Civil Commitment Laws Research Articles

Sex-Offender Commitment Law Ruled Unconstitutional

Sex-Offender Commitment Law Ruled Unconstitutional

‘The witness who saw, /he left little doubt’: a comparative consideration of expert testimony in mental disability law cases in common and civil law systems

AbstractThe question of how courts assess expert evidence—especially when mental disability is an issue—raises the corollary question of whether courts adequately evaluate the content of the expert testimony or whether judicial decision making may be influenced by teleology (‘cherry picking’ evidence), pretextuality (accepting experts who distort evidence to achieve socially desirable aims), and/or sanism (allowing prejudicial and stereotyped evidence). Such threats occur despite professional standards in forensic psychology and other mental health disciplines that require ethical expert testimony. The result is expert testimony that, in many instances, is at best incompetent and at worst biased. The paper details threats to competent expert testimony in a comparative law context—in both the common law (involuntary civil commitment laws and risk assessment criminal laws) and, more briefly, civil law. We conclude that teleology, pretextuality, and sanism have an impact upon judicial decision making in both the common law and civil law. Finally, we speculate as to whether the new United Nations Convention on the Rights of Persons with Disabilities is likely to have any impact on practices in this area. Copyright © 2009 John Wiley & Sons, Ltd.

Diagnostic and Risk Profiles of Men Detained Under Wisconsin’s Sexually Violent Person Law

Previous studies described the characteristics of individuals committed under sexual offender civil commitment laws in Arizona, Florida, and Washington. This study describes the diagnostic and risk profiles of 331 sexual offenders held under Wisconsin's sexual offender statute and compares them to the people held in those other states. Persons detained under Wisconsin's law substantially differ from those in the other states. This variability is attributed to differences in both diagnostic procedures and statutory risk thresholds. The authors believe this is the first study to directly compare diagnoses and risk measures of sex offenders referred for commitment in different states, thereby offering a more national view of who is detained under these laws.

Adult Sexual Attraction to Early-Stage Adolescents: Phallometry Doesn’t Equal Pathology

The finding of Blanchard et al. (2008) that adult self-reports of sexual preference for early-stage adolescents generally matched their phallometric responses to such adolescents does not justify the broad and startling conclusion of these researchers that ‘‘hebephilia exists as a discriminable erotic age-preference’’ so as to justify an expansion of the DSM diagnostic category of Pedophilia to include early-stage adolescents. DSM-IV-TR draws the distinction between pathological and non-pathological age-related sexual arousal at the onset of pubescence: adult arousal to prepubescents is considered pathological and adult arousal to pubescents and post-pubescents is considered non-pathological. This distinction is more than academic. It has serious, real world implications, given that, in the U.S., a diagnosis of Pedophilia can result in the diagnosed individual being subject to potential lifetime confinement pursuant to so-called ‘‘sexually violent predator’’ civil commitment laws (Zander, 2005). There are at least three major reasons why the Blanchard et al. proposal to extend the diagnostic criteria for Pedophilia to include adult sexual attraction to early-stage adolescents is a leap that is insufficiently supported by their data. First, as conceded in their article, ‘‘The main methodological limitation of the present study was the absence of models age 15–18 (midto late-adolescence) among the phallometric stimuli.’’ This means that we do not know if men who were aroused to early-stage adolescents—whom Blanchard et al. would now classify as paraphilic—might not also be equally or more aroused to midto late-stage adolescents, with respect to which they acknowledge, ‘‘Few would want to label erotic interest in late-or even mid-adolescents as psychopathology.’’ Yet, their proposal may do just that by pathologizing men attracted to early-stage adolescents as part of an overall arousal pattern to adolescents in all stages of sexual development. In other words, conspicuous by their absence are any data to refute the alternative hypothesis that sexual attraction to adolescents at all stages of sexual development is a discriminable, but not pathological, erotic preference. Second, the proposal to extend the already problematic diagnosis of Pedophilia to include early-stage adolescents would complicate the diagnosis further by exacerbating the problem of the diagnostic discriminability that Blanchard et al. aptly and punningly identify by pointing out that ‘‘[T]he onset of puberty varies from child to child and.. the boundaries of puberty are fuzzy to begin with.’’ Clinicians already wrestle with the line of demarcation between pre-pubescence and pubescence in the current diagnostic criteria, given: (1) the many definitions of pubertal onset (e.g., for girls is it menarche [mean age, 12.1 years, for African-American girls] or thelarche/pubarche [mean age, 9 years, for AfricanAmerican girls]); (2) the wide variability of individual pubertal onset age; and (3) the overall decreasing age of pubertal onset (Herman-Giddens, 2006). Imagine how much more impractical it would be to require forensic evaluators to determine the existence of Pedophilia based on the stage of adolescence of the examinee’s victim. Such determinations could literally devolve into a splitting of pubic hairs— resulting in an interrater reliability for the expanded diagnosis of Pedophilia that is even worse than is the case with the current version (Wollert, 2007). Their proposal to have diagnosticians specify the examinee’s preferred age to which he is aroused does little to solve the problem of discriminating early-stage adolescents from midto late-adolescents given the aforementioned diagnostic ambiguities resulting from variable and decreasing age of puberty. T. K. Zander (&) 10936 N. Port Washington Rd. #285, Mequon, WI 53092-5031, USA e-mail: DrTomZander@aol.com

