Dr. Tonia L. Nicholls is a distinguished scientist at BC Mental Health and Substance Use Services (BCMHSUS), an investigator at BC Children’s Hospital, and a psychiatry professor in the faculty of medicine at the University of British Columbia (UBC). She holds cross-appointments in the School of Population and Public Health at UBC and is an adjunct professor with the department of psychology at Simon Fraser University (SFU). Dr. Nicholls is also president-elect of the International Association of Forensic Mental Health Services. Dr. Nicholls will be one of five panelists at the Women in Science event on Feb. 10, 2022.
I’m trained as a forensic psychologist, which means I work at the intersection of the criminal justice and mental health systems. Our research and knowledge-exchange activities are intended to enhance well-being, public safety and justice. We aim to improve services to marginalized populations, including people who have mental health and substance use problems and/or contact with the criminal justice system. Often people in these populations have experienced other social determinants of health, such as dysfunctional or abusive childhoods and diminished educational and occupational opportunities, all of which are often reflected in poor social inclusion and poverty. Our research examines how best to support recovery and community reintegration.
We’ve found that punitive interventions are ineffective. Virtually everyone who goes to prison or is involuntarily hospitalized in Canada will eventually return to the community, thus our intention must be to support recovery on all levels — substance use, mental illness or disengagement from criminal activity.
Treatment should include trauma-informed, strengths-based and patient-centred interventions that provide hope and facilitate people in living their best lives.
Mentors and motivation
I was very fortunate to grow up in a healthy, supportive family in a northern Alberta town, where I saw disparities. Even as a child, I recognized that I was extremely fortunate to have parents who supported my athletic, artistic and academic interests and told us we could be whatever and whoever we wanted to be.
I’ve always had the benefit of mentors in my personal life, academia and in the community. I was provided opportunities and had people who believed in me, and I remember knowing there were other children, other families who were not afforded the same benefits.
I was close to a family member who was a lawyer and I was committed to a helping profession, so I considered becoming a lawyer. When I got pregnant in the first year of my undergrad, I panicked, thinking I needed to get an education that gave me a clear-cut career path, so I decided to become a teacher. I went to the University of Lethbridge (U of L) because they have a distinguished education program.
At the U of L, I had several excellent professors who took a special interest in me. They inspired me to go to graduate school and provided me with opportunities to develop the skills I needed to be a competitive applicant. I got invited to collaborate on a survey for the Lethbridge transit system, and my psychology and law professor, Dr. Don Read was especially influential. He taught me about the field, hired me as a research assistant, supervised my honour’s thesis and mentored me to go to the best program in the world for forensic mental health, at the Mental Health, Law and Policy Institute at SFU, and helped me get an interview with my master’s/PhD mentor, Dr. James Ogloff. To supplement my graduate school applications, I volunteered at the Lethbridge Correctional Centre with a psychologist researching intimate partner violence (IPV) with female inmates, on a Samaritans' crisis line, as a probation officer, and I also co-facilitated a treatment program for men who had been convicted of IPV.
When professors started talking to me about grad school, I didn’t even know what that was. I thought, who the heck goes to school for that long?
Finding mentors in my undergraduate program who actively encouraged me to aspire to a PhD was a real turning point.
When I took a psychology and law class that blended my interest in the law and understanding human behaviour — as well as in human rights, justice and social responsibility — I knew I had found what I wanted to do.
Transitioning from being an undergraduate to a graduate student
I had a very supportive spouse, so I was able to make the transition to graduate school. It was ironic going to school for 15 years (I ended up doing a two-year postdoc after my PhD) after thinking I just needed to find a clear career path. I remember family members jokingly asking, “Are you ever going to get a real job?!”
But once you’re out of undergrad and in grad school, you’re doing what you love. The focus of your courses gets more refined and you are learning outside of the classroom more often. I spent many long days at Riverview Hospital, reading clinical files to collect data for my master’s thesis. I had a position for several years as a mental health screener in provincial prisons.
Psychology graduate students are very fortunate as there are a lot of good research, teaching and clinical opportunities that pay reasonably well, and, more importantly, provide exceptional learning opportunities. There are also good graduate awards from provincial and federal agencies. You’re not putting away a pension or anything like that, but it’s manageable. It was a long haul, but I love what I do.
Our research offices are at the Forensic Psychiatric Hospital (FPH) in Coquitlam, and a lot of our studies have been focused on forensic psychiatric patients. There’s a lot of misunderstanding and stigma around mental illness, criminal justice involvement and substance use.
