
 Forensic
psychology covers legal and
criminological psychology.
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This is concerned with the understanding,
assessment and treatment of criminal behaviour.
Forensic Clinical Psychology
 Seeks
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to combine both
Alleviation of distress
Enhancement of skills
Reduce future offending risk
Protect the public
Roles
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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
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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
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Wide range, e.g.
Violence
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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
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Engagement
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Number 1
Assessment (incl. preadmission)
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General clinical
Risk assessment
Neuropsychological
Intellectual
Personality attributes
PTSD
Psychosis
Malingering & deception
 Formulation
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Telling the story of mental health/ risk
 Predisposing
 Precipitating/
Triggers
 Perpetuating/ Maintaining
 Protective
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Collaborative
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Intervention targets
 Enhance
strength/ protective factors
 Reduce or manage risk factors
 Re-evaluate/
reformulate
 Therapy
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Individual
Group
 Issues
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Trust
Shame
Stigma
Fear
Misunderstanding in
MDT
Safety
Location
 Consultation
 Indirect
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intervention
Formulation
Behaviour plans
Function of dangerous behaviour
 Self
harm
 Violence towards others
 Substance use
 Staff
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support/ reflective practice
Impact of clients, the work, environment
 Training
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E.g. psychological models/ interventions
 Meetings
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Case Conference
PQC Reviews
Discharge planning
Service development/ review
Tribunals
Parole Commission
 Supervision
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Trainee clinical psychologists
Assistant psychologists
Other professionals
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Research/ Service Evaluation
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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
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Formulation
Individual approach
Training
Best parts of the job
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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