Dearth of Data Doesn't Slow Rush to Commit Sexual Offenders

Data on the effectiveness of psychiatric treatments for sexual offenders are scarce, and what few data there are show mixed results. Despite the lack of information, however, states continue to enact laws allowing them to involuntarily commit sexually violent predators to psychiatric facilities once they have completed prison terms.

The issue stems from the 1997 U.S. Supreme Court ruling in Kansas v. Hendricks that states have a right to confine potentially dangerous sex ual offenders in psychiatric hospitals once they are released from prison. In 2002 the Court issued a follow-up ruling to clarify the criteria under which sexual offenders released from prison can be committed (Psychiatric News, March 1, 2002).

Supporters of commitment laws for sexually violent predators maintain that offenders who have completed their sentences but continue to display violent tendencies can benefit from treatment in psychiatric facilities. But significant disagreement exists over the effectiveness of treatment for these offenders.

“Diagnostically they are a problem, and clinically they are a problem,” said Howard Zonana, M.D., a member of APA's Council on Psychiatry and Law, during a workshop at APA's 2007 annual meeting in San Diego in May.

Zonana said the research data on the effectiveness of long-term treatments remain “very mixed.” He noted that there are no data showing the effectiveness of one of the key outcomes of treatment for these patients—admitting all past crimes.

Despite a lack of comprehensive study, some research has indicated that recidivism among sexual offenders who want treatment may be reduced from 17 percent to 10 percent. However, no comparative research has pinpointed which treatments are most likely to be effective, Zonana said.

Although APA has opposed laws that commit sexually violent offenders to psychiatric facilities after they complete prison sentences, psychiatrists still have a duty to these patients. APA's Task Force on Sexually Dangerous Offenders recommended in its 1999 report that once such patients have been placed in a psychiatric facility, psychiatrists should provide any effective treatments available to those committed and diagnosed with paraphilias. Zonana said the need for more research to guide psychiatrists in treating violent sexual offenders is crucial.

“The issue we're struggling with now as more states adopt sexually violent predators laws is how do we as a profession respond to the situation?” Zonana said.

One response has been lobbying by psychiatrists before state legislatures. A recent “success” in this area was enactment of a “hybrid law” in Connecticut, which includes psychiatrist interviews of sexually violent offenders to ensure that only those with serious mental illness are committed to psychiatric hospitals. That has resulted in a smaller number of such commitments than in other states.

“The irony is these people are coming into our facilities, [while] our usual patients go untreated, get arrested, and are thrown into jail,” Zonana said.

Another complication is that states continue to expand the numbers of crimes that qualify inmates for psychiatric commitment under violent sexual-offender laws, he noted. Those expansions include, for example, counting an offender's childhood convictions in cases in which multiple convictions qualify offenders as sexually violent predators.

The newest legal maneuver that states use on convicted sexual offenders is the imposition of residency restrictions, which limit how close they can live to schools or day-care facilities. The practical effect is that there are a growing number of cities where sexual offenders cannot legally live. This results in a higher likelihood that states will commit them to psychiatric facilities.

The impact of these laws on psychiatrists is increased pressure to identify sexually violent predators, which Zonana said is an unrealistic expectation that ignores the fact that most sexual assaults occur between people who are“ known and intimate.” ▪