Civil Commitment Changes Only as Good as Funding

Back to table of contents Previous article Next article Legal NewsFull AccessCivil Commitment Changes Only as Good as FundingRich DalyRich DalySearch for more papers by this authorPublished Online:6 Jun 2008https://doi.org/10.1176/pn.43.11.0011Virginia recently became the latest state to add muscle to its civil-commitment law when the legislature approved changes to it in March. But the impact of the changes, which were spurred by the April 2007 killing spree at Virginia Tech by a mentally ill student, will likely be limited by the amount of funding added to the state's mental health system.The crucial link between funding and plans to enhance treatment and access has been demonstrated repeatedly as states have moved in recent decades to strengthen or adopt civil-commitment laws, according to forensic psychiatry experts who spoke at a symposium on changes to such laws at APA's 2008 annual meeting in Washington, D.C., in May.They noted, however, that despite good intentions, changes in civil-commitment laws to get needed treatment to more seriously ill people usually have little effect on the number who receive treatment unless legislators enact funding increases to pay for the changes.“Having a wonderful law is meaningless if you don't have adequate resources available,” said Lawrence Real, M.D., medical director of Philadelphia's Belmont Center for Comprehensive Treatment.The More Things Change...Long-term research on civil-commitment laws has shown that regardless of whether legislators liberalize or tighten their statutes, the number of people treated decreases or increases for a short period before returning to the level it was before the change, he said. The reason for the limited impact of the change is because available funds limit whether the personnel or facilities are able to provide the treatment mandated by judges, said Paul Appelbaum, M.D., past chair of APA's Council on Psychiatry and Law. He is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and director of the Division of Psychiatry, Law, and Ethics at Columbia University.The number of people who are civilly committed is more a function of the knowledge of local judges about what treatment resources are available than the standards delineated in state law, he said. This goes a long way toward explaining the wide variation in commitment rates attributed to judges within the same state.“I think [inpatient civil commitment] is actually driven by the availability of psychiatric beds,” Appelbaum said.Real noted that major changes in out-patient civil-commitment laws in some states—despite concerns about their cost—have not driven any states to economic collapse, nor, however, have they resulted in a substantial influx of funding for community mental health services.Increasing Role for PsychiatristsSome states have increased funding to support expanded treatment for those with serious mental disorders under laws that allow for commitment of a wider range of people, which spotlights the importance of a stepped-up role for psychiatrists, Real said. Studies of state commitment laws show that psychiatrists' involvement in the civil-commitment process has often been minimized. Most state laws lack detailed definitions of mental illness, although commitment regulations sometimes refer to the DSM.In many states a psychiatrist provides evidence that a mental illness caused the behavior that brought the person into the civil-commitment process. However, the psychiatrist's opinion in deciding whether to place that person in treatment “has been excised from the process and is no longer relevant,” Real said.Definitions of mental illness should be relegated to psychiatrists, Real said. And to ensure that, psychiatric clinicians need to become more involved in advocating for an increased role in the formulation of civil-commitment laws.“We shouldn't wait for case law to clarify this, because we don't know where and when that case law will come from,” he said.Appelbaum pointed out that it is unlikely that legislators will be able to identify a definition of mental illness that is “encompassing but not impossibly vague.” Instead he urged a pragmatic effort by mental health advocates in each state to ensure that help is available for “each category of person when [his or her] condition requires the kind of containment and attentive care or support that a hospital setting can provide.”Research and legislative efforts in each state, he added, should aim to identify and then address the need for civil commitment to respond to mental illness, substance abuse, and mental retardation in the U.S. population. This will allow physicians and state officials to identify treatment gaps and how the state can address them through the civil-commitment process.“When we know that there is actually enough of a problem here to warrant a legislative fix we can then decide what specific remedy is most likely to be effective,” Appelbaum said. ▪ ISSUES NewArchived

