NH- Predator law faces big tests (Civil Commitment law)

Unfortunately the media is using the wrong terms here, it is important to distinguish between "Prison and Civil Commitment." Compounding the problem is that New Hamshire civil commitment program is "Detaining" sex offenders in the state's "Secure Psychiatric Unit / Residential Treatment Unit" which happens to be in the State Prison at Concord.

6-7-2009 New Hampshire:

With the state's first sexually violent predator now confined, perhaps indefinitely, the state's new sexual predator law faces its biggest tests: How rigorous and effective will the state's treatment be, and will William Ploof, 49, have a fair chance of eventually earning his freedom?

To do so, he must persuade a judge that through treatment he is unlikely to commit more acts of sexual violence.

State officials have developed a five-page policy laying out the kinds of treatment sexual predators like Ploof will receive, and the director of the Department of Corrections' forensics and medical services division, Robert MacLeod, says he is committed to providing individualized, intense treatment.

"Any of the residents coming in here under (the new sexual predator law), I can assure you, will be treated appropriately according to medical models," MacLeod said. "It will not be punishment. It will be treatment. And as we move this program along, we hope that it will be successful for individuals."

Leo Keating, who oversees psychiatric care for sex offenders and others committed to the state's secure psychiatric unit, added to that: "If we are successful, the world will be a safer place."

But so far, New Hampshire's plan is untested because Ploof is the first offender to be committed under the new law, which took effect in 2007. The law allows convicted sex offenders to be held past their prison sentences for treatment if a jury believes they have a mental abnormality that makes them likely to re-offend.

In addition to New Hampshire's absence of a treatment record, there's no consensus nationwide on what treatment works best. In addition, there have been vastly mixed results among treatment facilities in the nearly 20 states with sexually violent predator laws.

According to a 2007 study by Adam Deming, director of Indiana's sex offender management and monitoring program, only eight of 17 states surveyed had released an offender because they'd completed treatment and/or earned a recommended release from treatment staff. (Others were let out on legal or technical grounds.) And those eight states released few: Of the more than 3,600 civilly committed sexual predators nationwide in 2007, only 57 had been released, Deming reported in the fall issue of The Journal of Psychiatry and Law.

That concerns defense attorneys and civil rights activists.

"There are a lot of fancy words in (New Hampshire's treatment plan)," said attorney Michael Iacopino, past president of the New Hampshire Association of Criminal Defense Lawyers, "and it looks like it will involve a lot of people's time and a lot of money. A whole lot of money."

Anatomy of treatment

The state's treatment policy, written by mental health, prison and legal officials from various state agencies, calls for an exhaustive intake examination as well as weekly, monthly and annual progress reviews.

MacLeod and Keating said the treatment provided to civilly committed offenders will differ greatly from the sex offender program offered at the prison. Whereas that program is the same for all offenders, treatment will be tailored to an offender's particular needs while confined under the new law.

"It's important that the treatment on day one is not set in stone," Keating said. "It really has to be developed around the population that we have. At this point, we have one convicted offender. If we had 25, there would be some differences in the way we'd interact with the population."

MacLeod put it this way: "A physician will develop a plan, and it will twist and turn in terms of someone's presentation as we work with them."

Treatment will be provided by medically trained staff inside the secure psychiatric unit, which sits inside the prison but is not run by the prison, MacLeod said. Staff will use a variety of industry-standard tests to monitor an offender's risk and arousal triggers, MacLeod said.

Tools will include a polygraph and a device that connects to an offender's genitals and measures his arousal to appropriate and deviant images. There will be individual therapy, but the plan calls for a heavy emphasis on group therapy and peer confrontation, something that will be difficult until there are more than one or a few sex offenders committed.

MacLeod and Keating said they will work around that by including Ploof and other sexually violent predators in other groups within the unit. The unit also houses residents suffering from mental illness or people found not guilty by reason of insanity. Often, Keating said, they share a need for help with anger management, emotion control and checking distorted thinking.

