Offenders on a tightrope

How and where to house sex offenders is an
extremely sensitive issue – especially when the client shows no remorse about
past offending and is drinking heavily. Social worker Declan Henry, discusses
the dilemma of where to accommodate his client with Mike George.

While the Home Office presses ahead with plans
to extend the sex offenders register and tighten the monitoring of sex
offenders, especially paedophiles, much of the everyday work falls to
psychiatrists, community psychiatric nurses, and social workers. The public and
politicians expect these staff to exert proper control and, if possible,
provide some sort of treatment to stop them re-offending.

But as many know, this is often much easier
said than done, and this is certainly been the case with Victoria Taylor (not
his real time). Now in his early 40s, Taylor has had several convictions and
custodial sentences for child sexual abuse over many years and several
admissions to psychiatric hospitals – during which he was diagnosed with a
personality disorder.

A few years ago, following a psychiatric
assessment in a medium secure hospital, he was referred to a registered
forensic unit for mentally disordered offenders, as part of an enhanced care plan.
This occurred, explains Declan Henry, a social worker who is the deputy unit
manager, largely because Taylor had been unable to cope with normal daily
living in the community; he lacked many life skills, and had abused alcohol to
the extent that his health was at serious risk.

Taylor has been on anti-libidinal medication
for many years. It was not known whether this had contributed to the fact that
he had not been convicted for the previous 10 years – though for part of that
time he was, of course, in custody. Even so, Henry and his colleagues were
aware that Taylor continued to have fantasies about offending, fantasies which
often included strangling children. Also, he admitted that during school
holidays he found the sound of children’s voices outside very unsettling.

“From the very start we found it difficult to
work with him because of his personality disorder,” says Henry. “Whenever we
tried to engage with him, to discuss anything about his past, he told us many
differing stories, often quite lurid; it was hard to avoid the conclusion that
he was an habitual liar, although whether he was always aware of this is
uncertain. He was reasonably bright, and although he had limited insight into
his offending behaviour he was clear about not wanting to return to prison. On
the other hand, he never expressed remorse about abuse he had perpetrated.”

Within the unit Taylor had his own room, with
weekly one-to-one sessions with his key worker, and regular visits from a
community psychiatric nurse, a psychiatrist, and a social worker from the local
authority. All of the unit’s staff, including Henry, monitored his behaviour,
so that although he was allowed out freely, his behaviour was checked
constantly, and, says Henry, he was very aware that his continued use of the
room depended on him maintaining acceptable forms of behaviour.

In the past, Taylor’s abuse of alcohol was
linked to his offending behaviour. So when he started to drink heavily at the
unit it concerned the staff a great deal. Henry says that he is unsure about
why the alcohol abuse has increased over the past few years. “We have tried on
numerous occasions to discuss this with him, but have never ascertained why,
nor have we been successful in persuading him to go on detox programmes,” he
says. “We’re not only worried about the link between alcohol and his offending
behaviour, but also because his health is seriously threatened.”

Henry adds that Taylor is vulnerable in other
ways. Previous assessments consistently recorded that he was sexually abused from
a very young age; he has never had any stability in his life; has little or no
ability to create or maintain meaningful relationships; and has few life
skills. He has refused help in developing life skills or becoming involved in
any group work in the unit.

Consequently he has a low quality of life,
spending almost all of his time watching television in his room. On the other
hand, this is the longest period he has ever spent in one place, and he has
gained some stability for the first time in his life.

“We have seen no significant signs of offending
behaviour, and although we’re very aware that he continues to have fantasies it
would appear that our work has been of significant help in this respect,” says
Henry.

Taylor has become quite
comfortable in the unit, he does not have to face the challenges presented by
independent living, and his benefits pay for his alcohol. But he cannot stay
long term. “Being here has reduced the risk he presents to others. He cannot
stay, yet where would we refer him to?” Henry asks.

Arguments against risk

-Taylor
has not offended for 10 years, and fears going back to prison.

