1. The Royal's Sexual Behaviours Clinic "Are Any Sex Crimes Necessary?”
Crime Prevention Ottawa
J. Paul Fedoroff, M.D.
Director SBC
Director Forensic Research IMHR
Chair, Division of Forensic Psychiatry
University of Ottawa
27/02/12

2. I get it – the old caffeinated-cop, decaffeinated –cop routine

3. COSTS OF CHILD ABUSE IN CANADA/Year (Juristat)
Cost of building Royal: Aprox. 150 million over 2 years
Cost of Child Abuse in MONEY per year equivalent to building 150 ROH’s PER YEAR
You will notice by the way that I have arranged this talk to start with big numbers and move toward small numbers.

4. Acknowledgements This presentation represents work done by a team...
• The University of Ottawa (U of O)
• The Institute of Mental Health Research (IMHR)
• The Royal Ottawa Health Care Group (ROHCG)
• The Integrated Forensic Program (IFP)
• The Sexual Behaviours Clinic (SBC)
• The SBC’s Patients, Their Families, and Children
This presentation represents work done by a team...
First a quiz...

5. At the turn of the (last) century…
• A disease with no known cause
• Associated with vampires
• Widespread but mainly in cities
• Possible cause: masturbation

6. Robert Koch, 1905
Awarded nobel prize in Medicine for discovery of TB baccilus... no X-ray; no antibiotics...

7. The Royal Ottawa 1909
The “cave cure”... asylum... 50% death rate in 5 years.

8. Treatment 100 Million deaths in the 20th century
Similarities to paraphilias: a) unknown cause b) stigmatization c) forbidding prognosis d) asylum
At same time convergence of thinking about another hopeless malady...sex crimes...

9. Some things have changed

10. Some things stay the same

11. Sex crime rates are dropping For Children
THE POPULATION OF THE USA INCREASED BY ABOUT 4 MILLION CHILDREN PER YEAR

12. And treatment seems to work (Cortoni & Nunes, 2008)
Recidivism
National SOP (347)
Control (137)
Sexual
1.1 %
4.4%
Violent/Sexual
2.0%
17.8%
Any
6.8%
36.5 %
A STUDY BY DRS. KEVIN NUNES AND FRANCA CORTINI (TWO FRIENDS OF THE SBC)... (LIMITED F/U APROX 2 YEARS, TIME OF GREATEST RISK)
MEN IN A FEDERAL SEX OFFENDER TREATMENT PROGRAM SEXUALLY REOFFENDED AT A RATE OF 1.1%
NOTICE ALSO CONTROLS SEXUALLY REOFFENDED AT 4.4%
36.5 % RE-OFFENSE RATE REFLECTS FACT THIS IS A GROUP OF FEDERAL SEX OFFENDERS

13. Hanson & Harris, 2004
• Reviewed 95 studies involving ,216 sex offenders
• Average community time: 5-6 years
• Any recidivism: 36.9%
• Sexual recidivism: 13.7 %
KARL HANSON AND ANDREW HARRIS (SOME MORE FRIENDS OF THE PROGRAM):
ANALYSIS OF A LARGE NUMBER OF SEX OFFENDERS WITH 5-6 YEARS IN COMMUNITY
SEXUAL RECIDIVISM 13.7%
IE: 86.3% OF SEX OFFENDERS NOT KNOWN TO HAVE SEXUALLY REOFFENDED IN 5 YEARS! THAT IS WHAT MOST PEOPLE CALL A CLEAR MAJORITY. BUT NOT PERFECT... HAVE THINGS IMPROVED SINCE 2004?

14. BATH INSTITUTE... FEDERAL OFFENDERS... MEDIUM TO HI RISK
Program Outcome Marshall, Marshall, Malcolm, Serran & Fernandez, 2005
Re-offence
Treated*
(N = 534)
Expected**
Sexual
3.2%
16.8%
General
13.6%
40.0%
*Mean follow-up = 5.4 years
**Based on Static-99 and L.S.I
BATH INSTITUTE... FEDERAL OFFENDERS... MEDIUM TO HI RISK
EXPECTED SEX REOFFENSE FOR HIGH RISK S 16.8% (INSTEAD OF 86.3% NOT REOFFENDING, ONLY 83.2% WERE KNOWN RE-OFFENSE FREE AT 5+ YEARS)
BUT... FOR TREATED HIGH RISK OFFENDERS PERCENT REMAINED SEX REOFFENSE FREE AT 5+ YEARS FOLLOW-UP
WHAT DOES THAT MEAN?

15. FINANCIAL COST PER FAILURE IS CONSERVATIVELY $200,000
COST-BENEFIT ANALYSIS OF TREATING SEXUAL OFFENDERS IN THE PROGRAM
Treated
Per year
Actual Failures per year
Expected failures per year
Reduction in number of victims per year 60 2 10 8
2 FAILURES OUT OF 60 PER YEAR COMPARED TO THE EXPECTED 10 FAILURES PER YEAR
FINANCIAL COST PER FAILURE IS CONSERVATIVELY $200,000
THIS MEANS THE PROGRAM WHICH COSTS THE SYSTEM $205,000 PER YEAR...
Cost per re-offender
$ 200,000
Cost to treat 60 sexual offenders for a year
$205,000

16. Overall Program (Financial) Impact
Savings per year
Savings (8 x $200,000) $1,600,000
Less costs $ ,000
TOTAL SAVINGS $1,395,000
....APPROXIMATELY 1.4 MILLION DOLLARS PER YEAR...
THIS DOES NOT INCLUDE THE BENEFIT OF SAVING CHILDREN FROM BEING ABUSED!!!!
BUT THE PROGRAM DESCRIBED DOES NOT INCLUDE SYSTEMATIC PHARMACOLOGIC TREATMENT NOR FOLLOW-UP!
MAYBE WE CAN DO BETTER...

17. COSA (N=47)
Control (N=47)
Sexual Recidivism
2.13 % (1)
12.77% (6)
Violent Recidivism
8.51 % (4)
31.91 % (15)
General Recidivism
10.64 % (5)
38.30 % (18)
THIS STUDY INVOLVES FEDERAL OFFENDERS AT WARRANT EXPIRY... HIGH RISK OFFENDERS RELEASED WITH NO FOLLOW-UP...
COSA INVOLVEMENT REDUCES KNOWN SEXUAL RECIDIVISM FROM 13% TO 2% (98% non-reoffense)
....BUT CAN WE DO BETTER? 27

18. Here is what the SBC does now
We see anyone, from anywhere, without delay.
We do complete assessments.
We start treatment immediately.
We insist harm to children stops immediately (we do not “taper”).
We lead by example.

19. We lead by example. We are lawful. We are honest. We are respectful.
We do not work alone.
We deliver what we promise.
We are optimistic and insist on success.
We do not do anything without consent.
We admit we can be wrong and fix mistakes.

20. Good cop- Bad Cop

21. ! So that’s it? A single victim is at least two too many.
A single offense affects:
The victim
The victim’s family
The offender’s family
The community

22. With the right treatment things changed…
Percent five year mortality from TB
Similar trends have occurred in the area of sex crimes... (note left to right decreasing trends are good)

23. Do you like kids too much?
.... Surely prevention is better than tertiary treatment!
SOMETIMES IT MAKES SENSE TO STEP BACK AND TAKE ANOTHER LOOK...

24. Police line-up

25. Director, Sexual Behaviours Clinic
J. Paul Fedoroff, M.D.
Director, Sexual Behaviours Clinic
Thank You/Merci
Mental health and well-being for all • La santé mentale et le mieux-être pour chacun

26. Questions/Comments