Tuesday, June 10, 2008

Sex Offenders: Patient release - an unreachable goal?

Patient release - an unreachable goal?
Star Tribune
June 9, 2008

ST. PETER, MINN. - Mike Meyer says that in his 13 years locked inside Minnesota Sex Offender Program facilities, he's gained insight into why he molested 36 children and young adults, and how to stop himself from doing it again.

One technique psychologists taught him is privately repeating a deviant thought over and over until it loses its allure. Another is telling on himself -- confessing to a counselor or support group when he feels a taboo attraction. Both are supposed to break the cycle of thoughts and behaviors that led to his crimes.

"When I was offending I felt like I was a freak -- like I couldn't talk to anybody," said Meyer, 38. Now he recognizes secrecy as "a big red flag."

Meyer completed all the required phases of treatment in the Minnesota Sex Offender Program four years ago and has an 18-page Predischarge Plan listing his strategies for not reoffending. But he remains locked up.

Of similar programs in 19 states, only the 14-year-old MSOP and three others that are much newer have released no patients. While most states leave release decisions to the courts, Minnesota is one of only two states that until this year put that authority in the hands of a political appointee, the human services commissioner, and a paid review board he or she appoints. Their decisions could go to a court only on appeal.

This year, the Legislature removed the commissioner from reduction-of-custody decisions, but left that authority with the appointed review board.

Because no one can guarantee an offender won't rape or molest again, the safest course for political appointees has been to keep offenders locked up regardless of how their treatment has progressed. The result has been a ballooning MSOP population, with each resident costing taxpayers about $130,000 a year, three times what it costs to treat them in a conventional prison.

In the MSOP's history, a commissioner has approved only one provisional release, which was revoked in 2003 for rule violations. That same year a sex offender released from prison murdered 22-year-old Dru Sjodin of Pequot Lakes, and Gov. Tim Pawlenty prohibited releases from the MSOP unless required by law or ordered by a court. Pawlenty's order remains in effect.

The situation has prompted several of the experts who designed and ran the MSOP to become disillusioned and leave. Many patients also have given up -- currently about 20 percent don't participate in treatment -- while dozens who have completed the requirements for release wait in limbo, struggling to hold onto the hope that it wasn't all pointless.

"This place is morbidly hopeless and morbidly depressing," Meyer said recently. "I really have to believe there's going to be something better than this. Because if I don't, I'm going to die here."
Dealing with deviance

Dr. Michael Farnsworth was the forensic psychiatrist at the St. Peter Security Hospital in the early 1990s, when a series of shocking sex crimes prompted Minnesota to become the second state, after Washington, to start committing its most disordered and dangerous offenders to mental hospitals after their prison sentences.

Farnsworth said the hospital opposed the move.

"We said it would be a money pit, that there'd be no end to it, and that there's no proven technology to treat them," Farnsworth said. "Most of the literature said don't even treat these people."

When state leaders pushed ahead with the plan, Farnsworth was assigned to design the treatment regimen. The model he and his colleagues chose -- a cognitive-behavioral approach stressing relapse prevention -- is still in use today, in Minnesota and most other states with similar programs.

It requires offenders to own up to their histories, recognize their "high risk factors'' -- the thoughts, feelings and situations that preceded their crimes -- and learn to interrupt their "offense cycle" when faced with those factors again. Much of this work is done in groups of eight to 10 patients.

One of the "internal high risk factors'' identified in Meyer's case was low self-esteem, which used to cause him to avoid peers and seek out children, with whom he felt in control. Like many offenders, he struggles with his own issues of abuse, having been sexually abused by a farmer for whom he worked when he was young. Psychologists say offenders who were themselves abused may often have difficulty feeling empathy for others and sometimes must learn to recognize and label their own feelings.

Meyer says treatment taught him to recognize when his self-worth is low, through "cues" such as catching himself engaging in "inappropriate attention-seeking," such as horseplay. His planned coping responses include exercise and committing "random acts of kindness."

He also plans to avoid his "external high risk factors," including TV shows and movies featuring the type of children who fueled his fantasies. MSOP's clinicians also challenge patients to revise core beliefs that have led to offending, such as the idea that some women want to be raped or that laws against pedophilia are wrong. Such changeable attitudes or behaviors are labeled "dynamic risk factors," which patients must discard in order to advance in treatment.

Patients aroused by rape or abuse fantasies are taught to avert them by taking whiffs from vials of ammonia or rotten meat. The technique, called "olfactory aversion," is commonly used in sex offender programs, and some studies say it is effective in reducing deviant thoughts.

The MSOP also treats other problems that can interfere with patients' treatment and may have contributed to their crimes, such as chemical addictions, clinical depression and mental illnesses or retardation. Patients must keep journals to improve their self-awareness and insight, and to hold themselves accountable.