The treatment will be overseen by Keating's employer, MHM Services, a private company that also provides treatment for the male sex offenders in Massachusetts who've been civilly committed for treatment.

What does it cost?

MacLeod and Keating said they looked at the Massachusetts program, which developed from the state law passed in 1999, for an example.

According to a 2007 New York Times survey of treatment programs throughout the country, Massachusetts was spending $30.7 million to confine and treat a little more than 105 sexually violent predators between the ages of 20 and 70.

The cost broke down to about $48,300 per prisoner. Only four offenders had been fully discharged, without ongoing supervision, when the story ran in March 2007.

The Times found that the cost of treatment programs varies widely among states, from $32,000 a year for each offender in Texas, which, unlike other states, treats them in the community, to $180,000 a year for each offender in Pennsylvania, where they are confined.

The price tag for New Hampshire isn't available yet, but it's bound to be more than the nearly $30,000 it costs the state a year to incarcerate a prisoner, experts said.

"The interesting thing will be, can the state maintain the program?" Iacopino said. "And if they don't, and anyone who's deemed a sexually violent predator is supposed to receive treatment and doesn't, they would have a valid right to sue the state of New Hampshire."

In 2007, the New York Times reported on a Florida facility's failure to adequately treat sexually violent predators confined to its care. The private contractor providing the care blamed the state, saying it had not budgeted enough money for proper treatment

The men in the Florida facility were having sex with one another or staff, assaulting staff and hiding knives in their rooms, the Times reported. One escaped on a helicopter that set down within the facility. In 2005, 35 percent of the offenders were not attending therapy, and only one of the hundreds committed had earned a recommendation for release, the Times said.

Iacopino and others said the state has to be ready to adequately pay for the law it passed.

"If our intention is to lock these people up for the rest of their lives, and that does appear to be some peoples' intentions, it's going to be a cost at least as much as incarcerating them, and in some states, twice as much," said public defender Mark Larsen, who is supervising the defense of sex offenders targeted for confinement and treatment under the new law.

Future cases

In August, a second sex offender, Thomas Hurley, will go on trial in Hillsborough County to face civil commitment. And state officials have been asked to assess another sex offender from Keene to see if he meets the definition of sexually violent predator.

It's those potentially high costs that concern Iacopino.

"I'm afraid of a future where we have these nice rules but where (sexually violent predators) will end up being warehoused," he said.

In New Hampshire, sexual predators such as Ploof are committed for up to five years at a time if a jury believes they suffer from a mental abnormality that makes them likely to commit more acts of sexual violence.

That's what a Hillsborough County Superior Court jury concluded about Ploof, 49, last week. He has served a 10-year sentence for sexually assaulting a boy twice in the 1990s and admitted to prison officials that he had 20 to 50 other victims, children included.

A state mental health expert testified that he believes Ploof continues to suffer from pedophilia in a way that makes him unable to control himself and that he's likely to commit more sexually violent acts.

Ploof or his treatment providers can petition the court anytime between now and five years for his early release if they believe treatment has made him safe to be in the community. If the petition comes from the provider, a court must hold a hearing on the request. If it comes from Ploof, it can hold the hearing or dismiss the request outright.

At the end of five years, Ploof will be freed unless prosecutors can persuade the court that he still suffers from a mental abnormality that makes him dangerous. If the court agrees, Ploof will be recommitted for up to five more years, a process that can be repeated indefinitely.

Ploof's public defenders will monitor his treatment and progress as much as they are able, Larsen said. He'd like Ploof and other offenders to have more rights before the court to request their early release and clearer language in the law allowing offenders' lawyers to intervene in their care if it is not adequate.

Larsen hesitated to guess what Ploof's experience might be like. He said he believes the state will find it challenging to create an effective program immediately - especially since there is such disagreement over what treatment is best and whether treatment helps.

"Nationwide, either they're not treating them or they don't have any effective treatment because people aren't getting out," Larsen said. "The jury is still out on what is effective treatment. It's not one of those areas where the answers are absolutely clear." ..Source.. by ANNMARIE TIMMINS, Monitor staff