Themes and risk of sexual violence among the mentally ill: implications for understanding and treatment

Abstract

This study examined the files of 11 men from a regional forensic service who committed acts of sexual violence in the context of a mental disorder. The aim was to identify what factors other than a mental disorder may be relevant when considering acts of sexual violence by the mentally ill and what treatment implications this might raise. Several men experienced troubled childhoods, involving abuse in the home and outside and adulthoods were marked by employment difficulties, psychiatric morbidity and criminality. Static-99 found most men presented a medium-high or higher risk of re-offending and risk was mostly linked to sexual deviance and range of victims. Thematic analysis suggested sexual violence was primarily motivated by factors such as anger/violence; psychotic drive; sexual disinhibition and paedophilia. However, medication was the primary treatment intervention, with no treatments aimed at addressing other motivational or risk factors. Although men with a mental illness exhibit similar psychiatric features, this study found they commit sexual violence for a variety of reasons. However, whilst anti-psychotic medication is an important treatment, there is a need to consider others if the nature and level of their future risk is to be effectively managed.

Keywords:

• sexual offending
• mental illness
• risk assessment
• individual therapy

Acknowledgements

The authors are grateful to Drs McKenna, Crispin, Shaw and Plunkett from Guild Lodge medium secure unit near Preston, for allowing us access to their patients' files. We also would like to thank the reviewers of this journal for their helpful comments on an earlier draft of this paper. Finally, the first author wishes to thank Dr David Holmes, from the Manchester Metropolitan University, for supervising the original version of this study.