Division of Forensic and Correctional Psychiatry | Psychiatry | School of Medicine

Division Chair: Dr. Najat Khalifa
Administrative Support: Susan Beck

Vision

We strive to achieve excellence in forensic mental health care by providing evidence-based forensic mental healthcare, high quality education and training, innovative research, and quality improvement initiatives.

Mission

The Division of Forensic and Correctional Psychiatry at Queen's University is an academic and clinical Division with a mission to provide specialised forensic mental health services for justice-involved adults with mental disorder. We strive to enhance the quality of these services through research, education, training, and collaboration with community partners.

Clinical Services
Research and Scholarship

In addition to academic deliverables, such as research, education, and training, the Division of Forensic and Correctional Psychiatry has a mandate to provide clinical services across three areas: the Forensic Mental Health Service, the Forensic Community Service (At-Risk) Program, and Correctional Service Canada.

Forensic Mental Health Service

The Forensic Mental Health Service at Providence Care provides court-ordered assessment for individuals on remand and specialist forensic mental health services to clients who are under the jurisdiction of the Ontario Review Board, namely those found Not Criminally Responsible (NCR) or Unfit to Stand Trial (UST) on account of mental disorder. The service includes the inpatient Forensic Program at Providence Care Hospital and the Forensic Outreach Program in Kingston.

Inpatient Forensic Program

The Inpatient Forensic Program is a 30-bedded mixed-gender unit located on Heritage 0 at Providence Care Hospital. The unit accepts patients from across Ontario as well as interprovincial transfers, almost exclusively through either a judicial order or a decision of the Ontario Review Board (ORB). The unit provides services to those who have come into conflict with the criminal justice system. Patients admitted under judicial orders (Section 672 of the Criminal Code of Canada), are shorter-stay patients, typically admitted for 30-day inpatient interdisciplinary assessments to determine Fitness to Stand Trial and/or Criminal Responsibility. Judicial orders may also include treatment and keep fit orders. Patients admitted under an ORB detention order are longer-stay patients who require specialised assessments, treatment, and rehabilitation.

Using the Recovery Model of care, the Inpatient Program has a mandate to provide high quality interdisciplinary forensic mental health services within a framework of ORB dispositions that are necessary and appropriate to ensure that public safety is the paramount consideration. The interdisciplinary team includes representation from psychiatry, nursing, social work and social service work, psychology, occupational therapy, spiritual health, behavioural therapy, and recreation therapy. As a university-teaching site, students and residents from various disciplines are also active members of the interdisciplinary team.

Forensic Outreach

The Forensic Outreach Program provides community-based services and supervision to patients whose Ontario Review Board disposition allows for community living. Transitional Case Managers, psychiatrists, social workers and psychiatric nurses, primarily provide these services. Psychologists provide additional input in relation to risk assessment and psychological interventions. As with the Inpatient Forensic Program, the Forensic Outreach Program has a mandate to provide patient-centered care while ensuring the safety of the public under the least onerous and least restrictive conditions as per Law C-14. Following the Recovery Model of Care, patients are empowered to develop the skills required to become productive members of society. This service is also in the process of developing specialized community beds for justice-involved individuals who are living with dually-diagnosed developmental and mental health diagnoses.

Forensic Community Service (At-Risk) Program

The FOCUS program is an interdisciplinary program that provides mental health services to justice-involved individuals with serious mental illness who are not under the jurisdiction of the Ontario Review Board but are at high risk of reoffending and/or continued involvement with the criminal justice system.

The program provides outpatient assessments as well as follow-up and psychological interventions in partnership with local probation and court diversion services. The Forensic Mental Health service at Providence Care is the main source of referrals to the FOCUS program.

Correctional Psychiatry Services

Psychiatric services to the Ontario Region of Correctional Service Canada (CSC) are provided under a Memorandum of Understanding between CSC, South Eastern Ontario Medical Organization (SEAMO), and Queen’s University, with a complement of four full-time equivalent psychiatrists. These services involve providing psychiatric services and consultations to interdisciplinary teams across five Institutions, including Collins Bay, Bath, Joyceville, Millhaven, Regional Treatment Centre (Millhaven site only) and Warkworth, as well as oncall services for the Ontario Region of CSC.

