Research Lead, Forensic Psychiatric Services, BCMHSUS
- Mental health
- Evidence-based practice
- Risk assessment and risk management
- Distinguished Scientist, BC Mental Health and Substance Use Services Research Institute
- Professor, Department of Psychiatry, University of British Columbia
- Adjunct Professor, Department of Psychology, Simon Fraser University
- Adjunct Professor, Health Sciences, Brandon University
Dr. Nicholls began her academic career at the University of Lethbridge, where she completed her undergraduate degree in psychology before moving to Vancouver. She completed her master’s and doctorate in law and forensic psychology at Simon Fraser University and her post-doctoral fellowship in the Department of Psychiatry at the University of British Columbia and the BC Institute Against Family Violence.
She began working as an assistant professor in psychiatry at UBC in 2007 and progressed to full professor in 2017.
“First and foremost, we’re trying to ensure that patients receive evidence-based care that helps to improve their outcomes in respect to mental health and well-being,” Dr. Nicholls says.
Much of her research focuses on the intersections between mental health and the criminal justice system.
“Research demonstrates that punitive approaches do not improve public safety,” Dr. Nicholls says. If we do a good job of caring for people in a trauma-informed, strengths-based manner, it’s in the best interests of the individual and their family. By improving the physical health, mental health, and quality of life of the individual, we also serve the broader interests of the general population. Better outcomes for the individual translates into reduced risk of crime and lessens the economic burden through re-hospitalizations, ED visits, re-incarceration as well as increased employment.
“One of the aspects of my work I find most rewarding is that there has been a very palatable shift in practice in the past decade or so, to increasingly building upon a person’s strengths, as well as intervening in ways that serve to reduce their vulnerabilities, in an effort to prevent adverse outcomes (e.g., crime, suicide). If we only think about people’s vulnerabilities, we lose sight of valuable information. It’s not a very balanced approach. If you were trying to plan for retirement, but the bank only asked you about your debts and not your assets, that wouldn’t present an accurate picture. It’s no different when we’re planning for treatment and supervision needs.”
Dr. Nicholls’ scholarly work has earned her and her research teams multiple grants and awards totalling over $15 million. She was a Michael Smith Foundation for Health Research Scholar and a CIHR New Investigator. She was also the recipient of a Canadian Institutes of Health Research Foundation Award to fund her research. Professor Nicholls is also active in serving the research community. She was editor in chief of the International Journal of Forensic Mental Health Services and is presently president-elect of the International Association for Forensic Mental Health Services.
The National Trajectory Project (NTP-1) is the largest Canadian study of persons found Not Criminally Responsible on Account of Mental Disorder (NCRMD, Canada’s insanity defence). Researchers tracked individuals within the forensic system found NCRMD between 2000-2005 in Ontario, Quebec, and British Columbia. The trajectories of NCRMD individuals, as well as historical data before their NCRMD verdict, and provincial differences across forensic systems, were assessed. The NTP team was awarded the Significant Contribution Award from the Criminal Justice Section, Canadian Psychological Association, for “Unique and significant contribution to the application of psychology to criminal behaviour, criminal justice, and/or law.”
National Trajectory Project 2 (NTP-2) is another national study of opportunities and obstacles to successful community reintegration of forensic patients funded by a CIHR project grant (Co-I; A. Crocker, T Nicholls et al, $1,554,480). Building on the success of the first, the project examines a more current sample of NCRMD patients and expands the study substantially by including people found NCRMD in eight provinces, accounting for 98 per cent of all people found NCRMD in Canada between 2010 and 2015. The project’s goal is to understand better the needs of individuals found NCRMD, as well as to interprovincial similarities and differences in the application of the legislation obtain more in-depth information on patients’ trajectory than was possible in the first National Trajectory Project. Dr. Nicholls is the B.C. lead for both studies.
In the staff-supported community outings project at the Forensic Psychiatric Hospital, Dr. Nicholls and fellow researchers are studying the nature and success of staff-facilitated excursions into the community intended to support patients’ recovery
“Complex and Concurrent Disorders in the Provincial Correctional System in British Columbia” is a project that estimates the prevalence of mental disorders among offenders. With Dr. Ruth Lavergne, Dr. Nicholls is co-supervising Dr. Amanda Butler, who is using data from mental health screening and justice administration for nearly 10 years in all BC Corrections. Dr. Butler's Ph.D. dissertation is comprised of three main studies, focused on (1) the characteristics of people admitted to custody and the prevalence of mental health needs and substance use disorders, (2) the relationship between mental health and substance use disorder diagnosis and recidivism; and (3) the relationship between specific substance-use profiles and frequency of re-incarceration. This study will provide valuable insights into the characteristics and needs of the people who experience an incarceration by studying mental health and substance use disorders as well as recidivism and re-incarceration among people incarcerated in B.C. between 2009-2017 (over142, 000 admissions, representing more than 47,000 individuals).
