Sex offender outpatient program a small cost in big system

1-17-2015 Nebraska:

For 23 years Caesar lived in an institution -- either prison or treatment center -- after being convicted of raping a woman in her apartment.

His options were limited. Someone else cooked his meals, told him when to get up, when to eat, when he could have visitors. He served his time.

And for the past year, he’s lived in Lincoln -- first in a halfway house, now in his own apartment. It's been a transition.

He’s had to learn how to cook dinner, how to shop for food, how to buy his own clothes and wash them. He’s had to learn to manage in a society that moved from typewriters to computers while he was behind bars. It hasn’t been easy for Caesar, whose real name isn't being used here.

He’s been fired from two jobs after others discovered he was on the sex offender list. He was hit by a car while riding his bike. He doesn’t always have money to purchase minutes for his cellphone -- the phone on which he's still trying to figure out how to set up voicemail.

But Caesar isn't whining. This is his reality as an ex-con with the sex offender label.

And he wants people to understand that one of the things keeping him sane, giving him hope, helping him manage his frustration and his behavior is a therapy program offered by Lincoln psychologist Mary Paine.

Caesar, 53, remembers the long walk home after he lost that first job, a good job. It was a cold night. He was angry, so angry. Losing his job was so unfair.

He walked past bars, but he didn’t go in because drinking is one of the things that got him in trouble.

He kept on walking. And he kept reminding himself of Paine’s advice: “There is nothing so bad we can’t fix, as long as you don’t re-offend.”

For about 50 men, the Sexual Trauma/Offense Prevention Program, or STOP, is a protective shield that tries to help keep them from re-offending or from acting out in the first place, and thus keeps them out of prison and keeps the public safe.

But the outpatient program that offers group and individual therapy based on individual needs faces problems this summer unless state government steps in with additional funding.

Paine’s program is one of the least expensive parts of the system the state has set up for sex offenders.

Right now, 1,120 sex offenders are in Nebraska prisons or state institutions and another 450 are supervised under parole and probation programs at a cost of more than $58.5 million.

Treatment at regional centers

As laws have changed and legislators have focused on sex offenders, more people are being kept in prison for longer or in the state's regional centers' sex offender treatment programs.

Today, more than 18 percent of Nebraska inmates have a sex offense as their most serious crime. It's the biggest category of offenses, with drugs coming in second at 12.9 percent.

In addition, the state run regional centers, which historically cared for people with serious mental illness, have been converted to sex offender treatment programs. In fact more than half the adults at Lincoln and Norfolk regional centers are sex offenders deemed too dangerous to return to the community without treatment.

Each year, mental health boards commit a dozen or more people about to get out of prison to the Norfolk Regional Center because they have served their sentences, but are considered dangerous sex offenders.

About 85 men are in the Norfolk center's program, at a cost of about $15.8 million last fiscal year. Norfolk’s entire mission is sex offender treatment and the men generally stay there for several years.

When they have finished the Norfolk program, people move to the next step, a sex offender program at the Lincoln Regional Center, which can house 85 people and in November had 78 patients, including three women. The cost was about $9.9 million last fiscal year.

When people in the Lincoln center's treatment program are ready to move out on their own, the local mental health board sometimes requires outpatient treatment.

Many of these people stay in Lincoln and use Paine’s program.

A public safety net

Programs like Paine’s provide transition for the client and a safety net for the public, said Shannon Black, a psychologist with the Lincoln Regional Center program.

Paine’s program helps clients adjust to life outside an institution.

For example, if someone loses a job and is trying to make ends meet, the added stress of not having a job could result in a crime being committed again. "We want to make sure they have the support, have someone who can talk with them," Black said.

Programs like STOP are also a safety net for the public.

Paine understands the risk factors, recognizes when someone is starting to demonstrate high-risk behavior, and she's willing to go back to the mental health board and have someone committed as an inpatient, Black said.

Where the money comes from

Paine's STOP program also includes people on probation and parole who have been convicted of sex offenses and are being supervised in the community.

People convicted of less serious sex offenses, including failure to comply with sex offender registration, are often given probation rather than prison sentences.