Law & Psychiatry: Florida's Outpatient Commitment Law: A Lesson in Failed Reform?

An involuntary outpatient commitment law became effective in Florida in January 2005. However, only 71 orders for outpatient commitment have been issued in three years, even though during that period 41,997 adults had two or more 72-hour involuntary emergency examinations under Florida's civil commitment law. This column describes the criteria for outpatient commitment in the Florida statute and discusses possible reasons for its low rate of use, including additional statutory criteria that make filing a petition for outpatient commitment difficult, lack of community treatment resources, and lack of enforcement mechanisms.

The Effectiveness and Ethical Justification of Psychiatric Outpatient Commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.

Short‐term involuntary examination of older adults in Florida

The elder population continues to grow rapidly in many countries. Florida's elder population is growing faster than most states', with over one-quarter of the Florida population projected to be aged 65 and over by 2025. Involuntary examination (i.e. emergency commitment) under a state's civil commitment law is one means by which older adults experience assessment for acute mental health care. In Florida, the civil commitment law permits the involuntary examination of an individual for up to 72 hours to determine whether the person meets standards for involuntary treatment. From calendar year 2001 through 2005, there were 531,091 involuntary examinations in Florida for 301,886 people of all ages. Thirteen percent were 60 years and older at the time of their examination. The purpose of this paper is to describe the characteristics of older adults subject to involuntary examination and the nature of their examinations. While these data permit a number of inferences, there is an expansive area of research and policy analysis that remains untapped and would permit better understanding of how older adults experience such examinations. These research and policy issues will also be discussed.

The mind of the sexual predator

This review reports recent articles in the criminological literature that may be of help in understanding the psychodynamics of sexual predators in the hope of better defining them and preventing recidivistic behavior. Recent literature presents the motivations behind sexual offending, attempting to explain in a psychodynamic way the complex problem of the aberrant sexual drives of the sexual predator. Recent civil commitment laws and their implications are touched upon. The literature presented will enable the criminology practitioner to reach a more holistic understanding of the sexual predator and better detection of them.

The function of punishment in the “civil” commitment of sexually violent predators

Two experiments find that support for civil commitment procedures for sexually violent predators is based primarily upon the retributive rather than incapacitative goals of respondents. Two discrete samples composed of students (N = 175) and jury-eligible citizens (N = 200) completed experimental surveys assessing their support or opposition to scenarios in which a sexual predator was to be released after completing his criminal sentence. Respondents were sensitive to likelihood of recidivism only when the initial sentence was sufficiently punitive. When initial sentence was lenient, respondents strongly supported civil commitment without regard to future risk. Results are discussed in light of the U.S. Supreme Court's ruling in Kansas v. Hendricks (1997) on the constitutionality of civil commitment laws for sexually violent predators.

