4 days ago
Chemical castration stopped Peter's deviant thoughts. Should it be mandatory for all sex offenders?
When Peter* was arrested for indecent exposure in his 40s, what happened next was almost a relief. Plagued by deviant sexual desires since the age of seven, he was consumed by self-hatred but felt unable to control the ideas that came, unbidden, into his head.
After his arrest and subsequent conviction (his first), he was handed a community supervision order and presented with another, more unusual path to rehabilitation: 'chemical castration'.
The treatment, which involved taking a drug to suppress his sexual urges, was voluntary but Peter (who is now in his 60s) agreed to try it. The decision changed his life and he noticed the difference within a week.
'It gave me back the head space to think about things other than sexual urges,' he says now. 'It has enabled me to be certain of remaining offence-free for the rest of my life. [It] stopped me feeling any need or desire to offend.'
Governments have long grappled with the question of how the law should deal with sex offenders. Roughly 20 per cent of the UK prison population is serving a sentence for a sexual offence, while more than 850 men a month are arrested for online child abuse offences in England and Wales.
Usually, the answer is to hand down as harsh a sentence as possible; mandatory life imprisonment has been mooted by politicians in the past. Yet, in practice, prisons are full to bursting, and eight in 10 of those convicted of possessing child abuse images in the UK avoid jail. Could so-called 'chemical castration' be the solution?
Justice Secretary Shabana Mahmood, who is set to unveil plans for a major overhaul of the way the state punishes criminals this week, has said she will consider making the treatment mandatory for paedophiles and other sex offenders.
An existing pilot scheme was commended by David Gauke's independent sentencing review and has shown promising results, suggesting recidivism could be cut by up to 60 per cent. Owing to its success, and a recommendation by Gauke, the programme (which offers 34 offenders in eight prisons voluntary chemical castration) is set to be expanded to 20 prisons, before being rolled out nationally.
But suggestions the forthcoming Sentencing Bill may one day lead to mandatory medication, have been met with dismay by experts, who warn that forcing treatment on offenders 'will not work'.
Not a panacea for sexual abuse
Prof Belinda Winder, a forensic psychologist at Nottingham Trent University, has been evaluating the use of 'medication to manage problematic sexual arousal' (MMSA) for the past 15 years.
She says mandating the drugs – typically taken in pill form – would be costly, impractical, and possibly illegal.
To explain the psychology of an offender with problematic sexual arousal, Prof Winder uses the analogy of a radio turned up to full volume: 'It's like people are carrying a little radio around with them that's saying 'sex, sex, sex'.
'Everything in their world has sexual elements, or they're trying to bring sex into it,' she says. 'You're getting people masturbating ten times a day, every day, or wanting sex with their partner five, six, times a day… the medication gets sexual arousal back either to a low or manageable level.'
But it won't work for all offenders, Prof Winder and others argue. It is only truly effective for those who have 'genuine difficulties in managing arousal', and want to change that, says Prof Don Grubin, emeritus professor of forensic psychiatry at Newcastle University.
It will not be suitable for offenders who are primarily motivated by anger, or who struggle to moderate their behaviour while using alcohol or drugs, he adds. In fact, Prof Grubin argues, it is only really an option for a sub-section of the offender population: those with 'paraphilias', who are motivated by an intense sexual fixation.
As Prof Grubin suggests, the treatment seems to work for some. A study from Scandinavia found that MMSA reduces rates of reoffending by 40 per cent. Results from a small clinical trial of 52 men in Stockholm, Sweden, showed that paedophiles living in the community had a significantly reduced risk of reoffending just two weeks after starting treatment.
Indeed, in some jurisdictions, these treatments are already compulsory. Poland, Kazakhstan and a number of US states including California and Florida already have mandatory prescribing of anti-libidinal drugs to some sex offenders. Other countries including Germany, France, Sweden and Denmark offer chemical castration on a voluntary basis, as in the UK.
In 2009, Prof Grubin introduced a pilot scheme in the UK, at HMP Whatton, a category-C prison which specifically holds men who have committed sexual offences. Volunteers were treated with chemical castration, or given anti-depressants. 'It would be wrong to think of it as a magic bullet,' he says, but 'when these drugs work, it's really dramatic. People's whole outlook and motivation changes.'
Medications for sex offenders have actually been trialled in some UK prisons for more than 15 years, and used across the world for more than 60. Previously, they have been employed with ill-intent – most famously in the case of Alan Turing, the computer scientist and code-breaker, who was convicted of homosexuality in 1952 and accepted chemical castration as a way of avoiding imprisonment. He took his own life two years later, and received a posthumous royal pardon in 2013.
More recently, critics have argued the treatment diminishes the responsibility of men who have committed appalling crimes, potentially allowing them to shorten or avoid time in prison. Earlier this year, Zhenhao Zou, a 28-year-old Chinese PhD student at University College, London, and one of Britain's most prolific serial rapists, offered to undergo chemical castration in the wake of his conviction, according to court documents. Rather than a show of remorse for his 'predatory' behaviour, this was adjudged to be an attempt by Zou to avoid a life sentence. It was refused and he was jailed for 24 years.
Still, a growing body of experts believe the treatment can also be used to do good – to improve the lives and prospects of men who have committed sexual offences, and to cut rates of reoffending.
'Not every sex offender wants to be a sex offender'
In UK prisons, chemical castration primarily involves the use of anti-androgens or Gonadotropin Releasing Hormone (GnRH), both of which lower levels of the male sex hormone testosterone to pre-pubescent levels, effectively wiping out sex drive and rendering the patient functionally impotent. They can also provoke severe side effects – including breast development, hormonal hot flushes, osteoporosis and cardiovascular changes.
SSRI's, a class of antidepressant which can reduce compulsive sexual thoughts, are also used (most commonly Fluoxetine).
But Prof Grubin says criminals don't feel angered by the impotence and loss of libido these medications cause. Quite the opposite: they have taken them voluntarily and often feel only relief, having been freed from the intense sexual urges that drove them to criminality.
The three-year trial he piloted at HMP Whatton, which ended in 2012, delivered promising results. The treatment was formally adopted, and later introduced in other prisons. Along with Prof Winder, Prof Grubin is now running a double-blind controlled trial [where neither the participants nor researchers know who is receiving the active treatment, and who is receiving a placebo] to prove its efficacy – an important step, given the key criticism of the medication to date has been its lack of exposure to this type of testing.
Dr Adarsh Kaul, a forensic psychiatrist who works in prisons in Nottinghamshire, says that 'most, if not all of' the men who are referred to him are relieved by the results. Contrary to the public perception of people who commit sexual offences, he says, 'it is not the case that every sex offender wants to be a sex offender'.
'There are some for whom you might compare it to alcohol,' says Dr Kaul. 'Does every person who drinks to excess want to screw up their life and destroy their health? No. There's a whole range of people.'
It is often so effective that some of his patients consider themselves 'cured', though medics stress such a conclusion (as well as the term 'chemical castration' itself) is misleading because the results are reversible. 'There are people who I treat who get better, and at some point they say to me, 'I'm well now, and I don't need the treatment any more',' says Dr Kaul.
'But many of them, after a few weeks or months, will come back to me and say, 'You know what, you were right – I'm not cured, and the reason I thought I was is because I was taking this medication.''
It's not up to the Government to say, 'this man needs medication'
Indeed, some have seized on arguments that the medication is not a silver bullet, criticising Mahmood's mooting of a nationwide, mandatory scheme.
Shadow justice secretary, Robert Jenrick, has dismissed Mahmood's suggestion as a 'gimmick', designed to draw the public's attention away from major sentencing reform that could see swaths of prisoners released from jail just a third of the way through their sentences, in order to deal with an overcrowding crisis.
'[Sir Keir] Starmer cannot mandate chemical castration without ripping up human rights legislation. Pigs will fly before that happens,' he said in May.
Mahmood and her fellow officials appear undeterred. 'Chemical castration works. Unlike the last Conservative government, this Government won't be squeamish about doing what works to keep the public safe. That starts by rolling chemical castration out nationwide – with two new regions soon to be announced. And we continue to explore mandation,' a Government source told The Times this week.
But experts with experience of administering these drugs warn of potential trouble ahead, particularly if criminals end up needing to be sectioned in order to be treated – something the Government has not ruled out – or taking the medication is made a condition of their parole licences.
'We treat patients, we don't treat risk,' says Prof Grubin, who adds that medics risk being turned into 'agents of social control' if the plan is pushed through. 'It's not up to the Government to say, 'this man needs medication'.'
Prof Grubin suggests doctors may even refuse to administer the treatment under such circumstances. After all, he argues, the reason they have been successful so far is because the men taking the drugs want to reduce their own risk.
* Name has been changed