Faculty within the Division of Forensic and Correctional Psychiatry also have ties with provincial correctional and detention facilities (e.g. Quinte Detention Centre), and the Family Law Clinic in Kingston. Residents completing rotations within the Division will have the opportunity to gain additional experience in these areas. There are also opportunities for student and Resident observerships in CSC.

Telepsychiatry

The Forensic Division actively utilizes Telepsychiatry to deliver services to marginalized populations. Telepsychiatry is utilised to conduct preliminary assessments of mentally disordered individuals awaiting trial at Quinte Detention Centre to determine the need for further inpatient forensic evaluation and/or treatment. It is also used to provide outpatient psychiatric services to the Metis Nation of Ontario.

Current Research and Program Development/Evaluation

Recent Research

Non-Invasive Brain Stimulation (NIBS)

The use of combined cognitive training and Anodal Transcranial Direct Current Stimulation (tDCS) to modulate risky decision-making: A double blind Randomized Controlled Trial (PI: Dr. Najat Khalifa with collaborators from Queen’s University).
The use of Anodal Transcranial Direct Current Stimulation (tDCS) to reduce impulsivity and aggression in people with Intellectual Disabilities: A Randomized Controlled Trial (PI: Dr. Najat Khalifa with collaborators from Queen’s University).
The use of non-invasive brain stimulation techniques in people with intellectual developmental disabilities: a systematic review and meta-analysis (PI: Dr. Andrew Bickle with collaborators from Queen’s University).
The use of non-invasive brain stimulation techniques to reduce body weight and food cravings: A systematic review and meta-analysis (Dr. Khalifa with collaborators from the University of Nottingham, UK).
Use of transcranial Direct Current Stimulation (tDCS) to modulate empathy: A systematic review and meta-analysis (Dr. Khalifa with collaborators from Queen’s University).

Terrorism and Mental Health

Risk factors for terrorism: an examination of family, childhood and personality risk factors among Iraqi terrorists, murderers and (Dr. Khalifa with collaborators from the George Washington University, USA).
Pathways to terrorism: The role of childhood factors, personality, and ideology (Dr. Khalifa with collaborators from the George Washington University, USA).
Classifying terrorism: A latent class analysis of primary source socio-political and psychological data (Dr. Khalifa with collaborators from the George Washington University, USA).
Distinguishing lone from group actor terrorists: A comparison of attitudes, ideologies, motivations, and risk factors (Dr. Khalifa with collaborators from the George Washington University, USA).
Terrorism and mental health (Dr. Hassan and Dr. Khalifa).
The psychiatric aspects of terrorism: Prevention and rehabilitation (Dr. Hassan and Dr. Khalifa with collaborators from Queen’s University).
Terrorism Typologies and implications for clinical practice in psychiatry (Dr. Hassan and Dr. Khalifa with collaborators from Queen’s University).
Psychiatric assessment of terror subjects and those at risk of engaging in acts of terrorism (Dr. Hassan and Dr. Khalifa with collaborators from Queen’s University).

Forensic Mental Health

Patient characteristics, outcome measurement and predictors of treatment completion in a community justice and mental health (At-Risk) program in Kingston (PI: Dr. Tariq Hassan with collaborators from Queen’s University).
Traumatic Brain Injury in Criminal Justice Systems: A Systematic Literature Review (PI: Dr. Andrew Bickle with collaborators from Queen’s University).
International Overview of Phallometric Testing for Sexual Offending Behaviour and Sexual Risk (PI: Dr. Andrew Bickle with collaborators from Queen’s University).
Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews (Dr. Khalifa with collaborators from Nottinghamshire Healthcare NHS Foundation Trust, UK).
Pharmacological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews (PI: Dr. Najat Khalifa with collaborators from Nottinghamshire Healthcare NHS Foundation Trust, UK).