Civil Commitment: A Therapeutic Jurisprudence Model

Back to table of contents Previous article Next article Book ReviewFull AccessCivil Commitment: A Therapeutic Jurisprudence ModelJohn Petrila J.D., LL.M.John Petrila J.D., LL.M.Search for more papers by this authorPublished Online:1 Apr 2007https://doi.org/10.1176/ps.2007.58.4.572aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Few topics in mental health are more controversial than involuntary civil commitment. Forty years ago, most state commitment laws relied on a medical model. However, litigation arguing that such statutes were too sweeping in their reach resulted in the eventual adoption of more legalistic commitment laws. As community care lagged behind need, civil commitment statutes were decried as overly legalistic, and states again began adopting more medically oriented commitment criteria, extending the reach of commitment laws to outpatient settings. As a result, the debate regarding civil commitment has reached a conceptual and intellectual impasse, with proponents of more medical or more legalistic approaches rehearsing arguments that vary little from those first raised 40 years ago. Bruce Winick, in his excellent new book Civil Commitment , offers a potential path away from this impasse. Winick, a professor at the University of Miami's School of Law, is one of the nation's leading mental health law scholars. With David Wexler, he is the cofounder of "therapeutic jurisprudence," which Winick defines as "an interdisciplinary approach to legal scholarship and law reform that sees the law itself as a therapeutic agent. … Therapeutic jurisprudence calls for the study of [the law's impact] with the tools of the behavioral sciences so that we can better understand law and how it applies and can reshape it to minimize its anti-therapeutic effects and maximize its therapeutic potential."Therapeutic jurisprudence has gained increasing influence over the last decade. For example, it is the philosophic foundation for the hundreds of drug courts and mental health courts that have emerged since the early 1990s. In this book, Winick uses therapeutic jurisprudence in a generally successful effort to determine which aspects of civil commitment law and practice have therapeutic or antitherapeutic consequences. He does this in 11 concise but thorough chapters by applying social sciences research on coercion, capacity, and choice to each element of civil commitment law. The result is a balanced, nonideological reframing of the topic. For example, Winick is respectful of individual liberty, arguing that research shows that treatment adherence is most likely when the individual's participation is voluntary and informed. He also asserts that the legal process required before a person is committed should be honored, because if a person is given a voice, "patients will respond more effectively to hospitalization."At the same time, he proposes relaxing legal standards when their rigid application might impede access to care. For example, he believes that individuals who voluntarily seek care should be considered competent in the absence of very compelling evidence to the contrary. In his view, to apply a competency standard too rigidly could result in denial of care or in civil commitment rather than voluntary admission to care, with antitherapeutic consequences. Anyone involved with civil commitment will find this book useful and thought provoking, particularly given continuing controversy regarding civil commitment and the use of coercion. It is becoming increasingly apparent that individuals in community care are subject to myriad types of leverage, including coercion, that are all designed to gain treatment adherence ( 1 ). Winick insists that one of the most important questions we can ask about legal rules and legal processes is whether they have a therapeutic or antitherapeutic impact. In doing so, he illustrates how the debate about civil commitment and coercion might be reframed in a way that permits proponents of both the legalistic and the medical models of commitment to begin talking to each other rather than past each other. Dr. Petrila is affiliated with the Florida Mental Health Institute, University of South Florida, Tampa.Reference1. Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56:37–44, 2005Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 58Issue 4 April, 2007Pages 572-573PSYCHIATRIC SERVICES April 2007 Volume 58 Number 4 Metrics PDF download History Published online 1 April 2007 Published in print 1 April 2007

