Sunday, February 28, 2010

"Chemical Castration" should be tried for some sex offenders

The BMJ 27 February has an article titled "Chemical Castration for sex offenders: Doctors should avoid becoming agents of social control".  It refers to an article on the National Probation Service site, which sets up a service for some forensic psychiatrists to advise on medical treatments for some sex offenders. The treatments are first Prozac-type antidepressants, and second, anti-testosterone drugs such as cyproterone acetate and gosrelin.

The BMA article (which is not yet on-line, and may not be for non-BMA members) is nothing if not cautious. It uses the "Chemical Castration" label, which is an emotively charged term. It says, "although ostensibly for public protection, it also carries with it a sense of symbolic retribution...straddle(s) the border between treatment and punishment".

One of the authors of the article is Don Grubin, who is named in the Probation Service article as setting up "a national advisory service for prisons and probation aimed at increasing the availability of medical treatments for sex offenders".

I personally welcome this development as a highly sensible approach, so long as it is fully audited to test its effectiveness and safety.

Anti-androgen therapy reduces the re-offending rate from 50% to 5%, which is a pretty impressive effect.

Given the huge media profile given to sex offences against children, and the understandable emotional public reaction against paedophiles, this development is many years overdue. I wrote to the Home Office about this in 2001, and they responded with the usual pathetic Government fob off. Now they have finally come round to trying it out.

I stress that this is not an official Green Party position. There is a debate to be had, because it is vital that the medical profession does not become an arm of the State, using its knowledge to control people that the State judges to be dissenters. But I really do not think that fear applies in this case.

We already routinely practice preventive social medicine in the case of psychotic patients who are sectioned and treated on grounds of "being a danger to themselves or others". A patient with hypomania may be blissfully happy with the way things are as far as they are concerned, and may not be asking for any help, but we may judge that they are a danger to others, and restrict their liberty and treat them with antipsychotics.

This is a pretty close parallel with the situation of some sex offenders. There is a spectrum of self assessment among this group, some feeling profoundly guilty about their thoughts, proclivities and actions, while others are in denial about the damage they cause to others.

It seems not unreasonable at least to offer treatment to those who ask for medical relief from their hypersexuality, which many do. There are some cases in the literature where hormonal therapy has abolished a paedophilic drive, and the patient has experienced a reversion to happy heterosexual sex with his partner.   Given that there is no evidence of the effectiveness of  the current treatment, CBT, offered to a sample of sex offenders, and given the enormous damage that sexual assaults can inflict on victims' lives, it is unreasonable to withhold hormonal therapy from sex offenders.

The forensic psychiatrists should design a plan for rolling out this treatment in a way that is carefully audited, to establish what does and does not work with what kind of offender.

I should stress that this is my personal opinion as a psychiatrist. The Green Party has not yet considered this matter.

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