Tuesday, September 30, 2014

Euthanasia & sexual abusers

Frank van der Bleeken is an imprisoned murderer and multiple rapist residing in Belgium. He he committed his sexual offences against young women in Antwerp (Belguim) during the 1980’s. Mr. van der Bleeken was sentenced to life imprisonment and has already been in prison for over 30 year’s (International Business Times). Recently, Mr. van der Bleeken successfully petitioned the Belgian government to be given allowed the right to die via assisted suicide through their euthanasia law (Belgian Act of Euthanasia, 2002; Cohen –Almagor, 2009). Euthanasia is controversial in and of itself, regardless of its use by offenders, with disagreements within and between countries about its legality as well as morality (The Lancet, Medical News Today and politics.co.uk). Mr. van der Bleeken’s argument for euthanasia is based upon his belief that he was not receiving adequate treatment for resolve his sexually abuse impulses (which is an issue in Belgium - The Globe and Mail), that these sexual impulses where not diminishing and that he was suffering significant psychological as well as emotional trauma as a result of this (The Sydney Morning Herald). In his application Mr. van der Bleeken was supported by medical professionals who supported his claim that his condition was not improving and that treatment was having no impact (The Sydney Morning Herald).


The decision by Mr. van ver Bleeken’s to seek euthanasia as a response to his sexually abusive raises a whole host of questions as well as issues for sex offender treatment, rehabilitation and reintegration:


-       Mr. van der Bleeken’s argument is that his sexual impulses are innate and causing him severe psychological as well as emotional trauma, as a consequence he is asking to be euthanatized so that his pain can be abated. In saying this he is placing his sexual cognitions and motivations in the same arena as other prolonged and depilating illnesses, such as MS, which euthanasia is used for. This reframes sexual abuse, and the related motivations, into a whole new biological light. Although, we recognise that there may innate drives that can motivate some sexual offenders this is not the case for all sexual offenders; sexual offending is heterogeneous in nature. Mr. van der Bleeken’s argument for euthanasia as well as being reductionist also works to cloud the fact that there are social aspects to sexual abuse. So even though he may suffer from cognitions and drives that are emotionally and psychologically based, so to do a lot of other individuals (i.e., people with severe personality disorders, schizophrenia, depression, etc) for whom euthanasia would not be considered. So why was euthanasia allowed for Mr. van der Bleeken? As a consequence of the nature of his offences, or his level of dangerousness, or his risk level? These seem difficult to justify, especially in a country that does not have the death penalty.


-       In this case the argument is that treatment has not help Mr. van der Bleeken and that another response is needed. Research has indicated that treatment works for different individuals in different ways at different times (Beech et al, 2009; Baim & Guthrie, 2014); it is not a homogenous solution. However, the suggestion that death is the only alternative solution to a failure in treatment is a very worrying precedent to set and feeds into the longstanding, although often rebuked, myth that nothing works with sex offenders so why bother. As professionals we recognise that sexually abusive tendencies and cognitions are incurable, and therefore that is not what treatment is really about; treatment is really about giving people the skills to reduce and manage these tendencies. Therefore it is a misnomer to say that the inability of treatment to cure a sex offender means that we must move to the most radical solution, death. This is why we have some individuals who are civilly commitment for their own as well as society’s benefit, which is not to say that everyone who is civilly committed is always going to be high risk forever but instead to say that those most resistant to change and in need of the most support have the appropriate responses available to them.


