James Kissinger MA LLP MDOC Sexual Offender Services Manager
Corey Spickler MA LLP MDOC Sexual Offenders Services Program Manager
Dr. Toni Crocilla, PsyD LP CSOTP – Executive Director Wise Mind PLLC
Criminal behavior is often confused or conflated with serious mental illness (SMI) by professionals working within our judicial system, law enforcement agencies and correctional facilities. What is less known about individuals with a history of engaging in sexually abusive behaviors is that MI is not considered a static or dynamic risk factor associated with risk for future criminal sexual behavior (Mann, 2010).
Treatment providers must learn to distinguish between those who present risk to public safety as a high risk sexual offender (based on static, stable and acute risk) from those with SMI whose behaviors are simply the result of the untreated symptoms of psychiatric disorders (Harris, 2010). Andrew Harris notes, “Some sexual offenses such as lewd and lascivious behavior and inappropriate touching, are really manifestations of untreated psychiatric illness and are manageable with medications, more standard mental health system interventions, such as outpatient commitment, should be considered instead of labeling such behaviors as sexual offending and criminalizing those involved.”
Across multiple studies, mental illness is associated with negative treatment outcomes or poor responses to traditional sexual offender specific treatment models. This makes intuitive sense for most therapists. Individuals struggling with major depression or a formal thought disorder are much less likely to actively engage in a process-oriented group therapy session. Without active engagement in group therapy, treatment gains are significantly minimized. Furthermore, individuals with a history of engaging in sexually abusive behaviors and mental illness struggle with being “dually stigmatized.” These leads individuals to being under served by the mental health system. For those individuals who cannot form those group or community connections research, has repeatedly shown social rejection and isolation as risk factors that have strong correlates with sexual recidivism.
In comes the Good Lives Model (GLM): a strengths-based approach offering of sexual offender treatment targeting client strengths and goals for the future rather than focusing on what they did, or what society fears they may do again. While we know that responsivity concerns (e.g., cognitive, personality, mental health issues, etc.) can significantly impact successful treatment with those clients with a history so SMI, GLM seeks to reduce barriers to treatment, where present, and meet the client where they are. According to goodlivesmodel.com, “GLM is a strengths-based approach to offender rehabilitation and is therefore premised on the idea that we need to build capabilities and strengths in people, to reduce their risk of reoffending.” They go on to state, “According to the GLM, people offend because they are attempting to secure some kind of valued outcome in their life. As such, offending is essentially the product of a desire for something that is inherently human and normal.” For many of our clients offending may be in part a product of SMI for those with that history present.
The Good Lives Model (GLM), while in its infancy, does show promise for its empathic and positive, goal- directed approach to recovery. The model does not yet have empirical validation for reduction in recidivism; however, we do know that the GLM has been shown to reduce dropout rates (Willis et al., 2012) and that dropout rates verses successful completion of therapy is tied to recidivism rates of sex offenders (Hanson & Bussiere, 1998; California Department of Corrections and Rehabilitation, 2007). It appears to be perceived in a more positive light by offenders and therapists than relapse prevention treatment approaches. For individuals with the dual stigma of sexual offender and mentally ill, the GLM approach is of particular importance to improve treatment engagement.
Individuals who engaged in sexually abusive behaviors often do suffer from mental illness. As Dr. Brad Booth summarizes in his article, Mental Illness and Sexual Offending, “Sexual offenders suffering from mental disorders are common, and require appropriate diagnosis and treatment of their mental disorders to optimize treatment outcomes.” (Booth, 2014) Community mental health organizations, probation and parole agents, our judicial system and our specialized sexual offender assessment and treatment providers must work together to ensure the safety of our communities as well as the holistic treatment of those under our care. Communication and collaboration amongst treatment providers is not only best practice, but also necessary.
A brief informal survey of local Michigan providers who have worked or currently work in a variety of CMH capacities (i.e., supervisors, case managers, therapists) was conducted by the authors resulting in the identification of some reasons why it can be difficult to collaborate with specialized providers in service of their consumers with SMI and sexual self-regulation difficulties. Some of their comments refer to systemic issues, while others point to a lack of training opportunities. What was common among them, though, was a genuine interest to collaborate for more effective care. A few of the most noteworthy and paraphrased responses are include here:
- High caseloads allowing little time for meeting frequently enough or spending enough time in each session to address more difficult treatment targets.
- Extensive paperwork requirements that must be prioritized even over client care at times.
- There is an evident gap in training and comfort to ask about and support consumers on sexual self-regulation issues and general sexual behaviors among the SMI populations served in CMH settings.
- These clients often have Medicaid funding or no insurance and specialized providers are less likely to accept this coverage or do reduced fee sessions.
- CMH can be limited in their collaboration to only agencies with whom they are contracted.
- Frequent budget cuts impact caseload sizes, burn out, and time to attend to all treatment targets.
As can be seen here, ongoing discourse is required among multiple types of providers and organizations to continue working together to reduce the gaps in research, treatment, funding, and training to more adequately address this population in more meaningful ways that ensure treatment compliance, success, offender well-being, and community safety.
References
Booth, B. &. (2014). Mental Illness and Sexual Offending. Psychiatric Clinics of North America, 183-194.
Good Lives Model. (2020) General Ideas. https://www.goodlivesmodel.com/information.shtml#General
Hanson, R. K., & Bussière, M. T. (1998). Predicting relapse: A meta-analysis of sexual offender recidivism studies. Journal of Consulting and Clinical Psychology, 66, 348–362.
Harris, A. (2010). Sex Offending and Serious Directions for Policy and Research. Criminal Justice and Behavior, 596-612.
Mann, R. H. (2010). Assessing Risk for Sexual Recidivism: Some Proposals on the Nature of Psychologically Meaningful Risk Factors. Sexual Abuse: A Journal of Research and Treatment, 191 – 217.
Oliver, M., Stockdale, K., Wormth, J. (2011). A Meta- Analysis of Predictors of Offender Treatment Attrition and Its Relationship to Recidivism. Journal of Consulting and Clinical Psychology, 79.
Willis, G., Yates, P., & Gannon, T. (2012). How to integrate the good gives model into treatment programs for sexual offending: An introduction and overview. Sexual Abuse 25,2. doi.org/10.1177/1079063212452618