Dr. Heather Palis is a postdoctoral fellow working with Dr. Nicholls and Dr. Amanda Slaunwhite. Dr. Palis is leading an evaluation of recent pharmaceutical interventions implemented for people at risk of overdose that is highly anticipated by regional health authorities, clinicians, the Ministry of Mental Health and Addictions, and other government partners. This team is also collaborating with several other colleagues across B.C. to measure the effect of the transfer of prison medical services to the health sector. Researchers want to determine if the transfer of responsibility for health care delivery in B.C. provincial correctional centres have affected health care use, recidivism, substance use and overdose and mortality following release from incarceration.
ROAR Canada stands for Reducing Overdose and Relapse: Concurrent Attention to Neuropsychiatric Ailments and Drug Addiction. ROAR CANADA is a five-year research study funded by Health Canada, focused on people being treated for severe concurrent disorders. Concurrent disorders are mental illness and substance use disorders that happen at the same time. Often, people with severe concurrent disorders only receive treatment for one of their conditions at a time. Currently, there are only a few places that provide integrated comprehensive treatment and recovery for severe concurrent disorders. Dr. Nicholls is collaborating on ROAR project with principal investigator Dr. Christian Schütz. The study will involves extensive interviews with patients at The Burnaby Centre for Mental Health and Addiction and the Red Fish Healing Centre for Mental Health and Addiction.
Dr. Nicholls is also collaborating on a CIHR-funded systematic review of the women, victimization, and homelessness literature. The project, led by Ph.D. student Faith Eiboff, looks at the literature to date on the violence experienced among women who are homeless. The review seeks to assess violence across the lifespan, factors associated with victimization, and the effects of trauma and violence. The goal is to evaluate information for future policy, practice, and research.
Dr. Nicholls’ team also took up the challenge that COVID presented for our patients, families, and programs. In collaboration with colleagues in Quebec, Dr. Nicholls was part of a team that obtained a SSHRC grant to conduct a study to better understand the dual restrictions that inpatients experienced during the pandemic. She and her team in B.C., being led by Drs. Karen Petersen and Heather Palis, will be interviewing patients, family, and staff at various BC Mental Health and Substance Use Services sites.
They are also studying the efficacy of implemented virtual health initiatives studying virtual treatment for sexual offending from the perspective of patients and clinicians.
Finally, they will be examining how patients, clinicians and stakeholders (legal professionals, family members) experience virtual B.C. Review Board hearings compared to in-person hearings for people found NCRMD.
Dr. Tonia Nicholls is one of the authors of Short-Term Assessment of Risk and Treatability (START), a tool to assess a person’s risk across a variety of outcomes. START is used in developing an individual’s treatment plan and is the primary risk assessment tool used throughout FPSC, BC Mental Health Substance Use Services. START has been adopted internationally and translated into eight languages.
START: Adolescent Version. The success of the adult START led to many clinicians being interested in using the measure with youth. Dr. Nicholls brought together a team of forensic mental health experts on development, adolescent risk assessment, and trauma (Drs. Jodi Viljoen SFU; Dr. Keith Cruise) to collaborate with START authors (Dr. Sarah Desmarais, Dr. Christopher Webster) to develop the START: Adolescent Version intended for use with clients/patients 12-18/25 years (depending on individual and context) that has been translated into three languages.
Dr. Nicholls has given workshops on START and the START:AV in Australia, Finland, Germany, Spain, the UK, and across North America.
Contact us if you are interested in organizing a training workshop.
Dr. Nicholls is lead author of the Jail Screening Assessment Tool (JSAT) used in all correctional centres across BC and Ontario. A structured interview, it is designed to identify mental health problems and risk for suicide, self-harm, violence, and victimization among new admissions to jails and pre-trial facilities. Dr. Nicholls has conducted workshops dozens of works for B.C. Corrections and ON Corrections on the JSAT which also won her the American Psychological Association award for distinguished contributions. She and her team are presently integrating an acknowledgement of the prevalence and severity of victimization among marginalized populations (e.g., child abuse) and the importance of Trauma Informed Practice in prisons and hospitals. She has given related Keynotes at the 2019 -Queen’s University/ Correctional Service of Canada; 2021 European forensic adolescent conferences. Consulted/testify in court on matters at provincial (seclusion) national (segregation, care of mentally ill inmates and external reviewer of deaths in custody of Correctional Service of Canada) international levels (dangerous/severe personality disorders, risk assessment).
A woman who experiences abuse in an intimate relationship is confronted with several decisions about how to cope with the abuse. In most of these cases women focus on how best to maintain their safety and the well-being of any children. The task of advocates for women with abusive partners is to assist women in that effort with the ultimate goal to help women achieving non-violence in their lives.
The DIARI is developed to guide assessments of the needs of women who have been the victims of violence by their partner or ex-partner. The tool can especially be helpful in the safety and intervention planning in order to increase the health and well-being of the victims of intimate partner violence. The DIARI 1.2 aims to contribute to increase the accurateness of the assessment of the needs of these victims and the subsequent enhancement of the prevention of revictimization. Moreover, an objective of this structured approach is also to increase the knowledge of the decision-making process of women abused by male (ex)partners.
