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Preventing and reducing sexual abuse
Belinda Winder and Nicholas Blagden
Dedication
This chapter is dedicated to Ruth Mann, a Chartered Forensic Psychologist, previous Head of Evidence for HMPPS, and a wonderful human being. Ruth is an inspiration to us all – her kindness, intelligence, thoughtfulness and passion humble us, and we are, and will always be, indebted to her. Go well, Ruth.
Introduction
This chapter focuses on the prevention and reduction of sexual offending and reoffending. It details work conducted by the Sexual Offences, Crime and Misconduct Research Unit (SOCAMRU). SOCAMRU was set up by the first author in 2007 and is now jointly led by the two authors. The purpose of SOCAMRU was to build upon the collaborative relationship between ongoing research within the Psychology department at Nottingham Trent University (NTU) and Her Majesty’s Prison Whatton (HMP Whatton). Whatton is one of the largest prisons in Europe for prisoners with sexual convictions, housing approximately 840 individuals. HMP Whatton is a specialist institution with a large Programmes and Psychology department which provides almost two thirds of all specialist treatment to people serving custodial sentences for sexual offences in the UK (K. Hocken, personal communication, March 24, 2020). Its ethos is therapeutic, respectful and progressive, with research utilised to drive forward changes and rehabilitative initiatives. The prison houses predominantly adult males, with a small population of transgender prisoners.
SOCAMRU’s primary aim is to conduct and facilitate applied forensic research in the area of sexual crime. The unit sits at the juxtaposition between the domain of prison, police and criminal justice practitioners and that of academia. Researchers in the unit, including ourselves, spend lengthy periods of time in prisons housing people with sexual convictions. Working alongside the governors, senior management teams, psychologists, programme facilitators and prison staff, as well as spending considerable amounts of time with the prisoners themselves, allows us to conduct research that is consonant with prisons, prisoners and prison life. As part of our work within the unit, the authors of this chapter have a monthly service user group at Whatton prison where we meet with six to eight prisoners and discuss research ideas with them. We listen to what prisoners and prison staff say is important to them, and we link this with the literature on understanding prevention and reduction of sexual abuse. We also work regularly in several other prisons throughout the UK, including HMP Stafford, HMP Grendon, and HMP Whitemoor (Fens unit). All this is done with the primary aim to conduct research that makes a significant contribution to our understanding of sexual crime and people who commit such offences. In SOCAMRU, we utilise a range of methodologies, including qualitative, mixed methods and quantitative methods; we maintain a strong service user approach and focus in order to ensure the research is authentic, useful, and robust, bringing together theories and practice. Our work stretches more broadly than this, however. We have moral and social objectives, and envision part of SOCAMRU’s work as existing to challenge the culture, politics and rationale for excluding ex-prisoners, particularly those with sexual convictions, from reintegrating positively and purposefully back into society.
Perhaps because of this social objective, and as one of the consequences of our strong service user focus, a small group of us co-founded a charity, the Safer Living Foundation (SLF). The Safer Living Foundation (www.saferlivingfoundation.org) was founded 13 February 2014 as a joint venture between HMP Whatton and Nottingham Trent University, and is supported by the likes of the National Probation Service (East Midlands) and Nottinghamshire Police. As a charitable incorporated organisation that adopts a multi-agency approach with a strong research component, the Safer Living Foundation is focused on reducing offending, particularly sexual offending through rehabilitative and preventative initiatives. The charitable objectives of the Safer Living Foundation are:
- To promote the protection of people from, and the prevention of, sexual crime
- To promote the rehabilitation of persons who have committed or who are likely to commit sexual offences against others
SOCAMRU works with the Safer Living Foundation charity to conduct work, and to research and evaluate this work, in order to create and evidence a demonstrable impact in reducing and preventing sexual crime.
Context of the research
There are approximately 13,400 people in UK prisons with sexual convictions, which is around 19% of the overall UK prison population (MoJ, 2018). This is an increase from the early 1990s when 10% of the prison population comprised people with a sexual conviction (MoJ, 2016). The number of people with sexual convictions in society is growing and this increase is not restricted to the prison population. Approximately 55,000 members of the UK general public have previously been convicted of a sexual offence and are now living in the community, albeit under the conditions set out by the Sex Offenders’ Register (SOR; i.e. who committed a sexual offence post the UK’s Sex Offenders Act, 1997). There is a further unknown number of people living in the community who committed a sexual offence before 1997 and who therefore were not required to be on the Register. In summary, this means that around 1 in 950 people in the UK currently have a sexual conviction.
The number of people charged and convicted with a sexual offence and the number of people serving custodial sentences for a sexual offence is increasing (ONS, 2019). There are several explanations for this. Public attitudes to reporting sexual offending have changed given some high-profile cases over the last five years and the rise of valuable social campaigns and movements such as #metoo. Consequently, people are now more likely to report sexual crimes. The number of possible imprisonable sexual offences has increased (CPS, 2017), prison sentences are longer (ONS, 2019) and the proportion of people prosecuted and serving sentences for non-recent sexual offences has grown (ONS, 2018).
Most individuals who serve a custodial sentence for a sexual offence are released back into the community. Post-release, approximately 90% of these individuals will live out their lives offence-free. Thus, recidivism rates for sexual crimes are around 10% (Mews, Di Bella & Purver, 2017). Each year, prisons housing residents with sexual convictions release individuals into the community. For example, HMP Whatton alone released around 40 men into its local area (Nottinghamshire) last year; other prisons throughout the UK will also be releasing prisoners into each area. Consequently, there are hundreds of individuals with sexual convictions released into each county in the UK each year.
