FORENSIC CLINICAL PSYCHOLOGY

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Presentation transcript:

FORENSIC CLINICAL PSYCHOLOGY Dr Nicola Gillespie Highly Specialist Clinical Psychologist Belfast 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 Stalking Organised crime Theft 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 Collaborative Predisposing Precipitating/ Triggers Perpetuating/ Maintaining Protective Collaborative Intervention targets Enhance strength/ protective factors Reduce or manage risk factors Re-evaluate/ reformulate

Therapy Issues Individual Group Trust Shame Stigma Fear Misunderstanding in MDT Safety Location

Indirect intervention 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 Supervision 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