Sexual offending and the treatment of sex offenders

This contribution outlines the principles of assessment and treatment of sex offenders with the aim of clarifying the role that psychiatrists can play in sex offender management. It is emphasized that assessment of treatment need is inherent in the assessment of risk, both in terms of specific treatment targets and in respect of issues related to sex offender management more generally. So-called 'static' risk factors can be assessed using actuarial instruments which provide an indication of long-term risk. More immediate risk and areas for intervention are addressed through more 'dynamic' risk factors, for which a number of assessment instruments have been developed. Psychometric testing and techniques such as polygraphy can also make useful contributions to the understanding and management of risk, the identification of treatment targets and monitoring progress in treatment. Although cognitive-behavioural-type treatment approaches form the mainstay of therapy, medication can be an important adjunct where high sex drive, strong sexual urges or sexual preoccupation are prominent. Psychiatrists and other mental health professionals now have a duty to cooperate with public protection procedures, which must be balanced with the duty of confidentiality they owe to their patients.