People convicted of sex offenses and nearing the end of their sentences are sometimes released to the parole program and finish their sentences living in the community.

State tax dollars pick up the costs of sex offenders in prison and in the regional centers. But there’s not always dedicated funding for sex offenders when they move into local communities.

The state picks up therapy costs for 25 people each year who come from the Lincoln Regional Center to the STOP program.

For the first time this year, the probation system also has money to pay for outpatient treatment like Paine’s program for people on probation.

But there is no money for people with low or no income who are on parole, no longer being supervised by the justice system, who have moved from other states or who want to make sure they don’t commit a crime in the first place.

Historically, Lancaster County picked up those unfunded STOP program therapy costs, but that ended when the county privatized mental health services for very low-income residents and turned them over to Lutheran Family Services in 2013.

Not all sex offenders are mentally ill

Sex offender is a legal status, not a mental health diagnosis, so funding can get complicated.

Not every person with a sex offense conviction is mentally ill.

“You can be totally sane, without a diagnosable mental health disorder, and be a sex offender,” said Scot Adams, director of behavioral health at the Nebraska Department of Health and Human Services.

There is state and federal funding for people with mental illness but no funding mechanism for sex offenders, he said.

Finding money for outpatient programs like Paine’s can be difficult.

“No one wants to pay for this,” said Dean Settle, retired director of the Lancaster County Mental Health Center. "Even if people do have a mental health diagnosis, many elected leaders don’t want to spend a dime on sex offender therapy."

And he guesses that about half of the people with sex offense convictions who could benefit from therapy do not have mental health diagnoses.

Outpatient programs like Paine’s are cheap compared to inpatient options: $6,000 per client annually for STOP, $33,525 average per inmate cost in prison, $194,545 per patient for the Norfolk Regional Center.

Paine’s program and others like it are a public safety matter, said Settle. Local public officials need to be aware of that and fund it at the local level or make sure the state is addressing it, he said.

Research shows therapy can help

Therapy can work for people convicted of sex offenses, according to professionals in the field.

“Absolutely, you can treat sex offenders,” said Adams.

People have the impression of once a sex offender, always a sex offender, said Black.

"Research just doesn’t hold that to be true,” she said.

In many circumstances, Paine said, the recidivism rate is low.

“We treat people to make them better functioning individuals as a whole and to stop the sexual offending behavior," she said.

Research into what works should provide guidelines for treatment and sentencing, she said.

Long sentences are not always necessary and they make the readjustment after release more complicated, Paine said.

The longer people are institutionalized the more complicated their return to society becomes, she said.

"I don’t have a problem with putting individuals away, but that is something we need to do much more thoughtfully so it achieves the goals we are seeking."

Chance at life

Caesar was a victim as well as a victimizer. He’s learning through counseling with Paine how to heal those childhood wounds and said his childhood is no excuse for the crime he committed, the harm he caused.

It is an explanation, he said, “but it doesn’t absolve me of doing what is right.”

Paine’s program also helps Caesar deal with the stresses many ex-cons have readjusting. And her program helps him avoid the behavior that led to that rape decades ago, behavior he does not intend to repeat.

Caesar sorts through a small stack of papers from his therapy, and spreads a large sheet of newsprint, several feet square, on the floor of his apartment.

On it, he’s printed the phases of the assault cycle -- trigger event, negative thinking -- phases he would likely go through before committing a violent act.

“If you don’t know what is happening, then you can’t stop it," he said.

But the knowledge gives him a chance to intervene.

He gets lonely, but he doesn’t try to hit on women.

He has money in his pocket, but he doesn’t go to bars.

He gets bored, but rather than wallow in it he cooks up black-eyed peas and cabbage like his mama used to make.

He gets angry because there seems to be no way to keep a job, find friends, fit in, because he is branded with the sex offender label.

But he puts on his music, cleans his house, behaves like a responsible adult.

It’s part of what he has learned with Paine.

"Dr. Paine gave me a real chance at life," he said. ..Source.. by Nancy Hicks | Lincoln Journal Star