Civil Commitment: A Therapeutic Jurisprudence Model

Back to table of contents Previous article Next article Book ReviewFull AccessCivil Commitment: A Therapeutic Jurisprudence ModelJohn Petrila J.D., LL.M.John Petrila J.D., LL.M.Search for more papers by this authorPublished Online:1 Apr 2007https://doi.org/10.1176/ps.2007.58.4.572aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Few topics in mental health are more controversial than involuntary civil commitment. Forty years ago, most state commitment laws relied on a medical model. However, litigation arguing that such statutes were too sweeping in their reach resulted in the eventual adoption of more legalistic commitment laws. As community care lagged behind need, civil commitment statutes were decried as overly legalistic, and states again began adopting more medically oriented commitment criteria, extending the reach of commitment laws to outpatient settings. As a result, the debate regarding civil commitment has reached a conceptual and intellectual impasse, with proponents of more medical or more legalistic approaches rehearsing arguments that vary little from those first raised 40 years ago. Bruce Winick, in his excellent new book Civil Commitment , offers a potential path away from this impasse. Winick, a professor at the University of Miami's School of Law, is one of the nation's leading mental health law scholars. With David Wexler, he is the cofounder of "therapeutic jurisprudence," which Winick defines as "an interdisciplinary approach to legal scholarship and law reform that sees the law itself as a therapeutic agent. … Therapeutic jurisprudence calls for the study of [the law's impact] with the tools of the behavioral sciences so that we can better understand law and how it applies and can reshape it to minimize its anti-therapeutic effects and maximize its therapeutic potential."Therapeutic jurisprudence has gained increasing influence over the last decade. For example, it is the philosophic foundation for the hundreds of drug courts and mental health courts that have emerged since the early 1990s. In this book, Winick uses therapeutic jurisprudence in a generally successful effort to determine which aspects of civil commitment law and practice have therapeutic or antitherapeutic consequences. He does this in 11 concise but thorough chapters by applying social sciences research on coercion, capacity, and choice to each element of civil commitment law. The result is a balanced, nonideological reframing of the topic. For example, Winick is respectful of individual liberty, arguing that research shows that treatment adherence is most likely when the individual's participation is voluntary and informed. He also asserts that the legal process required before a person is committed should be honored, because if a person is given a voice, "patients will respond more effectively to hospitalization."At the same time, he proposes relaxing legal standards when their rigid application might impede access to care. For example, he believes that individuals who voluntarily seek care should be considered competent in the absence of very compelling evidence to the contrary. In his view, to apply a competency standard too rigidly could result in denial of care or in civil commitment rather than voluntary admission to care, with antitherapeutic consequences. Anyone involved with civil commitment will find this book useful and thought provoking, particularly given continuing controversy regarding civil commitment and the use of coercion. It is becoming increasingly apparent that individuals in community care are subject to myriad types of leverage, including coercion, that are all designed to gain treatment adherence ( 1 ). Winick insists that one of the most important questions we can ask about legal rules and legal processes is whether they have a therapeutic or antitherapeutic impact. In doing so, he illustrates how the debate about civil commitment and coercion might be reframed in a way that permits proponents of both the legalistic and the medical models of commitment to begin talking to each other rather than past each other. Dr. Petrila is affiliated with the Florida Mental Health Institute, University of South Florida, Tampa.Reference1. Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatric Services 56:37–44, 2005Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 58Issue 4 April, 2007Pages 572-573PSYCHIATRIC SERVICES April 2007 Volume 58 Number 4 Metrics PDF download History Published online 1 April 2007 Published in print 1 April 2007

The application of civil commitment law and practices to a case of delusional disorder: a cross‐national comparison of legal approaches in the United States and the United Kingdom

Legal approaches to civil commitment in the United States and the United Kingdom are compared. A concise overview of the historical evolution of civil commitment in both countries precedes a discussion of the present scheme of commitment standards in each system. These current standards in U.S. and U.K. jurisdictions are then applied to a hypothetical case of delusional disorder. A discussion of the constructive use of civil commitment in patients with delusional disorder who may be dangerous focuses on its value as a preventive measure against potential harm to self or others, as well as the pros and cons of coercive assessment and treatment. Despite the many differences in approach to commitment, the authors concur that in both countries the patient with delusional disorder was committable before the commission of a serious criminal offense.

Clinical and legal characteristics of inmates with bipolar disorder

Individuals with bipolar disorder are at an increased risk of criminal arrest compared with those in the population at large. The combination of manic symptoms and substance abuse seem to be the primary illness factors for this increased risk, and the public mental health system has faced challenges in treating these patients successfully in community settings. To decrease the risk for arrest in bipolar patients, clinicians can screen and refer patients for substance use disorders, stabilize mania in hospital settings, and take measures to improve outpatient adherence in the postmanic hospitalization period. Psychiatric advance directives, new developments in civil commitment law, and mental health courts are legal mechanisms that may be critical in preventing the criminalization of those with bipolar disorder.

