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Psychiatric hospitals may be deluged with sex offenders

Yale Medicine Magazine, 1998 - Winter/Spring

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When convicted sex offenders finish serving prison time, many of them will go directly from a jail cell to a psychiatric ward. A June 1997 U.S. Supreme Court ruling says that prisoners who fit the profile of "sexually violent predators" will immediately be committed to hospitals for psychiatric care.

At an estimated annual cost of between $60,000 to $130,000 per patient, this will drain a psychiatric system that is already strapped for funds, says Howard V. Zonana, M.D., professor of psychiatry at the medical school and clinical lecturer at Yale Law School.

"Society certainly has a right to be protected from sexual violence," says Dr. Zonana, who chairs the American Psychiatric Association's Task Force on Sexually Dangerous Offenders. "But I am also concerned with the enormous cost and the impact on the quality of care this ruling will have on patients with severe incapacitating mental illnesses whose ability to survive in the community requires extensive resources."

According to Dr. Zonana, whose views were expressed in the Nov. 14 issue of the journal Science, treatment for sex offenders requires maximum-security facilities that are not usually found in hospital settings.

"If sex offenders are unable to control their behavior, they should be given longer prison terms and those who need psychiatric treatment should have it available before the end of their criminal sentences," says Dr. Zonana.

The U.S. Supreme Court ruling found that "sexually violent predators" can be hospitalized after and only after they have served their entire criminal sentence. Dr. Zonana maintains that these statutes provide a very low threshold for people to be determined mentally ill. The court's decision makes it possible for sex offenders to be hospitalized based on remote past behavior and any mental abnormality or personality disorder that makes them likely to repeat their behavior.

According to Dr. Zonana, this issue raises tough questions such as what mental illnesses or conditions are sufficient to meet the sexually violent predator requirement.

"This law is so broadly drawn that rapists who display anti-social behavior or traits could be hospitalized," says Dr. Zonana. "This is transforming criminal behavior into mental illness, further stigmatizing the mentally ill and serving a primary function of preventive detention."