Psychiatric Assessments

Co–occurring mental health difficulties are relatively common among criminal and juvenile justice–involved individuals, including those who have committed sex offenses. Therefore, specialized psychiatric assessments are an important component of a comprehensive assessment process. Indeed, adult and juvenile sex offenders should, at the very least, receive mental health screenings as they enter the criminal or juvenile justice systems. When these screenings identify potential concerns, prompt referrals for further evaluation should be made to qualified mental health professionals.

Ultimately, psychiatric assessments may lead to recommendations for adjunctive services such as psychotropic medication, individual therapy, and/or other interventions. Depending upon the nature and severity of these psychiatric concerns, recommended interventions may need to be initiated prior to or concurrent with offense–specific interventions. If left unaddressed, some mental health symptoms or disorders (e.g., attention–deficit/hyperactivity disorder or impulse control, psychotic, mood, or anxiety–related disorders) may interfere significantly with an individual’s ability to engage in or benefit fully from interventions or to maintain stability in the community.

Thorough psychiatric assessments can also be useful for identifying potential links between certain disorders (i.e., paraphilias) and the onset or maintenance of sexually problematic behaviors, particularly for adult sex offenders. In those instances, an important goal of the assessment process is to identify an appropriate course of intervention, which may include the use of pharmacological agents such as antiandrogens or selective serotonin reuptake inhibitors (SSRIs) (Abel et al., 1987; Abel et al., 1989; Berlin, 2000; Kafka, 2001; Kafka and Hennen, 2002; Prentky, 1997). Whether to manage mood disorders, mitigate psychotic symptoms, or reduce sexual urges or compulsions, these medications must be considered as an adjunct to a broader strategy of sex offender management (Berlin, 2000; Bradford & Greenberg, 1998; Grubin, 2000; Laws & O’Donohue, 1997; Prentky, 1997). (For additional information about these medications, see the Treatment section of this protocol.)

Finally, to ensure that the psychiatric needs of adult and juvenile sex offenders are understood and taken into account by all stakeholders who are responsible for management efforts, key information from these assessments must be shared, and their specific relevance to treatment and supervision interventions must be discussed. As always, when assessment information will be shared across agencies or disciplines, health/medical information–sharing policies must be established and/or reviewed, and relevant releases signed.

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