Sexual offender treatment during COVID-19 [PODCAST]

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“Let’s not suffer more hardship then already incurred by COVID-19. Recognizing that both the psychosocial stressors arising from COVID-19 and the withdrawal of effective sexual offender treatment increase the risk of sexual violence, public safety demands that offenders have access to treatment. Without sexual offender treatment during COVID-19, we exchange one public health crisis for another.”

Renée Sorrentino is a psychiatrist.

She shares her story and discusses her KevinMD article, “Sexual offender treatment during COVID-19.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Renée Sorrentino. She’s a psychiatrist, and she wrote the KevinMD article “The withdrawal of effective sexual offender treatment during COVID-19.” Renée, welcome to the show.

Renée Sorrentino: Thank you.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Renée Sorrentino: Sure. So I’m kind of an unusual psychiatrist. There are not many of us that treat sexual offenders or the paraphilic disorders. Paraphilic disorder is kind of a jargon term for sexual disorders. I am a forensic psychiatrist, and during my training in forensic psychiatry, I developed, or had, an interest in a subspecialty, which is working with either sexual offenders or individuals that have problematic sexual behavior.

Nationally, most sex offenders are treated by psychologists. One of my areas, or what I call my mission, is encouraging or training psychiatrists to work in this area, because I feel that we as psychiatrists have something unique to offer to this population. More specifically, we as psychiatrists can do biologic treatment, and under that umbrella of biologic treatment, I provide hormonal treatment, or testosterone-lowering medications, for either sexual offenders or individuals with problematic sexual offenses. There’s probably a handful of us nationally, but as I mentioned, I’m trying to encourage psychiatrists to start to think and work in this particular area.

Kevin Pho: So not many clinicians have experience treating sexual offenders. Now, what are some typical treatment regimens that they’re offered?

Renée Sorrentino: So the mainstay of treatment, and the evidence-based treatment, is the group therapy modality. It’s a cognitive behavioral approach, so the standard of care for sex offender treatment is to offer this kind of treatment. We as psychiatrists, for individuals who don’t do well or don’t have a satisfactory response, offer biologic treatment, which would be anything from treating a comorbid psychiatric disorder, which impacts their ability to control their sexual behavior, to a targeted treatment for the sexual behavior.

Let me just be more specific. So for someone who has pedophilic disorder, we would use a medication that will lessen testosterone. Those are the two mainstays of treatment: the psychological treatment, and then a medication or a biologic treatment.

Kevin Pho: And generally speaking, how effective are those two types of treatment?

Renée Sorrentino: So there’s been some controversy over the years about whether sex offender treatment in general decreases the risk of recidivism, but the well-designed studies are showing that individuals who engage in treatment have a lower risk of reoffending, or sex offender recidivism. And the studies that look at medications, actually, there’s a meta-analysis that looks at all kinds of psychiatric medications in sexual recidivism, and what those studies show is that the only effective medication treatments are the medications that lower testosterone, or hormonal treatments. In some settings, they may be referred to as chemical castration.

Kevin Pho: And you mentioned that you’re one of the few psychiatrists who specialize in treating sexual offenders in the country. Can you give us an idea of how available or unavailable support is?

Renée Sorrentino: Yeah, so it is rare to have psychiatric treatment for this population, which you might be concerned about, because, as I shared, biologic treatment is a successful treatment. Unfortunately, there are a lot of reasons that psychiatrists have not gone into this area, probably the most important being stigma.

But to answer your question, if you’re in the New England area, there’s a handful of us, but there are many states where there are no psychiatrists that have this particular interest or expertise. So it is not uncommon for my clinic to turn down, on average, five to 10 individuals who want treatment for their sexual offending behavior, simply because we don’t have the resources, or because of the geographic challenges.

Kevin Pho: So let’s talk now about your KevinMD article, “The withdrawal of effective sexual offender treatment during COVID-19.” Now, for those who haven’t read your article, can you walk my audience through it and perhaps share the story of why you decided to write it?

Renée Sorrentino: Yeah, so the story about why I wanted to write that article is because we, working in the field, felt that it was outrageous that during COVID-19, when there might be increased risk factors for engaging in sexual offenses, there would not be any treatment. So, like other physicians, most of the treatment during COVID has now been relegated to online treatment, and what’s happened with a fair number of sexual offenders is that one of their conditions of probation is to refrain from, or not have, access to the internet.

So I just want you to think about this. Individuals may be experiencing increased stress and less ability to manage their stressors, or the coping skills or usual things that they do to manage their behaviors may not be available during COVID-19. So think about that setup, and then think about actually withdrawing treatment. Most of these individuals were in ongoing weekly treatment. Risk factors go up, and they actually don’t have access.

We thought it was very hypocritical that during this time, when risk factors may be higher, we would remove treatment. And the hypocrisy is that the individuals couldn’t get treatment because their condition of probation said that they couldn’t have access to the internet, which is the way we were delivering the treatment.

Kevin Pho: Are there any solutions to this problem?

Renée Sorrentino: The solution is really quite common sense. What we thought made sense, for those individuals that couldn’t have access to the internet, is simply to approach the probation officer and share with the probation officer why the internet would be important for this particular use. But that common, sensible approach was not very effective.

What’s happened is that most probation officers were not willing to consider that, and then the probation officers that were willing to consider it felt like they had no avenue to approve it, because legally they’d have to go back to court and have the judge rule on that. And as we know, what’s been happening with the court system is that they’ve, in essence, been defunct. So that’s been the problem. For those individuals who realize, like the probation officers who realize that this is an important treatment, they haven’t been able to get the approval for such treatment.

Kevin Pho: Now, you wrote this article back in July, and we’re speaking in the beginning of October. Now I’m seeing more patients face-to-face and fewer virtual visits. Has anything changed since you wrote that article?

Renée Sorrentino: No, because, as I mentioned earlier, the standard of care, or evidence-based treatment, is the group therapy, and even though there’s been some relaxing of some of the restrictions, the idea of having groups still is not, I don’t think, safe. So none of the group therapies have returned. Certainly I am seeing those individuals who are on biologic treatment, but that’s only one portion or part of their treatment.

Kevin Pho: We’re talking to Renée Sorrentino. She’s a psychiatrist, and she wrote the KevinMD article “The withdrawal of effective sexual offender treatment during COVID-19.” Now, I’m a primary care physician. There are a lot of primary care clinicians who listen to this podcast. Do you have any tips or lessons that you could share when it comes to dealing with potential sex offender patients?

Renée Sorrentino: Yeah, so I think that there is effective treatment for sexual offenders, and in particular, what I want to focus on is pedophilic disorder, because that’s probably what most individuals are going to see or come across. And I actually have a good working relationship with my primary care doctors, where they’re actually helping administer some of this testosterone-lowering medication.

The important message that I want to get out to providers is that there is effective treatment, and probably the best way to identify that treatment, if you have a patient who is in need of that treatment, is to look for ATSA, the Association for the Treatment of Sexual Abusers. Most states have state chapters, and if you look at the state chapter, you’ll see in most states there’s an identification of where there are clinicians working in that area.

Kevin Pho: And my final question: Do you have a take-home message that you want to share with the KevinMD audience?

Renée Sorrentino: Yes, thank you. My take-home message is that psychologic and biologic treatment is effective for decreasing sexual violence, and that we as physicians have a pivotal role in treating those individuals. And I ask that my physician colleagues set aside their stigma and start to work to decrease the problem instead of contributing to the problem by ignoring it.

Kevin Pho: Thank you so much for sharing your insight and expertise, and thanks again for being on the show.

Renée Sorrentino: Thank you.

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