Post-conviction polygraph testing of sex offenders.

Post-conviction polygraph testing of sex offenders (typically referred to as PCSOT) is common in the US, increasingly applied in England and Wales, but hardly if ever used elsewhere in the world. This article provides an account of the nature and aims of PCSOT, research into its efficacy, and controversies associated with it.

The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence.

This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compare their treatment approaches. This report is a summary of their discussions, including empirical data from CR and Russia which have not previously been published in the English language. All participants agreed that continuing international collaboration would be very useful for the development of ethical international prescribing guidelines, as well as pooling data from studies on the efficacy and utility of pharmacological and other biological treatments for people who have committed sexual offences.

Learning from research: Adapting interventions for sexual offending to improve outcomes.

BACKGROUND: Sexual behaviour towards another person who does not or cannot consent to it causes serious harm to its victims. Understandable tendencies towards isolating or shaming the offenders, however, may actually increase risks of recidivism and further such harms. AIM: The study aims to consider evidence for the effectiveness of interventions for sex offenders, mainly in a U.K. context, across four areas: criminal justice system programmes, medication, interventions for sex offenders with personality disorder and a community-based model for the reintegration-Circles of Support and Accountability, and identify key evidence gaps. METHODS: We searched for reviews in the following four strands of work-psychosocial programmes, medication, personality focused therapies, and Circles of Support and Accountability-and identified gaps in knowledge. FINDINGS: Randomised controlled trials in this field are rare but have been achieved. Findings from more naturalistic outcome studies of sex offender treatment programmes are disappointing, but recidivism rates among released sex offender prisoners are low, regardless. Medication relying on substantial physiological change raises substantial ethical concerns. Not all sex offenders have a mental disorder but up to half have been diagnosed with a personality disorder, which may need specific treatment. Evidence is growing that lay work such as Circles of Support and Accountability is a valuable adjunct to other interventions. CONCLUSIONS AND IMPLICATIONS FOR FUTURE RESEARCH: In this field, where tensions between attributions swing between "madness" and "badness," there is growing evidence for optimism that complexity of history and presentation can be met through cooperation between the many disciplines, integrative strategies, and wider community engagement. The need now is for large, prospective controlled trials of interventions, with long periods of follow-up. Perhaps, the most exciting developments have come from the wider public. More research into the qualities of these volunteers might inform public education and health strategies supporting wider safety.

Health screening of people in police custody--evaluation of current police screening procedures in London, UK.

BACKGROUND: Previous research has highlighted excess health morbidity in offender populations. A small number of studies have described health problems within police custody settings. The efficacy of police screening procedures has not been evaluated. METHODS: Prospective clinical interviews with custody detainees in London were conducted. Clinical findings were compared with those recorded in police health screening documentation. RESULTS: High levels of health morbidity were observed. The sensitivity and specificity of the current screen with respect to its ability to trigger a call for a health-care professional (HCP), regardless of the reason, was 70 and 66%, respectively. Fifty-one percent of the detainees with asthma, 36% with diabetes mellitus and 40% with epilepsy were not picked up by the screen. Fewer than one-half of the detainees at risk of alcohol withdrawal syndrome had 'alcohol' documented on their screen, although 81% saw the HCP. The police screen missed heroin use in 28% and crack cocaine use in 68% of users. A HCP was called in 84 and 64% of the cases, respectively, for any reason. Two of the 12 detainees (17%) who described a head injury with serious-associated symptoms were detected; 9 had a HCP called for any reason. Whereas mental disturbance was detected in 79% of the detainees with serious mental illness, one-third of the detainees with a risk history of suicide and one-half of the detainees with suicidal ideation were not documented as such on the police screen. CONCLUSION: Given the amounts of morbidity and the need for reliable triage, improvement in the health screening procedures used by the police is needed.

A large-scale evaluation of Risk Matrix 2000 in Scotland.

Risk Matrix 2000 is a statistically derived risk-assessment instrument for use with convicted male sex offenders. It is a core element of the sex offender risk assessments carried out in England, Wales, and Scotland. This study examines its validity in a large cohort of sex offenders released from Scottish prisons. It compares 5-year outcomes with findings from the original Risk Matrix validity sample (a 1979 cohort of sex offenders in England and Wales). The instrument had moderate predictive validity and performed in a similar manner in the two studies in spite of different underlying base rates of reconviction.

