Psychiatric aspects of the assessment and treatment of sex offenders

Training in general and forensic psychiatry in the assessment and treatment of sex offenders is in need of considerable improvement. Although most sex offenders are not mentally ill, many are subject to substance misuse, abnormal personality traits, personality disorder, learning disability or dysphoric mood, and in some organic factors will be involved. Comprehensive assessment of sex offenders includes a full history and mental state evaluation, obtaining a collateral history from other sources, observation, psychometric testing, and psychophysiological methods of assessment, including penile plethysmography. Trials of the use of the polygraph are also under way. The treatment of sex offenders, especially those with paraphilias, may include medication with selective serotonin reuptake inhibitors or anti-libidinal agents. Ethical considerations can be problematic, but a balance can often be found between the welfare of the offender and the safety of the public. Harvey Gordon is a consultant forensic psychiatrist employed by the South London and Maudsley NHS Trust (Bethlem Royal Hospital, Denis Hill Unit, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK) and an honorary lecturer in forensic psychiatry at the Institute of Psychiatry, London. He previously worked at Broadmoor Hospital for 17 years. He has a wide range of interests in general and forensic psychiatry. Don Grubin is Professor of Forensic Psychiatry at Newcastle University and an honorary consultant forensic psychiatrist at St Nicholas’ Hospital, Newcastle upon Tyne. He is an expert in the assessment and treatment of sex offenders in Britain, and an adviser on sex offenders to the police, Home Office and Department of Health.