I just got into Edinburgh and I'm still getting settled into the conference while fighting off jet lag. So far, I've listened to a fascinating presentation on a topic that I've been meaning to write about for a while. Beginning in 1991 when Kansas became the first U.S. state to allow indefinite confinement of sex offenders, civil commitment legislation has been increasingly used to force convicted sex offenders into psychiatric facilities following the end of their prison terms. Although classifying sex offenders as mentally ill has an old history, psychiatric hospitals have been left scrambling to deal with influx of sex offenders for which they were poorly prepared. States that have adopted Sexually Violent Predator (SVP) laws include Illinois, Arizona, California, Minnesota, Washington, Texas, New York, Virginia, and many others.
Typically, SVP laws tend to have three components: conviction for a sexually violent offense, presence of a mental disorder, and substantial likelihood that the offender will engage in sexual violence in future. Offenses that have led to SVP status include sexual assault (involving a child or adult) or other types of violent crime with a sexual component. Mental disorders (defined as a "congenital or acquired condition affecting capacity that predisposes a person to engage in acts of sexual violence") can include diagnoses such as pedophilia, personality disorder, or Sexual Sadism. Persons held under SVP acts are substantially different from the patients usually found in mental health settings. While the clinicians giving the presentation assured me that there was little real conflict between the civilly committed sex offenders and the conventional psychiatric patients, I'm finding that hard to believe (and many jurisdictions are starting to segregate the two populations).
The commitment process seems pretty much the same for all jurisdictions with a pre-screening phase in which convicted sex offenders are reviewed for SVP eligibility. Eligible sex offenders are then given a psychological assessment including clinical interview, psychometric testing, and actuarial measures of re offense risk. Once the psychologist makes the recommendation for SVP status, the Attorney General then files a petition with the civil court for probable cause. If the probable cause hearing is successful, a new hearing is conducted with state and defense evaluators providing opinions regarding SVP criteria. After a court determines that an offender is an SVP, they are indefinitely committed with their status being reevaluated on a regular basis (usually once a year). In all reevaluation hearings, the burden of proof is very much on the offender to demonstrate that they are a manageable risk in the community.
While all SVP treatment programs are considered voluntary, treatment participation is one of the factors that are taken into consideration during reevaluation hearings and SVPs who don't participate are rarely released. Treatment usually consists of group and individual sessions focusing on relapse prevention and cognitive behavioural therapy. Many committed sex offenders are also placed on medication to lower their sex drive (usually leuprolide acetate). Offenders with special needs (i.e. learning disorders or psychiatric issues) receive addi tonal treatment resources.
Constitutional challenges to SVP legislation have been largely unsuccessful despite concerns about double jeopardy and ex post facto law. A 1997 decision by the U.S. Supreme Court upheld the use of preventative long-term confinement of "mentally disordered" persons. Despite some victories by psychiatric organizations opposing civil commitment as well as the imposing of lengthier prison sentences for sex offenders, the use of psychiatric hospitals to hold SVPs after the end of their sentence is likely to continue.