Preventive Detention Versus Civil Commitment: Alternative Policies for Public Protection in New Zealand and California

There has been a resurgence in the use of indefinite civil commitment of dangerous sexual offenders in the United States since the early 1990s. This current generation of civil commitment laws differs from previous statutory schemes in the underlying approach to dangerousness and the conditions under which they can be applied. As implemented in California, the law results in the post-sentence detention of approximately 1% of the registered sexual offenders released from prison since the law came into effect in 1996, representing those seen as most at risk for sexual recidivism. New Zealand has taken a different approach to the indefinite detention of dangerous sexual offenders through the use of preventive detention sentencing. In recent years the relevant New Zealand statutes have broadened their criteria to allow application to a wider range of offenders. While both approaches appear to identify a similar group of high risk offenders, preventive detention appears less legally ambiguous, more clinically practical, and a better allocation of resources.

Sexually Violent Predator Evaluations: Empirical Evidence, Strategies for Professionals, and Research Directions.

Several states have passed civil commitment laws that allow the precautionary detention of sex offenders who have completed their criminal sentences. Over 2,500 sex offenders have been committed across states with such statutes and several thousand more sex offenders have been evaluated. Most statutes call for an evaluation of risk by a mental health professional and, although each state statute is worded differently, three main elements common to sexually violent predator evaluations are used to guide evaluators: mental abnormality, volitional capacity, and likelihood of future sexual violence. The current article presents empirical evidence for the main tenants of these forensic evaluations, provides recommendations for evaluators in light of current limitations of evidence, and offers suggestions for future research in this area of forensic assessment.

Sexually Violent Predators and Civil Commitment Laws

ABSTRACT This article analyzes the civil commitment models for treating sexually violent predators (SVPs) and analyzes recent civil commitment laws. SVPs are commonly defined as sex offenders who are particularly predatory and repetitive in their sexually violent behavior. Data from policy literature, a survey to all states, and a review of law review Websites identify 16 states that have civil commitment statutes to address the problem and treatment of SVPs, four states that are in the process of passing such laws, six states that failed to enact proposed statutes, six states that lack SVP legislation, and 18 states that do not have relevant data available. The majority of such laws have created a false sense of safety because they address only convicted sex offenders. New approaches to the civil commitment of sexually violent predators have created multifaceted demands, controversy, ethical dilemmas, and learning opportunities. It is advised that research should be focused on the parameters of sexually violent behaviors, program flexibility, and treatment effectiveness.

The hidden prejudice: mental disability on trial

Setting the Stage - Why Mental Disability is on Trial On Sanism On Pretextuality Involuntary Civil Commitment Law The Right to Treatment The Right to Refuse Treatment The Right to Sexual Interaction The Americans with Disabilities Act Competence to Plead Guilty/Competence to Waive Counsel The Insanity Defence The Federal Sentencing Guidelines Therapeutic Jurisprudence Unpacking Mental Disability Law.

Improving police response to mentally ill people.

Improving police response to mentally ill people.

Sex offender commitments in Minnesota: a descriptive study of second generation commitments.

Civil commitment laws intended to prevent sexual violence are being considered and enacted by many state legislatures. In their use of "preventive detention" to lock up the "most dangerous," the laws are highly controversial legally and morally. As well, critics raise questions about the extent to which the laws advance their stated goals. Considering the growing expense of these programs, evaluation efforts based on an empirical foundation are imperative. This study collected data on all 116 men committed under Minnesota's program during the period 1975-1996. The authors report descriptive summary data on admission rates and population trends, demographic characteristics of detainees and victims, pre-commitment criminal and mental health histories, and current status of detainees. The article also compares the committed group with sex offenders in the state's correctional system. The article describes the history and functioning of sex offender commitment programs, and draws implications for policy-makers from the data presented.