One of the basic premises of the DIARI is to organize the intervention together with the woman around her needs and in line with her preferences, and not to focus on stay or leave decisions. In reassessments, the safety and intervention planning can be adjusted according to the evolvement of the woman and/or the circumstances in which she lives.
The DIARI 1.2 was the result of an international collaboration between mental health professionals and researchers in Canada, Spain, and Sweden. The measure reflects a review of the literature, consultation with shelter staff and community stakeholders (domestic violence court advisors, lawyers, forensic/clinical psychologists) and focus groups and interviews with survivors.
The DIARI 1.2 can be used with women who are cohabiting with their abusive partners, women who have just left their abusive partners, and women who have been out of their relationships for some time but are in the process of decision-making about the future of their relationships. The DIARI 1.2 is not intended to be used as a violence risk assessment of perpetrators, rather it is recommended for use to complement assessments of perpetrators of partner abuse in situations where the assessors are responsible for or are working with both parties involved in domestic violence.
The BARSTOOL assesses a patient’s level of risk for aggression during air transport. This in turn forms the basis for establishing the level of sedation required. Dr. Johann Brink led the development of this measure.See Dr. Tonia Nicholls' publications on ORCID
Farrell, C., Nicholls, T. L., Pelletier, L., & Petersen, K. (revise and resubmit). Perspectives on the COVID-19 pandemic response in a forensic psychiatric hospital: Informing future planning. Journal of Forensic Psychology, Research & Practice.
Goossens, I., Marlee, J., & Nicholls, T. L. (in press). #AbolishNCR: A quantitative analysis of social media narratives around the insanity defense. Canadian Journal of Criminology and Criminal Justice.
Butler, A., Nicholls, T. L., Samji, H. & Lavergne, M. R. (revise and resubmit). Prevalence of mental health needs, substance use disorders, and co-occurring disorders among people admitted to provincial correctional facilities. Psychiatric Services.
Nicholls, T. L., Petersen, K. L., Kendrick-Koch, L., Singh, B., Ross, H., & Webster, C. D. (In press). Critical review of treatment approaches with mentally disordered offenders, strengths-based models and programs. In C. Langton & J. Worling, (Eds.) The Wiley Handbook of Offender Desistance from Aggression and Crime: Theory, Research, and Evidence-Based Practice. Chichester, UK: John Wiley.
Charette Y, Goossens I, Seto MC, Nicholls TL, Crocker AG. Is Knowledge Contagious? Diffusion of Violence-Risk-Reporting Practices Across Clinicians’ Professional Networks. Clinical Psychological Science. 2021;9(2):284-293. doi:10.1177/2167702620954797
Nicholls, T. L., Petersen, K. L., Almond, M. F. E., & Geddes, C. W. (2021). The Short-Term Assessment of Risk and Treatability (START): Rationale, application, and empirical overview. In R. K. Otto & K. S. Douglas (Eds.), Handbook of violence risk assessment (2nd ed., pp. 359-388). Routledge. https://doi.org/10.4324/9781315518374
Nicholls, T. L., Goossens, I., Odgers, C. L., & Cooke, D. J. (2021). Women and girls with psychopathic characteristics. In A. R. Felthous & H. Saβ (Eds.), The Wiley international handbook on psychopathic disorders and the law (2nd ed., Vol. 1, pp. 465-505). John Wiley & Sons Ltd. https://doi.org/10.1002/9781119159322.ch21
Lemieux AJ, Leclair MC, Roy L, Nicholls TL, Crocker AG. A Typology of Lifetime Criminal Justice Involvement Among Homeless Individuals With Mental Illness: Identifying Needs to Better Target Intervention. Criminal Justice and Behavior. 2020;47(7):790-807. doi:10.1177/0093854819900305
Edalati H, Nicholls TL, Schütz CG, et al. Examining the Relationships between Cumulative Childhood Adversity and the Risk of Criminal Justice Involvement and Victimization among Homeless Adults with Mental Illnesses after Receiving Housing First Intervention. The Canadian Journal of Psychiatry. 2020;65(6):409-417. doi:10.1177/0706743720902616
Gan, W.Q., Kinner, S.A., Nicholls, T.L, Xavier, C.G., Urbanoski, K., Greiner, L. Buxton, J.A., Martin, R.E., McLeod, K.E., Samji, H., Nolan, S., Meilleur, L., Desai, R., Sabeti, S., & Slaunwhite, A.K. Risk of over-dose related death for people with a history of incarceration. Journal: Addiction, 2020. doi: 10.1111/add.15293
MC Seto, Y Charette, TL Nicholls, AG Crocker. Predicting Which Clinically Documented Incidents of Aggression Lead to Findings of Guilt in a Forensic Psychiatric Sample - International Journal of Forensic Mental Health, 2020