A person is considered to be a sexual offender or a sexual abuser if he has committed a sexual crime or a sex crime. In most countries, sexual crime varies by either legal jurisdiction or even by the diversity of the cultures. Most sexual offenders are usually not mentally ill or disturbed but most of them are usually subjected to substance abuse, personality disorders, personality traits which are abnormal and other learning disabilities. The comprehensive assessments of these sexual offenders usually include an evaluation of the mental state of a person and also obtaining the collateral history by either observation, testing or even penile plethysmography. The treatment of the mentally disordered sex offenders like for example those with paraphilia may have to be medicated with anti-libidinal agents of which in most cases is considered to be problematic but it helps bring a balance between the offender’s welfare and the public’s safety.
If a person is convicted of a sex crime and suffers from a mental disorder, he should be seriously be examined by an experienced psychiatrist or a police surgeon. Local arrangements should then be made to ensure that mental health services are made available to the prisoner and also the access to an experienced psychiatrist. In the assessment of sex offenders, a comprehensive mental state evaluation should be carried out and also a full history should be made available. If a mental disorder is diagnosed, its direct relationship with the sexual offending, or any other abnormal behavior should be evaluated since all the information on record is useful in determining the onset of the mental disorder and the sexual offending. Some behaviors should be noted like the learning disability, substance abuse and misuse, any conduct disorder, antisocial personality disorder, elements of organicity, etc.
A psychosexual history of sexual behavior and sexual fantasy should also be carried out on the offender however; self-report is in most cases not reliable. Hyper sexuality like masturbation and the incidence of a person having many sexual partners should be detected and also rumination or sexual preoccupation like frequent sexual urges and sexual fantasies which may indicate that the offender may be suffering from paraphilia. When one is diagnosed with paraphilia, his intensity of the sexual fantasies should be keenly assessed and in the case of a mental illness or disorder, the evaluation should be used to determine the deviant fantasies.
Penile plethysmography is a means of determining sexual arousal of the offender by measuring the volume of the penile circumference in response to auditory cues and visual cues. This technique has been used largely to secure prisons and hospitals in the treatments of sex offenders. Blackburn (1996) argued that penile plethysmography should be made available for the assessment and the treatment patients in the medium secure units and in the community. Other studies have also shown that there is the risk of sex offense recidivism which is associated with the plethysmographic evidence of pedophilic stimuli response and also the response to non-sexual violence. This penile plethysmography is considered to be intrusive and in most cases it ends up showing pornographic material to the offenders which makes people to want to fake non arousal which alters the final results of the test.
Abel et al. (1994) came up with a method which was meant to assess sexual offenders which consisted of a questionnaire of sexual thoughts, behavior, fantasies, and assessment of the gaze times at slides which was computerized. This method was very useful to offenders who faked to be mentally ill and child molesters. These slides were made of scenes which suggested paraphilia, adult males and females and also teenagers.
Polygraphy on the other hand unlike penile plethysmography is used to detect deception in an offender. It is based on the responses of the nervous system which are associated with anxiety of depression. The assessment of risk that the sex offenders pose whether they are mentally disordered or healthy requires a very good of the many dynamic factors and the assessment methods use.
The factors that are associated with the increasing rates of mentally disordered sex offending include the following; the presence of sexual fantasies, a previous criminal record or history, being a victim of severe and prolonged sexual abuse during childhood, the offender having committed several sex crimes, cognitive distortment, pedophilic pornography, the presence of mental disorders which are comorbid, pathological changes in the temporal lobe, alcohol and substance abuse, learning disability, offenders with hypomania which may show sexual dis-inhibition and also others with schizophrenia which may directly link the sex crime and the psychosis (Lilienfeld, 1998).
When a person who is mentally disordered arrested and charged or goes into a criminal justice system, the prisoner in most cases is unlikely to be entirely transferred to a mental health system where he /she becomes severely disordered before his trial and is normally treated in the hospital ward or treated in the jail and if the condition worsens and the jail facilities become incapable of treating him/her, then the prisoner gets transferred to a mental health hospital (Blackburn, 1996) .The numbers of people with mental disorders are highly increasing in the criminal justice systems. They have the difficulty of accessing mental health treatment. Treatment programs are used to utilize the anti-libidal medication to improve the survival rates of the offenders. These utilized treatments are geared towards the needs and the capabilities of the offenders (Marshal et al., 1990).
Adequate treatment for the mentally disordered sex offenders may not be sufficient enough in reducing further risk of sexual offending. However, in most of these cases, most of the abnormal sexual fantasy in the patients may be independent of psychosis and may require further additional treatment. In the recent years, the growth in cognitive-behavioral treatments of the mentally disordered sex offenders is drastically increasing. These behavioral controls enable the offender to avoid situations which can make him/her to reoffend (Marshal et al, 1990). Cognitive-behavioral methods like covert sensitization and olfactory aversion have been proven to reduce deviant arousal but in real sense they do not provide a cure though many offenders usually practice the skills that they acquired and learned.
Psychiatrists may be involved in cognitive-behavioral programs in which they make good contribution in other treatment areas like surgical castration which is in a form of punishment but in the recent years, it’s not commonly used hormonal treatment where there is the use of oestrogens to help reduce sexual drive, psychotropic medication and dynamic psychotherapy.
There is only a small number of sex offenders are mentally ill that is why it is highly recommended that a psychiatrists help is needed to assist in this case since most of these offenders usually suffer from disorders and abnormal personal traits while others have biological factors which in most cases lead them to commit these sex crimes (Blackburn, 1996). The creation of a treatment program for mentally disordered sex offenders is a task that is very difficult and it demands the cooperation of knowledgeable professionals and the acceptance of the mental health treatment and criminal justice system tenets. As the mentally disordered sex offenders are treated in the society, there is the hope that the sexual crimes in the future will be minimized because these offenders only need to be assisted and most of them are most willing to change.