Recent Publications

Mottershead, T., Khalifa, N. & Völlm, B. (2020). A Mixed Methods Examination of Patient Feedback within Forensic and Non-Forensic Mental Healthcare Services. Journal of Forensic Psychiatry & Psychology, 31 (1), 106-122. DOI: https://doi.org/10.1080/14789949.2019.1680726
Khalifa, N., Talbot, E., Barber, S., Schneider, J., Bird, Y., Attfield, J., Bates, P., Walker, D.M., & Völlm, B.A. (2020). A cluster feasibility of Individual Placement and Support (IPS) for patients with offending histories. Frontiers in Psychiatry. DOI: https://doi.org/10.3389/fpsyt.2019.00952
Dhumad, S., Candilis, P., Cleary, S., Dyer, A.R., & Khalifa, N. (2020). Risk factors for terrorism: an examination of family, childhood and personality risk factors among Iraqi terrorists, murderers and controls. Behavioral Sciences of Terrorism and Political Aggression, 12(1), 72-88. DOI: https://doi.org/10.1080/19434472.2019.1591481
Khalifa, N., Hadfield, S., Thompson, L., Talbot, E., Bird, Y., Schneider, J., Attfield, J., Völlm, B.A., Bates, P., & Walker, D.M. (2020). Barriers and facilitators to the implementation of Individual Placement and Support (IPS) for patients with offending histories in the community: The UK experience. The British Journal of Occupational Therapy, 83 (3), 179-190. DOI: https://doi.org/10.1177/0308022619879334
Yang, C.C., Mauer, L., Völlm, B., & Khalifa, N. (2020). The use Transcranial Magnetic Stimulation (TMS) and transcranial Direct Current Stimulation (tDCS) to modulate impulsivity in people with mental disorder: A systematic review and metaanalysis. Neuropsychology Review, 30(4):499-520. doi: 10.1007/s11065-020-09456-2.
Khalifa, N., Gibbon, S., Völlm, B.A., Cheung, NH-Y., & McCarthy, L. (2020). Pharmacological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews. Issue 9. Art. No.: CD007667. DOI: 10.1002/14651858.CD007667.pub3.
Gibbon, S., Khalifa, N., Cheung, NH-Y., Völlm, B.A., & McCarthy, L. (2020). Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews. Issue 9. Art. No.: CD007668. DOI: 10.1002/14651858.CD007668.pub3.
Cameron, C. Khalifa, N., Bickle, A., Safdar, H., & Hassan, T. (2020). Psychiatry in the federal correctional system in Canada. BJPsych International. doi:10.1192/bji.2020.56.
Dudeck, M., Müller, J.L., Völlm, B.A., & Khalifa, N. (2020). Editorial on the Research Topic “Therapeutic Process and Well-Being in Forensic Psychiatry and Prison.” Frontiers in Psychiatry. 11:626241.doi: 10.3389/fpsyt.2020.626241.
Bickle, A., Hassan, T., Cameron, C. Safdar, H. & Khalifa, N. (2021). International Overview of Phallometric Testing for Sexual Offending Behaviour and Sexual Risk. BJPsych International, 1-4. doi:10.1192/bji.2021.17.
Hewson, T., Robinson, L., Khalifa, N., & Shaw, J. (2021). Videoconferencing in prison mental health during COVID. BJPsych Open, 7, e49, 1–3. doi: 10.1192/bjo.2021.13.
Bhaji, A., Forth, E., Yang, C.C., & Khalifa, N. (2021). Use of transcranial Direct Current Stimulation (tDCS) to modulate empathy: A systematic review and meta-analysis. Social Neuroscience. doi: 10.1080/17470919.2021.1889657.
Khalifa, N. & Candilis, P.J. (2021). Personality Disorder and Dangerousness. Psychiatric Times, XXXVIII(10), 47-50.
Khalifa, N., Magee, T., Shirazi, S., Salman, S., Yang, C.C., & Mela, M. (2021). The neurocognitive profiles of justice involved people with Fetal Alcohol Spectrum Disorder: A systematic review. Behavioral Sciences & the Law, 40(1), 87-111. doi: 10.1002/bsl.2550.
Dudeck, M., Müller, J. L., Völlm, B. A., Khalifa, N. R., eds. (2021). Therapeutic Process and Well-Being in Forensic Psychiatry and Prison. Lausanne: Frontiers Media SA. ISBN 978-2-88966-458-0. doi: 10.3389/978-2-88966-458-0 https://www.frontiersin.org/research-topics/9252/therapeutic-process-and-well-being-in-forensic-psychiatry-and-prison