Research has shown that individuals with sexual convictions are most likely to reoffend in the first few years following release, and the likelihood of reoffending reduces the longer the individuals remain offence free in the community (Hanson et al., 2018). Research also suggests that the risk of sexual reoffending is increased when people are socially and emotionally isolated; however, having a sexual offence creates emotional and social isolation. The empirical evidence points to the need to assist individuals with sexual convictions in reintegrating back into society and there is currently a large gap in service provision for this group (Blagden & Winder, 2019; Kitson-Boyce et al., 2018a).
Outline of projects
The research outlined in this chapter focuses on reducing sexual offending and reoffending. Our starting position has invariably been practical issues that have been highlighted by Her Majesty’s Prison and Probation Service and/or the current evidence base on what works with individuals who commit sexual offences. We have also listened carefully, and at length, to prisoners in formal and informal research settings including our regular service user group, prison staff, and psychologists and healthcare workers in order to understand what undermines the treatment, management and rehabilitation of people who have committed sexual offences.
We will consider three separate research programmes. All have utilised mixed methods to understand a particular challenge in managing, treating and preventing sexual abuse. Our first research project is focused on ongoing evaluation of medication to manage problematic sexual arousal in individuals convicted of sexual crime. The question was whether the medication was effective in reducing problematic sexual arousal (and there were a number of related questions regarding the attitudes and experiences of prisoners being offered the medication, the interaction of medication with psychological treatment programmes, and the role of medication in reducing risk of sexual harm both in the prison and, importantly, in the community). The second project we outline focuses on individuals who maintain their innocence apropos their sexual convictions (‘deniers’); this group were highlighted as a problem within the prison system. The question there was ‘what do we do with deniers?’ Finally, the chapter sets out research and evaluation of Circles of Support and Accountability (Circles/CoSA), a project delivered by organisations such as the Safer Living Foundation charity and researched and evaluated by the authors. Circles are a post-release intervention for high-risk and very high-risk individuals who have committed a sexual offence. The work outlined comprises research findings from the first prison-based Circles, together with data from the national evaluation of community-based Circles which is led by the two authors.
Project 1: Medication to manage problematic sexual arousal
Problematic sexual arousal has been cited as one of the most important factors for sexual reoffending (Hanson & Morton-Bourgon, 2005). The term ‘problematic sexual arousal’ (PSA) is represented by a number of different terms including: sexual preoccupation, sexual compulsivity, nymphomania, excessive non-paraphilic behaviours (Garcia & Thibaut, 2010), hypersexuality (Kafka, 2010), sexual addiction and excessive sexual desire disorder (Fong, 2006), obsession with sex and sexual appetite. A common feature among these, and the key elements of problematic sexual arousal, is the presence of intense sexual thoughts and/or the behavioural element in which individuals engage in excessive sexual behaviours. Problematic sexual arousal can also be related to sexual deviance, that is, an attraction to children or non-consenting adults. The presence of problematic sexual arousal is a serious health as well as a criminal justice concern. It is linked to adverse outcomes in relation to the wellbeing of individuals. This includes effects on psychological and emotional wellbeing with multiple psychiatric comorbidities associated with problematic sexual arousal (Khan et al., 2015). Problematic sexual arousal has been found to be the most strongly present treatment need for people who have offended sexually (Hocken, 2014) and is recognised as a crucial risk factor for, and significant predictor of, sexual recidivism (Mann, Hanson & Thornton, 2010). Despite this, it is the only risk factor that is not directly addressed by current UK sexual offending treatment programmes. Whilst the National Offender Management Service’s Healthy Sexual Functioning Programme (HSP) does address deviant arousal (arousal to children and other types of non-consenting sex, including non-consensual sex with adults) and promote healthy sexual functioning (HMPPS, 2016), it does not actively help men struggling with sexual preoccupation, a fundamental aspect of problematic sexual arousal. Post-conviction, problematic sexual arousal also impedes treatment progress for those convicted of sexual offences, affecting the ability of individuals to focus on treatment programmes (Winder et al., 2018), with problematic sexual arousal a key factor for treatment ineffectiveness (Grubin, 2018).
Research conducted by SOCAMRU has evaluated the effectiveness and role of anti-libidinal medication in reducing problematic sexual arousal and demonstrated the positive impact of prescribing anti-libidinal medication on the management, treatment and wellbeing of people convicted of sexual offences (Winder, Lievesley & Elliot, 2014; Winder et al., 2015; Winder, 2016; Winder et al., 2018; Winder, 2019b). These findings have been influential nationally and internationally, driving forward prevention work in the community as medication could become an important treatment option for some people before they commit a first offence.
While inability to manage problematic sexual arousal is a primary risk factor for sexual reoffending, its route of action and underpinnings are not clearly understood. Problematic sexual arousal can be classified in three ways: (i) as a clinically diagnosed paraphilia, (ii) as excessive thinking about sex (sexual preoccupation or hypersexual cognition) and (iii) as excessive impersonal sexual behaviours, or hypersexual behaviour (see Winder et al., 2019). In each of these instances, psychological treatment programmes have stru...