Sexual offenders with mental health problems: epidemiology, assessment and treatment

Authored by: Madelaine Lockmuller , Anthony Beech , Dawn Fisher

Handbook of Forensic Mental Health

Print publication date:  March  2008
Online publication date:  August  2012

Print ISBN: 9781843922629
eBook ISBN: 9780203118276
Adobe ISBN: 9781136308802


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The debate regarding the causal role of mental illness in sexual offending is represented, on the one hand, by the view that individuals who have a mental illness commit sexual offences because of factors specific to acute illness. For example, Jones et al. (1992) describe how psychosis may play a causative role in offending through direct experiences such as command hallucinations or sexual delusions and suggest that this type of offender is not at risk of offending when not acutely unwell. Risk reduction could, therefore, be achieved by treating the symptoms of psychosis directly. The opposing view is that the motivation to offend is related to factors other than acute psychosis and that the risk of the individual offending is roughly the same whether they are well or unwell; a number of studies conclude that mental illness/psychosis alone is not sufficient to explain the mechanism by which most mentally ill sexual offenders offend (Phillips et al. 1999; Baker and White 2002). We would broadly ascribe to the latter view and suggest that treating the symptoms of psychosis alone may not be enough to reduce the risk of offending (Lockmuller et al. in preparation) as there is, in fact, limited evidence for a direct link between command hallucinations/sexual delusions and sexual offending; Taylor and Smith (1999) found that 22 per cent of a sample of 80 men who were experiencing psychotic symptoms at the time of their index sexual offence had apparently responded to directly related symptoms.

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