Khalifa, N., Hawken, E., Jones, J., Bickle, A., Ayub, M. (2022). Use of transcranial Direct Current Stimulation (tDCS) to reduce impulsivity and aggression in people with intellectual disabilities. Trials. 23, 431. https://doi.org/10.1186/s13063-022-06350-5.
Shaw, A., Khalifa, A., & Hassan, T. (2022). The psychiatric aspects of terrorism: Prevention and rehabilitation. The International Journal of Risk and Recovery, 5(2), 31–36. https://www.forensicpsychiatryinstitute.com/journal/journal-archives/volume-5-issue-2-2022/
Dudeck, M., Müller, J.L., Völlm, B., Khalifa, N.R. & Streb, J. (2022). Editorial: Therapeutic process and treatment evaluation in forensic psychiatry and prison. Frontiers in Psychiatry, 13:1095592. doi: 10.3389/fpsyt.2022.1095592.
Leung P, Khalifa, N., & Hassan, T. (2022). Mental health comorbidity in a Canadian Court. Journal of Pakistan Psychiatric Society, 19(4), 12-14. https://jpps.pk/index.php/journal/article/view/169
Bishop, B., Völlm, B., & Khalifa, N. (2022). Women with antisocial personality disorder. In Black, D., & Kolla, N. (eds.). Textbook of Antisocial Personality Disorder. American Psychiatric Publishing.
Dudeck, M., Khalifa, N. R., Müller, J. L., Völlm, B. A., Streb, J., eds. (2022). Therapeutic process and treatment evaluation in forensic psychiatry and prison. Lausanne: Frontiers Media SA. doi: 10.3389/978-2-83251-006-3.
Dhumad, S., Candilis, P., Cleary, S., Dyer, A.R., & Khalifa, N. (2023). Distinguishing lone from group actor terrorists: A comparison of attitudes, ideologies, motivations, and risk factors. Journal of Forensic Sciences, 68(1), 198-206. doi: 10.1111/1556-4029.15154.
Candilis, P., Cleary, S. D., Dhumad, S., Dyer A. R., Khalifa, N. (2023). Classifying terrorism: A latent class analysis of primary source socio-political and psychological data. Behavioral Sciences of Terrorism and Political Aggression, 15:1, 64-81. DOI: 10.1080/19434472.2021.1874041
Alhindi, Y. A., Khalifa, N., Al-Khyatt, W., & Idris, I. (2023). The use of non-invasive brain stimulation techniques to reduce body weight and food cravings: A systematic review and meta-analysis. Clinical obesity, e12611. Advance online publication. https://doi.org/10.1111/cob.12611
Reid, R. Dolp, R. Hassan, T., & Khalifa, N. (in press). Terrorism Typologies and implications for clinical practice in psychiatry. The International Journal of Risk and Recovery.
Dolp, R., Reid, R., Hassan, T., & Khalifa, N. (in press). Psychiatric assessment of terror subjects and those at risk of engaging in acts of terrorism. The International Journal of Risk and Recovery.
Hassan, T., & Khalifa, N. (in press). Editorial: Terrorism and mental health. The International Journal of Risk and Recovery.

Inpatient Safety

A. Grading Risk of Inpatient Threat (GRIT)

GRIT is an assessment, communication, and risk management system for the imminent (within 24 hours) risk of inpatient violence. It has been designed for use on the Forensic Services Inpatient Unit at Providence Care, based on current research on imminent risk for violence, practices at other forensic facilities, and current legislative requirements. GRIT will shortly be pilot tested on Forensic Services; an adapted version of the GRIT system will later be implemented on other inpatient units at Providence Care Mental Health Services. The GRIT system will be formally evaluated for effectiveness in reduction of inpatient violence. In addition, data from the project may be combined with data from similar implementations at other forensic sites, as part of a larger scale multi-site research project.