-      This case also raises the issue of prisoner rights, so should Mr. Van der Bleeken be allowed to pursue this course of action when he is being held by the state for a crime(s) that he committed? Part of the role of prison is to remove an individual’s freedom and right for self-determination. However, prisoners do have health related rights and therefore are Mr. Van der Bleeken’s concerns over his emotional and psychological state congruent with prisoners suffering for physical ailments for would euthanasia would be more readily accepted? Or is it an attempt to downplay his responsibility for the sexual assaults as he cannot control himself and his urges are beyond treatment? So in arguing for assisted suicide Mr. van der Bleeken could be seen as bypassing the criminal justice system as the Belgium government do not think that the death penalty is not an appropriate response to his offences. However this goes beyond the offender and the state to the victim, with the parents of Mr. van der Bleeken’s victims not wanting him to have access to assisted suicide instead arguing that he needs to serve out his sentence and be punished for his offences (Daily Mail). Consequentiality, the Belgian government’s recommendation that Mr. van der Bleeken can be allowed euthanasia means that the families of his victims feel betrayed by the criminal justice system and that they are not getting the justice that they were originally promised.


The Frank van der Bleeken case raises a lot of questions about the viability and impact of sex offender treatment (The Globe and Mail). The main issue seems to be whether euthanasia is appropriate response if sex offender treatment is not seen as successful by the client. This could have serious implications for the view of treatment from the judiciary as well as from the public, because if sex offenders feel that they deserve the death penalty and that they cannot be cured is this probable cause to invoke it?




Beech, A.R., Craig, L.A., & Browne, K.D. (2009). Assessment and treatment of sex offenders: A handbook. Chichester: Wiley.


Baim, C., & Guthrie,L.  (2014). Changing Offending Behaviour. London: Jessica Kingsley.


Cohen –Almagor, R. (2009). Belgian euthanasia law: a critical analysis. Journal of Medical Ethics, 35, 436-439



Friday, September 19, 2014

The Community and the “Cure”

In a recent television interview, a talk-show host asked boxer Mike Tyson why people should take his opinions seriously when he is a “rapist.” This referred to a crime that Tyson committed over two decades ago. Tyson’s response was swift and characteristic of his career; he insulted the interviewer and challenged him to a fight. Although the situation was unfortunately and entirely unnecessary, it demonstrated what research has found: people change, and violence and aggression are more likely to persist than sexual abuse. Mike Tyson may have persisted in many undesirable behaviors, but he has apparently desisted from further sexual abuse. Tyson objected to the label “rapist,” and perhaps we should as well.

In the interest of accurate language, Mike Tyson is a person who has been violent towards others in and out of the boxing ring. Sexual abuse is an area where, as Bill Marshall (personal communication, September 11, 2014) recently observed, our labels stick like glue. It is fascinating that the interviewer used this particular label rather than asking, “Why should people take your opinions seriously when you’ve bitten off parts of your opponents’ ears and assaulted strangers on the side of the highway?” Perhaps part of the answer lays in public ignorance about how sexual re-offense does – and more importantly – does not happen.

Relevant to this is a study (in press) that merits close attention. Karl Hanson, Andrew Harris, Leslie Helmus, and David Thornton studied 7,470 sexual offenders from 21 samples and found that:

The risk of sexual recidivism was highest during the first few years after release, and decreased substantially the longer individuals remained sex offence-free in the community. This pattern was particularly strong for the high risk sexual offenders (defined by Static-99R scores). Whereas the 5 year sexual recidivism rate for high risk sex offenders was 22% from the time of release, this rate decreased to 4.2% for the offenders in the same static risk category who remained offence-free in the community for 10 years. The recidivism rates of the low risk offenders were consistently low (1% to 5%) for all time periods. The results suggest that offence history is a valid, but time dependent, indicator of the propensity to sexually reoffend.

Certainly, official records of re-offense underestimate the true rate of sexual crimes. However, the overall trends in this study reflect what we already know from numerous other studies around the globe. Most sexual offenders are not known to re-offend, and only a small minority is at truly high risk. This presents many opportunities for reconsidering our current approaches to management, including the use of strategies that reduce risk, protect communities, and help assist those affected by sexual abuse that are more efficient and cost-effective than the many ineffective strategies in place today (e.g., residence restrictions).