A trial of voluntary polygraphy testing in 10 english probation areas.

Sex offenders taking part in treatment programs in 10 probations areas of England were asked to undertake polygraph testing on a voluntary basis. Over a 2-year period 347 offenders attended for testing (43% of those eligible). Outcome was compared with offenders from four probation areas where polygraphy was not introduced. Case managers of polygraphed offenders reported new disclosures relevant to supervision being made in 70% of first tests, compared with 14% of case managers of nonpolygraphed offenders who reported new disclosures in the preceding months (odds ratio [OR] = 14.4, confidence interval [CI] = 8.5, 24.5). Of the disclosures made during polygraph testing, 27% were rated as being of "medium" severity and 10% "high." Polygraph and nonpolygraph case managers reported making revisions in risk assessment with similar frequency, but nonpolygraph case managers were much more likely to consider risk to have reduced while changes in risk assessment made by polygraph case managers were usually upwards (OR = 5.0, CI = 1.7, 14.6). Case managers of polygraph offenders reported more treatment changes than case managers of the comparison group (OR = 3.1, CI = 1.6, 6.0), which were attributable to the polygraph test. Case managers rated polygraphy as "somewhat" or "very" helpful after 93% of tests for which we had information.

Commentary: Mapping a changing landscape in the ethics of forensic psychiatry.

In 1984, Alan Stone, writing in the Bulletin of the American Academy of Psychiatry and the Law, stated that "forensic psychiatrists are without any clear guidelines as to what is proper and ethical," adding that because of the nature of psychiatry and the realities of the law, no such guidelines can be drawn. Put starkly, his conclusion was that the practice of forensic psychiatry is fundamentally unethical. In the same issue, several contemporary commentators criticized his position, arguing that he misunderstood the social context of forensic psychiatry and that, in any case, he was wrong to say that ethics standards did not exist. In this article, these questions are reviewed again, starting from the principle articulated by the philosopher, A. J. Ayer, that that there is no such thing as an ethical fact.

Gonadotrophin-releasing hormone agonist treatment for sexual offenders: A systematic review.

BACKGROUND: Sexual offending is a significant international issue causing long-term consequences for victims, perpetrators and society. AIMS: The purpose of this study was to review the existing research data assessing the efficacy of gonadotrophin-releasing hormone agonists for treating adult, male, sexual offenders. METHOD: The method of this review involved the examination of studies involving participants prescribed at least one month of a gonadotrophin-releasing hormone agonist for the purposes of reducing sexual drive related to offending. The primary outcome measures were recidivism rates and sexual functioning. Secondary outcome measures included assessment of side effects and effects on interpersonal/psychiatric functioning. Studies in the English language that were dated 1969-2015 were included. RESULTS: Twelve eligible studies (323 participants) were identified. A reduction in a variety of measures of sexual functioning and/or risk was found in all studies. Robust recidivism data was limited. Medication was rarely described as ineffectual. All studies reported side effects. Reduction in bone density and potential long-term reduction in fertility in some subjects were issues of concern. CONCLUSION: Whilst identified studies showed promising results with respect to sexual functioning, challenges in performing randomised control trials in this subject group meant that included studies were methodologically limited. This review recommends that future research must be performed before the effectiveness and tolerability of gonadotrophin-releasing hormone agonists in this population can be confirmed.

Commentary: getting at the truth about pathological lying.

Lying is common, and in its many aspects forms a normal part of social interchange. In this issue, Dike et al. review the literature on what has been referred to as pathological lying, highlighting the lack of information available about this phenomenon. In this commentary on Dike et al., it is noted that if pathological lying exists, it is not the lie, but the liar that is abnormal, with the abnormality relating not to the nature of the lies told, but to the mental state associated with the behavior. Before forensic opinions regarding pathological lying can be given with confidence, we need more data to help determine whether it is in fact a psychiatric entity, and if it is, about the physical and psychological characteristics that underpin it.

Casenote assessment of psychopathy in a high security hospital.