Project Lead/Primary Investigator: Dr. Rebecca Douglas
Collaborators: Kim Knight, RN; Dr. Tariq Hassan

SAFEWARDS implemented on forensic units to improve inpatient safety

The model of care in the Forensic Inpatient Service at Providence Care Hospital incorporates the key components of the Safewards Model, namely originating domains, flashpoints, conflict, and containment.

Originating domains are those six broad aspects that affect a patient’s well-being: patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and external factors (e.g., visitors). The flashpoints are social situations, behaviours, or ways of thinking arising from those originating domains that can trigger a conflict. Conflict is defined as any action or behaviour that can threaten the safety of a patient and those around them. Containment entails actions that staff must take in order to eliminate or reduce conflict.

Education and Training

Education

Members of the Division are at the forefront of providing high quality education at undergraduate and graduate levels. The Division takes prides in coordinating the ‘Biological Psychiatry’ graduate course at the Centre for Neuroscience Studies. This is a modular course which is delivered annually in the winter semester over 12 weeks.

Training

The Division of Forensic and Correctional psychiatry is actively involved in providing high quality training for Psychiatry Residents and medical students as part of their training programs or as electives. The Division also provides observerships experiences of varying durations to other students and Residents.

Members

Dr. Najat Khalifa

Dr. Najat Khalifa MD, MBChB, FRCPsych, FRCPC

Professor of Psychiatry
Queen’s University Department of Psychiatry
c/o Providence Care Hospital
752 King Street West, Postal Bag 603, Kingston, ON K7L4X3

Email: nrk2@queensu.ca

Biography

Dr. Najat Khalifa (MD, MBChB, FRCPsych, FRCPC), is a Full Professor and Director of Research at the Queen’s University Department of Psychiatry, Kingston, Ontario, Canada. He is also the Chair of the Division of Forensic and Correctional Psychiatry and the Clinical Director of the Forensic Mental Health Service at Providence Care.

He is a graduate of the College of Medicine, University of Baghdad, Iraq. He obtained his Doctor of Medicine degree from the University of Nottingham, United Kingdom (UK), where he also completed his specialist training in Forensic Psychiatry. He is a Fellow of the Royal College of Psychiatrists, UK, and a Fellow of the Royal College of Physicians and Surgeons of Canada.

His research interests are the use of Non-Invasive Brain Stimulation (NIBS) techniques to modulate impulsivity, empathy and decision-making; terrorism and mental health; personality disorder and offending behaviour; and outcome measurement in forensic mental health. The main focus of his research has been on understanding the neuropsychological underpinnings of offending behaviour and evaluation of therapeutic interventions for justice-involved individuals.

He has a track record of academic achievements in the field of Forensic Psychiatry with many publications including peer-reviewed papers, books, and book chapters. He has presented many symposia and workshops at national and international conferences. Throughout his academic career, he been actively involved in university and clinical teaching activities, including the supervision of several honours, Masters, and PhD students, and many psychiatry trainees.

Publications

View Dr. Najat Khalifa’s publications in Google Scholar

Dr. Andrew Bickle

Dr. Andrew Bickle MBChB, BMedSc, DipMedSc(Dist), LLM(Dist), FRCPsych, FRCPC

Assistant Professor in Forensic Psychiatry
Queen's University, Department of Psychiatry
Correctional Service Canada
c/o Providence Care Hospital
752 King Street West
Kingston, ON, K7L4X3
Canada

Email: arb12@queensu.ca

Biography

Dr Bickle is an Assistant Professor in the Division of Forensic & Correctional Psychiatry at Queen’s University and the Regional Lead Psychiatrist for Ontario at Correctional Service Canada. With Dr Khalifa he co-ordinates the Biological Psychiatry graduate course at the Centre for Neuroscience Studies. He is Faculty Advisor to the Prison Health Coalition at Queen’s University Faculty of Health Sciences and is enthusiastic about offering clinical experiences in Correctional Psychiatry to students and residents. Dr Bickle has a clinical special interest in ADHD in all settings and is proud to serve as the Treasurer of the Canadian ADHD Resource Alliance. His research interests include ADHD, non-invasive brain stimulation, mental health law and traumatic brain injury.

