Pathways to Civil Commitment A Correctional Perspective By Mark Weilage, PhD

Two Roads The Old Road - LB Mentally Ill and Dangerous The New Road - LB 1199 – Dangerous Sex Offender

LB 1083 Two Key Components Mentally Ill – Major Mental Illness Mental Illness with Functional Impairment Dangerous- Risk of harm to others Risk of harm to self Active- Suicidal Passive- Gross Neglect or Gravely Disabled

LB 1199 A person who suffers from a mental illness which makes the person likely to engage in repeat acts of sexual violence, who has been convicted of one or more sex offenses, and who is substantially unable to control his or her criminal behavior or A person with a personality disorder which makes the person likely to engage in repeat acts of sexual violence, who has been convicted of two or more sex offenses, and who is substantially unable to control his or her criminal behavior. Likely to engage in repeat acts of sexual violence means the person’s propensity to commit sex offenses resulting in serious harm to others is of such a degree as to pose a menace to the health and safety of the public; Person who suffers from a mental illness means an individual who has a mental illness as defined in section ; Person with a personality disorder means an individual diagnosed with a personality disorder; Sex offense means any of the offenses listed in section for which registration as a sex offender is required; and Substantially unable to control his or her criminal behavior means having serious difficulty in controlling or resisting the desire or urge to commit sex offenses.

Correctional Assessment Intake/Reception Center Initial Treatment Assessment Post Treatment Re-Assessment Community Transition Assessment Pre-Discharge Assessment

Correctional Treatment Mental Illness Individual Counseling Psychiatric Services Residential/Inpatient Mental Health Unit Sex Offender Brief/Low Intensity Community Treatment Moderate to Moderate-High Intensity Secure Outpatient Treatment High Intensity Residential Treatment

What to Look For in an Evaluation Clinical Interview Mental Status Exam Diagnosis Assessment of Risk Risk for mentally ill is usually based on an interview and review of recent statements, threats, or behavior. Imminence is more relevant in this population than for sex offenders. More formal and specific instruments are used for sex offenders

What To Ask the Evaluator Expertise Diagnosis Risk Assessment Treatment

Expertise Licensure School Do you have any specialized training relevant to treatment of mentally ill or sex offenders ? What is your experience treating mentally ill or sex offenders (#s, years, etc)? Any specialized training relevant to sex offender assessment and general risk assessment. What is your experience assessing the mentally ill or sex offenders (#s, years, etc)

Diagnosis Is diagnosis X a mental illness? Is diagnosis X a personality disorder? Is diagnosis X related to sexual offending? Is diagnosis X related to dangerousness? Is diagnosis X related to an enhanced risk for future sexual offending for Mr./Ms. Y? Explain?

Risk Assessment Does assessment X predict Mr./Ms. Y's reoffense risk and or dangerousness? Describe assessment X? Is assessment X generally accepted as a useful tool for assessing sex offenders, mentally ill offenders, or dangerousness? What does assessment X tell us about Mr./Ms. Y? Combined what do these assessments tell you about Mr./Ms. Y? If underestimate of Mr./Ms. Y’s level of risk, explain why?

Treatment Did you assess Mr./Ms. Y for the least restrictive treatment option? Did you assess for referral to a specific treatment program? Are you familiar with things that may become barriers to treatment? What treatment options are generally accepted as viable for treating sex offenders and or the mentally ill? Based on your expertise, are there things about Mr./Ms. Y that would make outpatient difficult or prohibitive? Do you know of any outpatient treatment programs that could address all of the risk factors? Would Mr./Ms. Y’s risk factors likely be addressed in an inpatient treatment program?

Summative Statements Cover Two Areas Is the individual dangerous and appears to meet the standard of the applicable statute What are considerations for treatment

Sample Affidavit of Dangerousness I, Joe Evaluator, Ph.D., being first duly sworn on oath, state that the following is true to the best of my knowledge and belief: I am a Psychologist, duly licensed by the State of Nebraska. I have conducted an evaluation of Mr. X, which is attached. It is my professional opinion that Mr. X is a dangerous sex offender.

Sample Affidavit Regarding Treatment I, Joe Evaluator, Ph.D., being first duly sworn on oath, state that the following is true to the best of my knowledge and belief: I am a Psychologist, duly licensed by the State of Nebraska. Pursuant to the NDCS opinion that Mr. X meets criteria as a DSO. A further review has been conducted to determine the least restrictive and most appropriate treatment setting for Mr.X. The review is based on the risk, needs, symptoms and treatment responsivity issues of Mr. X. Factors considered in this review and identified treatment needs include: Poor Problem Solving Skills. Feelings of Social Rejection, Lack of Concern for Others, and Negative Emotionality need to be address not only as treatment targets but also as treatment interfering behaviors that would make initiating outpatient treatment more difficult. His poor Cooperation with Supervision is a concern as he sees no reason to do treatment and was resistant to this evaluation process. Both of these would be considered very significant treatment interfering behavior. Sexual Deviance, Sexual Preoccupation, and use of Sex as Coping would all need to be addressed in specialized sex offender treatment. His lack of veracity and consistency in self report poses a significant risk should he be allowed unsupervised in the community and be expected to self-report to providers. It is my professional opinion, based on my expertise in sex offender risk assessment and treatment and the information available to me about treatment options, that Mr.X would be best served in a secure setting that offers intensive supervision and intervention to address the issues outlined above and in the SOCA evaluation. Thus, should the Mental Health Board find Mr.X to be a Dangerous Sex Offender then the least restrictive treatment at this time would be inpatient.

Contact Information Mark Weilage, PhD Nebraska Department Of Correctional Services Mental Health Department Phone: