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Treating Sex Offenders in a State Hospital

Treating Sex Offenders in a State Hospital

As an avid reader of Psychiatric Times, I have followed the controversy surrounding civil commitment of sex offenders. I have noticed that those who oppose it have little or no experience treating sex offenders in an institutional setting. I want to share the experience of our state hospital staff, with the hope of stirring up some debate and perhaps opening a few minds.

Logansport State Hospital has a 22-bed unit dedicated exclusively to the treatment of sex offenders. All individuals on the unit are under civil commitment for mandatory treatment. The program is labeled the "Sexual Responsibility" unit. Responsible sexual behavior is the goal of treatment. Labeling the program the "Sex Offender" unit would be an inappropriate use of emotionally charged words.

In the unit's eight and a half years of existence, the re-offense rate has been less than 10% for individuals who successfully completed the program and entered the community, based on conversations with mental health care centers and known arrests. This recidivism rate for sex offenders seems better than the relapse rate for patients with schizophrenia or bipolar disorder treated in a typical state hospital.

It is inappropriate to waste precious health care dollars treating patients with schizophrenia in a state hospital due to the lack of long-term efficacy and the high relapse rate. I say this tongue in cheek, but those who argue against state hospital treatment of sex offenders need to demonstrate that resources spent treating sex offenders provide less benefit than resources spent treating those "deserving" of state hospital care. I detect a lot of countertransference (in the broad sense) and very little evidence when I hear arguments against civil commitment of sex offenders. If chronic shoplifting or temper problems can be considered psychiatric disorders, why not sex offenses? A particular constellation of behaviors can be both a psychiatric and criminal issue. If our expertise can be used to modify maladaptive behavior patterns, then those behavior patterns are worthy of our professional attention.

Key elements of our program include stimulus avoidance, development of personal prevention plans, gaining insight into the circumstances in which one is at high risk of re-offending, and treating the disorder as a chronic unremitting condition. Due to small sample size and selection bias, we can only provide the reader with some educated and possibly idiosyncratic guesses about the prognostic features of mandatory sex offender treatment through civil commitment. We hope to have an adequate discharge sample for regression analysis in the future, but selection bias will always remain an issue.

  • Ego-dystonic pedophilia seems to be a good prognostic feature.

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