Dr. Bickle joined Queen’s University in 2019 from the United Kingdom where he was an experienced forensic psychiatrist, having been a Responsible Clinician (Attending Physician) at low-, medium-, and high-secure psychiatric hospitals treating transferred prisoners and other patients at heightened risk of harm to others before focussing on Correctional Psychiatry, in which role he has served eleven different institutions in the UK and now Canada, alongside a medicolegal practice that included being an Expert Advisor to the National Crime Agency. He graduated from the Medical School of the University of Birmingham (UK) in 2001. He successfully challenged Membership of the Royal College of Psychiatrists in 2005 (later elected a Fellow in 2020) and completed specialty training to become an accredited forensic psychiatrist in 2009. He achieved a Distinction in his Master’s Degree in Mental Health Law from Northumbria University in 2007. He successfully challenged Fellowship of the Royal College of Physicians & Surgeons of Canada in 2021. He was a Visiting Research Fellow at the Institute of Psychiatry, King’s College, London, UK and Honorary Assistant Professor at the University of Nottingham, UK.

Dr. Rebecca Douglas

Dr. Rebecca L. Douglas, C.Psych.

Clinical Forensic Psychologist
Forensic Mental Health Services, Providence Care
Assistant Professor & Clinical Supervisor
Departments of Psychiatry & Psychology, Queen's University
752 King Street West
Kingston, ON, K7L 4X3

douglasr@providencecare.ca

Biography

Honours BA (McGill), PhD (Dalhousie), Residency (Royal Ottawa Health Care Group).

Dr. Douglas is a registered Clinical Forensic Psychologist, who works at Forensic Mental Health Services, Providence Care and is appointed as an Assistant Professor (Adjunct) with the Department of Psychiatry, in the Forensic & Correctional Psychiatry Division. Dr. Douglas’ primary clinical interests are in the areas of specialized forensic assessment and intervention for patients with complex presenting problems. Her research interests include psychopathology and offending, subtypes of violence, and imminent risk for violence. Dr. Douglas is currently leading a project on the development and implementation of an assessment, communication, and risk management approach for imminent inpatient aggression. Psychiatry Residents and Clinical Clerks may gain exposure to violence risk assessment, feigning assessment, and cognitive behavioural approaches to intervention under the supervision of Dr. Douglas. Dr. Douglas also supervises trainees from the PhD Program in Clinical Psychology at Queen’s and as part of registration with the College of Psychologists.

Dr. J. Christine Rose

Dr. J. Christine Rose, Ph.D, C.Psych.

Clinical and Forensic/Correctional Psychologist
Forensic Mental Health Services
Providence Care
752 King Street West
Kingston, ON, K7L 4X3

rosejc@providencecare.ca

Dr. Rose is a clinical and forensic/correctional psychologist with Forensic Mental Health Services at Providence Care Hospital. She is also an appointed member of the Ontario Review Board. Dr. Rose completed her doctorate in clinical psychology at the University of Ottawa and a CPA-accredited residency in the Forensic Program at Ontario Shores Centre for Mental Health Sciences in Whitby, ON. Dr. Rose has a board range of experiences with justice-involved persons including previous clinical experience in provincial and federal correctional facilities, as well as inpatient and outpatient forensic hospital programs. Dr. Rose is involved in the Correctional Service Canada Psychology Doctoral Internship Program through the provision of training in Legislation and ethical issues in forensic practice. Her research interests include compassion fatigue and moral injury amongst forensic professionals; personality disorders and offending behaviour; and older adults in custody.

Dr. Zoe Selhi

Dr. Zoe Selhi, MD, MA, FRCPC

Assistant Professor
Department of Psychiatry, Queen’s University
752 King Street West, Kingston, ON K7L 4X3

Email: zoe.selhi@providencecare.ca