Dangerous Sex Offenders: A Task Force Report of the American Psychiatric Association

In 1977 the Group for the Advancement of Psychiatry published a task force report that was instrumental in repealing the first generation of laws for civil commitment of sex offenders (1). The report's authors concluded that civil commitment of selected sex offenders to special treatment programs was not an effective way of handling such offenders. In 1990, after almost all of these special programs had been closed, Washington State passed the first of the second generation of laws on involuntary commitment of sexual offenders, against the active opposition of the American Psychiatric Association. This book has been written to explore APA's position on involuntary commitment and on the treatment of sex offenders in general.

The task force that compiled this work is composed of an impressive group of experts. They leave no doubt about their opposition to "violent sexual predator" commitment statutes—statutes aimed at civil commitment of sex offenders to mental health facilities after they have served their prison sentences—with statements such as "sexual predator commitment laws represent a serious assault on the integrity of psychiatry. … [They] threaten to undermine the legitimacy of the medical model of commitment. … Psychiatry must vigorously oppose these statutes in order to preserve the moral authority of the profession and to ensure continuing societal confidence in the medical model of civil commitment." Such statements also leave little doubt about the need for all mental health professionals to familiarize themselves with this issue.

The sections dealing with civil commitment of sex offenders are definitely the strong point of the book. They include an outstanding history of civil commitment laws and carefully-thought-out public policy recommendations. Other parts of the book summarize some of the crucial issues in treating both adult and juvenile offenders.

One problem is that either the task force or the book's editors do not appear to have a clear idea of the report's audience. Thus some chapters assume that the reader has little background in the topic while others assume a sophisticated understanding of advanced statistical or psychopharmacological concepts, which leads to confusion. In the chapter on drug treatment, "antiandrogen" is defined in a highly technical way that excludes the drug most commonly placed in that category. It also gives considerable space to a drug that cannot be used in the United States, without clarifying that point.

The chapter on recidivism devotes an inordinate amount of space to out-of-date studies with numerous methodological flaws that are not addressed. It is also overly reliant on meta-analyses that also contain problems not discussed. In addition, the chapter fails to address the greatest conundrum in studying sex offender recidivism—the low base rate that makes it almost statistically impossible to show strong treatment effects.

Overall, the book fills a need for a brief, readable summary, addressed to the nonspecialist, of basic issues associated with the management of sex offenders. Furthermore, it takes a refreshingly strong stand on highly controversial policies. All of the other major mental health professional organizations have chosen to stand mute on these issues. The American Psychiatric Association is to be commended for recruiting a group of knowledgeable professionals and allowing them the freedom to speak with such candor.

Dr. Schwartz is clinical director of the Justice Resource Institute's treatment program at the Massachusetts Treatment Center in Bridgewater.