These findings should prompt all professionals and the lay public to reflect on their beliefs about people who sexually abuse. Until recently, Colorado statutes stated that, “there is no cure for sex offending,” as though it were a disease instead of a preventable behavior. Likewise, by the time someone reads this blog, it is highly likely that they have heard the expression “once a sex offender always a sex offender.” Although even one sex crime is one too many, this study shows that short-term and intensive strategies for preventing sexual re-offense (such as high-quality treatment and sensible community supervision) are more likely to be effective than long-term, passive, and as-yet unproven methods such as Internet registries. 

Further, this study shows the opposite side of a familiar coin. Prisons and other forms of punishment do not actually reduce crime (Smith, Goggin, & Gendreau, 2002). However, time spent successfully in the community is associated with desistance from crime. Recent research has highlighted the success of many community-based programs and their emphasis on developing a balanced, self-determined lifestyle (Wilson et al, 2009). This study points to the importance of using treatment and supervision to expedite desistance-related processes (such as stability, staying occupied, having prosocial supports, and implementing plans for self-improvement) rather than simply as tools for monitoring behavior.

Human beings naturally default to detecting and managing risks in the short term.  Current research into assessment methods has helped us become even more adept at understanding and categorizing these risks. Developing effective means to ensure long-term public safety has taken longer. The most effective means for managing risks has presented far more challenges in our research and practice as well as the way we think about individual cases (such as Mike Tyson). Hanson and his colleagues’ findings point to the next steps we can take in supplementing our knowledge of risk with skillful reintegration.

As a final note, it is again important to note that not every crime is detected. However, it is noteworthy that these findings extend across all risk categories in a large sample and speak to the importance of allocating our most intensive resources to those who need them the most.

David S. Prescott, LICSW


Hanson, R.K., Harris, A.J.R., Helmus, L., & Thornton, D. (in press). High risk sex offenders may not be high risk forever. Journal of Interpersonal Violence.

Smith, P., Goggin, C., & Gendreau, P. (2002). The effects of prison sentences and intermediate sanctions on recidivism: General effects and individual differences. Research Report 2002-01. Ottawa, ON: Solicitor General Canada.

Wilson, R. J., Cortoni, F., Picheca, J. E., Stirpe, T. S., & Nunes, K. (2009). Community-based sexual offender maintenance treatment programming: An evaluation. (Research Report R-188). Ottawa, ON: Correctional Service of Canada.

Friday, September 12, 2014

The international dimensions of sexual abuse

Sexual and interpersonal violence are global issues with the capacity to affect anyone regardless of cultural, gender or social background. This means that sexual and interpersonal violence are part of the human condition as opposed to being specific to any given society. Although, how we prevent, discuss, report, treat, punish and reintegrate in respect to sexual offending will differ based upon geographical location as well as social context (ESRC Online Debate 4). We are starting to see an increase in the awareness of the reality of sexual abuse that transpires intentionally (i.e., in India and the recent revelations about ISIS). Recently UNICEF released a report on the degree of sexual and interpersonal violence globally based on data from 190 countries (Hidden in plain sight). The data is collected for an array of existing national and international data sources, not from the creation or distribution of new surveys. This means that the data is an accumulation of what we already know and therefore is not necessarily as up to date or rigorous as it could be. Important factors to keep in mind when examining this type of report, or data set, are that;

-           the same data was not available for all 190 countries, so the more developed and data driven the country is the more it will be represented in the report;

-          different countries record data at different points and in different ways;

-          there are different terms, categories and definitions of sexual abuse used in different countries;

-          there are different cultural barriers or sensitivities surrounding the discussion of sexual abuse in general, but particularly in regard to certain types of sexual abuse (i.e., male rape) and the gender of victims (i.e.., girl and female sexual victimisation as opposed boy and male victimisation).