"When I was out offending I was extremely immature," said Meyer. "I wasn't clear about what my sexuality was, and I felt sexually inadequate. In treatment, I've been able to deal with those issues."

Realizing he was gay was helpful but also raised other issues, he said. For example, he thinks it's unfair that the program penalizes consensual sex between two gay patients who are in what they consider a healthy relationship.

Department of Human Services spokeswoman Patrice Vick confirmed that the program requires patients to be celibate. She said those caught having consensual sex can be placed in "protective isolation," restricted to their rooms, or otherwise disciplined.

Such sexual activity "is not in keeping with a treatment environment that is attempting to address patients' deep-seated sexual issues and dysfunction," Vick wrote in an e-mail.

Benefits unclear
A report by the U.S. Congressional Research Service in July said that of 2,694 civilly committed sex offenders nationwide in the fall of 2006, only 252 had been discharged, most within the past few years. Experts say it's impossible to tell whether treatment works based on such a small number of mostly recent releases.

As to non-committed sex offenders, a 2002 study found that 12.3 percent of a group of treated offenders committed a new sex crime, compared with 16.8 percent of untreated offenders. The congressional report concluded that "research indicates that there is not enough evidence to definitively prove that treatment for sex offenders works."

Farnsworth said that in the years since he helped set up the MSOP, "there's not been a huge explosion in the knowledge or the evaluation of the efficacy of treatment. And so most of the offenders across the country who have been committed remain committed. So it's very difficult to determine whether this very expensive treatment option, versus simple containment in prison on extended sentences, is really any more effective than doing nothing."

The director of Wisconsin's civilly committed offender program, which is being eyed as a possible model for Minnesota, says treatment does appear to reduce a patient's risk of reoffense.

Since Wisconsin's program began in 1994, it has fully discharged 14 offenders after what was deemed successful treatment, said Steve Watters, director of the Sand Ridge Secure Treatment Center in Mauston. Wisconsin courts released another 19 patients after legal challenges or because of reassessment of their risk. Two committed new sex offenses after their release.

Wisconsin's program has a mix of treatment techniques similar to Minnesota's, with the greatest emphasis on changing disordered thinking and core beliefs.

"Relapse prevention was at one point very mechanistic -- 'If x happens, then do y,' '' Watters said. "But you can't [envision] every possible dynamic they'll encounter. It's better to make them understand their errors in thinking, and change their behavior."

Unlike the MSOP, which has no patients in non-secure settings, Sand Ridge is overseeing 16 offenders who completed treatment and have returned to their home communities, to demonstrate their worthiness for discharge.

Agents stop by at random and track their movements with GPS bracelets. If they obey a stringent set of rules for several years, Watters said, the courts typically remove them from supervised status and grant a full discharge.

Watters cites Wisconsin's reliance on the courts for release decisions as one reason for that state's success. In Minnesota, release authority rests with a review board appointed by the Human Services commissioner.

"Obviously there are no guarantees," Watters said. "If you wait until they're 'cured,' you'll never release any sex offender. But I think the evidence would support that well-designed and -implemented treatment does produce a significant reduction in risk."

Slow on purpose
Meyer maintains that his treatment has worked. Last year he petitioned the MSOP's Special Review Board for a transfer to the program's Community Preparation Services unit, an unlocked facility with less supervision, which would put him a step closer to discharge.

MSOP clinicians opposed his petition, saying he needs to pass polygraph and other examinations to prove his deviant thoughts are at bay. A test called the Abel Assessment, which measures how patients respond to various photographs, found in 2005 that he was no longer attracted to deviant themes.

Clinicians said they also want Meyer to prove he can move about the treatment center campus unaccompanied, without creating any problems, before they'll support his transfer.

Despite the program's objections, the review board recommended that Meyer's petition be granted -- a rarity. But Human Services Commissioner Cal Ludeman denied the petition, calling the board's recommendation "premature." Meyer appealed to a Minnesota Supreme Court three-judge panel, which has yet to issue a decision.

Assistant Human Services Commissioner Wes Kooistra, designated by Ludeman to speak for the department, said the process leading to discharge is deliberately slow. "The only way they're going to be even considered for discharge is if they show a pattern over time of changing," he said.

Psychologist Paul Reitman, who has treated and assessed sex offenders for 18 years, examined Meyer for the three-judge panel. "I urge the court to grant Mr. Meyer's request," he wrote. "In my opinion, [he] has made real transformations to become a law-abiding citizen and to control himself sexually."

Minnesota, Reitman wrote, has "committed vast financial resources to rehabilitate sex offenders. ... Either we are committed to rehabilitation, or we are going to keep sex offenders locked up indeterminately."

Also see: Sex Offenders: Problems Our Parents Wouldn't Speak


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