If you or your organization is interested in developing a sex offender treatment program, congratulations! I wish to welcome you to the cutting edge of psychiatric care. Treating sex offenders has the added benefit of guaranteeing full beds and minimal competition from other treatment providers. Taxpayers and governing bodies at this time seem willing to spend money for mandatory sex offender treatment. The following paragraphs may be useful in planning or developing your own inpatient sex offender program.
Funding organizations must understand that proper sex offender treatment is costly and time-consuming. If the funding organization is not aware of this, a facility could find itself in trouble when unrealistic expectations are not met and the next state budget is being prepared. Some states may actually prefer long stays and perhaps a lifetime of treatment if the patient continues to meet commitment criteria. Try to clarify this issue from the beginning so you can determine which individuals are appropriate for your program. If your state wants you to take the hardest of the hard core, and there is no concern over length of treatment, then you can eliminate selection bias and better clarify treatment and recidivism issues for the rest of us.
Our average length of stay is well over two years. If we included people who were transferred to other units but remained in the hospital, our average length of stay would be significantly longer. It is easy for sex offenders to con their way through a limited-stay program. It is much harder to keep the con going for several years. Understand from the beginning that there may be individuals who should never leave an institutional setting in spite of careful scrutiny at the outset for motivated individuals with good prognostic features. Some can be dangerous both to others and your career if you are in a hurry to discharge them. Ideally you will have step-down units and comprehensive outpatient care. Most likely, you will have no community support and will meet resistance when referring even your lowest-risk patients to outpatient care. Length of stay could be decreased substantially with comprehensive, competent outpatient care and residential treatment for motivated sex offenders.
Aggressively treat comorbidities. Unstable or severe psychiatric comorbidity of any type increases the risk of relapse and/or failure to achieve treatment goals. Offer hormonal treatment, psychiatric management, and specialized psychological and behavioral therapies. Most patients who need hormonal therapy will voluntarily take leuprolide (Lupron) if approached in the right way. Many sex offenders are willing to do anything possible to avoid re-offending.
Forcefully advocate criminal sanctions for those who relapse during or after treatment. Develop a working relationship with the local prosecutor from the beginning. Sex offenders should have only one chance. If they believe further recidivism will result in admission to a nice, clean psychiatric facility, then the risk of relapse increases. Sex offenses are a psychiatric and criminal issue. Our patients understand we will advocate for a lengthy prison sentence (life preferably) for those who commit a serious sex crime. Pedophiles in our program are aware that they run a higher than average risk of injury or death in prison. We clip newspaper articles showing lengthy sentences for repeat offenders. We use every tool available to reduce relapse, including our view of reality.