Our research has demonstrated that the patients coming out of FPH do so much better than people with mental health problems who are coming out of prisons, even when we match them for the severity of offence and other variables, such as criminal history and gender. They reoffend at significantly lower rates, which suggests providing care, comfort, coping strategies and supportive housing makes a huge difference. It’s in the best interest of the entire population, not just that individual and their family.
Similarly, there’s a common misperception that the not criminally responsible (NCR) defence and/or treatment in a forensic psychiatric facility is a get-out-of-jail-free card but, in fact, our research shows that people found to be NCR are actually detained in custody longer than if they been found guilty of an offence.
From risk assessment to risk management
Initially, my research focused on the validity and reliability of existing risk assessment measures. Over the course of my career, I have developed measures and treatment guidelines that have been adopted into practice locally, provincially and internationally.
Historically, the field focused on risk factors, including a history of violence, mental illness, substance use involvement and adversity in childhood. It’s like a tick box — if you get a lot of ticks, you’re considered high-risk and you’re less likely to get parole or you’re more likely to get an in-custody sentence.
One measure and manual I co-authored, the Short-Term Assessment of Risk & Treatability, supported a shift in the field, so we now provide a more comprehensive assessment by also considering a person’s strengths or protective factors. For example, instead of just considering whether a person has a substance use history, we evaluate their vulnerabilities and strengths related to substance use as well. Do they acknowledge it’s a problem? Are they engaged in treatment, motivated to change? Are they trying to restrict their triggers, such as avoiding socializing with people who use and, instead, building a social network of supportive people?
By shifting the focus to strengths-based factors, we acknowledge that people can change. If a person is making progress, that’s now built into the 20-variable assessment. The variables are coded twice, for strengths and vulnerabilities, and they’re all dynamic.
History is the foundation of any solid risk assessment, but we have to acknowledge that people can transform and grow.
This kind of risk assessment has been translated into several languages, adopted in Finland, Germany, Australia, the Netherlands, Spain, and in diverse settings across Canada and the U.S. I was particularly pleased to partner with two forensic psychologists with expertise in developmental psychology and trauma to produce a manual tailored to adolescents that has also had considerable uptake globally.
It has been so gratifying to see the field shift and to see lots of people turn their lives around.
Deciding to be a researcher, academic or clinician
In clinical practice, you can do a deep dive with an individual that results in an impactful, meaningful outcome for a person and their family. But with research, you get to have a broader impact on policies and practice, not only in a single site or clinical program, but also provincially, nationally and internationally.
Having a partner-track appointment — being a distinguished scientist with BCMHSUS and a professor of psychiatry at UBC — I have the unique opportunity of being a researcher with protected time to focus on grants, research, and mentoring graduate students and psychiatry residents, while working closely with diverse, interdisciplinary, leadership and direct-care providers, and even more importantly, with people with lived experience.
Working with these different groups means our research isn’t just disseminated in academic journals. The knowledge-to-practice gap is typically 15 years, but we get to work directly with people who are making the decisions about changing programs and practices and are bringing in new approaches. It’s rewarding to see changes happen quickly.
Range and relationships
Don’t put too much pressure on yourself to feel like you have to know precisely what you want to do. Having a bit of breadth in your education will give you a true sense of where your passion and success lie, allow you to meet different people and experience different fields.
I used to underestimate the value and importance of conferences. I was a young mom and one of the only people in our program who was married and had children. I was pregnant during my master’s thesis, so I had two children while doing my PhD. Going to conferences in Sweden and Australia seemed like a huge luxury. I often felt guilty about that.
I’ve since realized that going to conferences and building personal relationships with mentors and colleagues was such an important component of the trajectory of my career. I’ve been so fortunate to have built long-term collaborations and friendships with colleagues across Canada and the world. Those personal relationships have played a pivotal role in me being invited to collaborate on projects that have been some of the most rewarding and productive studies in my career. Those relationships have also resulted in invitations to deliver keynote presentations, facilitate workshops and teach courses in places like Germany, Finland, Sweden and the Netherlands. Now I tell my students that attending conferences is well worth the investment.
Join us virtually as we celebrate International Day of Women and Girls in Science
Thursday, Feb. 10, 2022
Click here for event details
Registration is open to high school students, university students, the health science community and the general public. The curriculum and discussion will be targeted for a grade 10–12 education level.
Registration will be accepted on a first-come, first-serve basis. Space is limited to 200 participants.
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