-He continues to comply with the
anti-libidinal medication regime.

-It is possible that his use of
alcohol helps him to deal with his disturbing thoughts and fantasies.

-He has clearly suffered from the
effects of his own past experiences of being abused, and of a lack of parental
or other affection.

-Although he expresses no remorse,
he has limited insight into his offending behaviour, and certainly understands
that his behaviour carries consequences for him.

-There has been an almost continuous
regime of risk assessment, and it appears that the risk he poses to others is
now greatly reduced.

-A planned and supported move into
independent living might force him to confront and deal with his lack of
everyday living skills, and this in itself could help him to move on from his
obsessional thoughts, and perhaps to move away from alcohol abuse.

Arguments
for risk

-Taylor continues to show no remorse
about the many serious offences he committed.

-His personality disorder makes it
very difficult for any professionals to engage effectively with him.

-Although he is mentally disordered,
it is possible that he is aware of what behaviour he needs to express towards
professionals to obtain security and a large measure of freedom.

-He appears to gain some
satisfaction from misleading professionals by weaving elaborate fantasies about
his personal history.

-It is possible that he has learned
much over the years about how he might offend again without having to go to
prison.

-He has in the past engaged in
significant self-harming activities, has misused painkillers and other
prescription drugs, and is now abusing alcohol to the extent that his health is
at serious risk.

Case notes

Practitioner: Declan Henry

Field: Deputy unit manager in a registered
forensic unit

Location: North London

Client: Victor Taylor (not his real name) is in
his early 40s, and has had several convictions and custodial sentences for
sexual offences against children, although he has not been convicted for 10
years. He has a diagnosed personality disorder, lacks independent living skills
and had no stability for much of his life. He has self-harmed and abused
alcohol.

Case history: Taylor was referred to the unit
under an enhanced Care Programme Approach, after a psychiatric assessment in a
medium secure hospital. The unit has provided him with his own room, with a
licence agreement that his behaviour is acceptable. He has one-to-one sessions
with a key worker and is seen regularly by a community psychiatric nurse, a
psychiatrist and a social worker. He has voluntarily registered on the sex
offenders register. His alcohol abuse has become pronounced and his health is
at serious risk. His personality disorder makes it difficult to work with him,
particularly as he lies compulsively.

Dilemma: He is at increasing risk, and may be a
risk to others, but so far the multi-disciplinary team has been unable to
engage meaningfully with him.

Risk factor: Taylor is due for discharge from
his registered forensic unit, but will it be safe to release him?

Outcome: His future is uncertain.  
                     

Independent comment

This case highlights how developments in the
risk management of offenders has not been matched by resources.

To assist in risk assessment there are now
actuarial measures, based on research which 
predicts key factors of risk – most recently Matrix 2000 (Home Office,
2000). Although the information here is insufficient to apply the model, there
is sufficient to indicate that outside an appropriate environment Victor
presents a high risk of re-offending.

Currently he has no internal motivation to
participate in treatment, therefore group programmes would not be appropriate.
This is regrettable as these have become increasingly effective.

The multi-agency approach to managing sex
offenders is becoming increasingly common. Recent legislation (Criminal Justice
and Court Services Act, 2000) established Multi-Agency Public Protection Panels
(MAPPPs).

If Victor were in independent accommodation,
referral to a MAPPP to consider measures to reduce risk would seem appropriate.

A priority would be representation from a child
protection agency to consider risk to specific children. New services bringing
together criminal justice and mental health services are also in the pipeline
to assess those who have not committed recent offences but are considered a
very high risk.

However, long-term, or permanent, accommodation
for those who will remain a risk in less structured settings has not yet been
addressed. Without this we manage risk, not reduce it as effectively as we
might.

Marcus Erooga is an NSPCC area
manager (www.nspcc.org.uk) and co-editor of the Journal of Sexual Aggression,
published on behalf of the National Organisation for the Treatment of Abusers,
www.nota.co.uk