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.