INTRODUCTION: There is now a large amount of data demonstrating the internal reliability and construct validity of the Hare Psychopathy Checklist (PCL/PCL-R) when used in the assessment of psychopathy in male forensic populations. It has well-established psychometric properties when scored following a review of collateral information and a subsequent interview. However, its internal reliability and factor structure, when casenote information alone has been used, have not been examined outside North America. METHOD: A sample of 89 patients from a British high security hospital, with the legal classification of psychopathic disorder, was scored retrospectively on the PCL-R from their medical files only. The psychometric properties of the PCL-R were analysed. Results The PCL-R ratings showed a high level of internal reliability. The factor structure was very similar to that found in Hare's North American sample of forensic psychiatric patients. DISCUSSION: The findings support the application of the PCL-R, when scored using existing file data alone, to a British high security hospital population.

Health screening in police custody.

BACKGROUND: There have been few previous studies on the health needs of police detainees. London's Metropolitan Police Service (MPS) uses health screening procedures which have not yet been evaluated. The objective of this study is to determine the extent of health problems and 'mental vulnerability' in detainees in police custody, and the efficacy of current health screening procedures. METHODS: Custody records from five London Boroughs were reviewed. Prevalence data for health problems and mental vulnerability was obtained from the anonymised records of 307 detainees who were referred to the Forensic Medical Examiner (FME). Data were analysed for the identification of physical and psychiatric morbidity. RESULTS: Injuries, epilepsy and asthma were the most common physical health problems noted. Drug and alcohol issues were also frequently encountered along with depression and self-harming behaviour and suicidal ideation. Morbidity was lower than that reported in other, interview based studies. Less than 2% of detainees were thought to require an Appropriate Adult to be present during police interview. CONCLUSIONS: A significant amount of health morbidity is present among detainees in police custody. Our findings suggest that current police screening procedures detect only a proportion of this. Further research is warranted to evaluate the effectiveness of health screening in police custody.

Accuracy and utility of post-conviction polygraph testing of sex offenders.

BACKGROUND: Polygraphy is used increasingly in the treatment and supervision of sex offenders, but little research has addressed its accuracy in this setting, or linked accuracy with utility. AIMS: To investigate the utility and accuracy of polygraphy in post-conviction testing of community-based sex offenders. METHOD: A self-report measure examined the experiences of offenders with polygraphy. RESULTS: Based on self-report, the polygraph's accuracy was approximately 85%. False negatives and false positives were not associated with demographic characteristics, personality variables or IQ. The majority of offenders found the polygraph to be helpful in both treatment and supervision. Nine percent of offenders claimed to have made false disclosures; these individuals had higher scores on ratings of neuroticism and lower scores on ratings of conscientiousness. CONCLUSIONS: These results support the view that the polygraph is both accurate and useful in the treatment and supervision of sex offenders.

A prospective study of the impact of polygraphy on high-risk behaviors in adult sex offenders.

This study examined whether polygraph testing would result in sex offenders engaging in fewer high-risk behaviors. Fifty adult male sex offenders taking part in community treatment programs were allocated into 2 groups: "Polygraph Aware" subjects were told they would receive a polygraph examination in 3 months regarding their high-risk behaviors, while "Polygraph Unaware" subjects were told their behavior would be reviewed in 3 months. Relevant behaviors for each subject were established at baseline interviews, following which both groups were polygraphed at 3 months. All subjects were polygraphed again at 6 months. The hypothesis was that subjects in the "Polygraph Aware" group would have engaged in fewer high-risk behaviors, based on their self-report during the examination. Thirty-two subjects (64%) attended the first polygraph examination, with 31 (97%) disclosing an average of 2.45 high-risk behaviors each previously unknown to supervising probation officers. There was no significant difference between the two groups. Because of the high failure rate, all subjects were told to expect a second polygraph. Twenty-one subjects (42%) completed the second polygraph test, with 71% disclosing an average of 1.57 behaviors, a significant decrease compared with the first test. Disclosures to treatment providers and probation officers also increased. It was concluded that polygraph testing resulted in offenders engaging in less high-risk behavior, although the possibility that offenders fabricated reports of high-risk behaviours to satisfy examiners is also considered; similarly, offenders seemed to be more honest with their supervisors, but this only occurred after experience of the test itself. Feedback from offenders who completed the study, taken together with the high drop out rate, suggested that those motivated not to reoffend found polygraphy useful, while those less motivated sought to avoid it.