The data presented in the UNICEF report therefore comes with its own health warning; it is a snapshot of the current global picture of sexual and interpersonal violence, not the complete picture. The key data is available in the report, but I would like to focus on the sexual abuse data specifically (see chapter 4 of the report for more detail);

-          Sexual abuse against children is not just limited to girls but that boys are impacted too. The report indicates that boys are subject to sexual violence at a lower level than girls and that boys are an under recognised population in respect to sexual abuse victimisation (reinforcing a recent comment by Barnardo’s - independent).

-          In the countries where data was available the majority of children who were victims of sexual abuse where aged between 15 -19 at the time.

-          In the countries where data was available the majority of children who were victims of sexual abuse the perpetrators was an intimate partner or someone known to them.

-          In the countries where data was available the majority of children who were victims of sexual abuse reported that the abuse occurred in everyday locations (i.e., the victim’s home, the home of the perpetrator, home of another known person or on route to a familiar location with a known person).

-          In the countries where data was available the majority of girls (15 – 19) who were victims of physical violence where not necessarily victims of sexual violence in tandem; however, girls who reported being victims of sexual violence also reported physical violence. This shows a complex correlation but not causality.

-          In the countries where data was available physical violence against boys (15-19) outweighed both sexual violence against boys as well as sexual and physical violence against boys combined.

-          The report indicates that victims of childhood sexual abuse delay in disclosing their victimisation, if they ever disclose at all. The reasons for this delayed, or lack, of disclosure includes fear of reprisals, feels of guilt and/or shame, lack of confidence and lack of awareness of support services available to them.

-          The report indicates that in some countries girls (15 – 19) are less likely to seek help and support than adult women, with boys and men seeking less help across the board than girls or women.

-          In respect to online sexual victimisation the report indicates that children are continuing to become more internet savvy, that children feel more comfortable in sharing inmate information online and feel safer online than previous generations. The report indicates that girls are more likely to be groomed online, that older children are more likely to be groomed online compared to younger children and that all children find it harder to differentiate online between “strangers” and “virtual friends”.

-          The report highlights a recent shift in terminology with many governments adopting “child abuse images” as opposed to “child pornography”.

-          The report highlights a recent increase, as reported by governments, in the volume and variety of images, recordings as well as the live streaming of child sexual abuse.

The data in this report reinforces what we already know from the academic literature and the government statistics about the prevalence as well as reporting of sexual abuse. In doing so the report reinforces that sexual abuse is a global issue and that the same types of sexual abuse problems arise globally regardless of location and/or culture. Hence, the issues surrounding child sexual abuse that we deal with on a day to day are not just western issues (albeit the specificity of them maybe) but global ones. The report comes with an additional document highlighting six strategies for action in responding to violence against children, including sexual abuse, which highlights the need for changing social norms, better education and support (for children, families and caregivers) as well as the need for better evidence based policy. These strategies are things that we can sign up to and are already doing in our own work, but what the report does is remind us that we need to be discussing these issues and sharing good practice internationally.

Kieran McCartan PhD

Friday, September 5, 2014

Got Prevention? The California Coalition Against Sexual Assault Certainly Does!

The California Coalition Against Sexual Assault (CALCASA) has a story worth telling about the power of collaboration and preventing sexual abuse. It started in 1980 when rape crisis centers from across California joined forces to create a unified voice of advocacy for survivors – the result was CALCASA, a true coalition and voice for prevention.  With a primary focus on the prevention of sexual abuse, CALCASA has three and a half decades of commitment to ending sexual violence through a multifaceted approach of prevention, intervention, education, research, advocacy and public policy. While so many rape crisis centers around the US struggle in isolation, CALCASA is an example of what can happen when the right people get together to create positive change.

I recently had the opportunity to discuss sexual abuse prevention with David Lee, M.P.H. – CALCASA’s Director of Prevention Services and a member of ATSA.  With over thirty years working within the field, David definitely understands the history, obstacles and successes within the field of sexual abuse prevention. Although his professional prevention work began in 1982, his interest in prevention started in his youth due to his mother’s involvement in the early battered women’s movement.  He described a direct impact from his mother’s work as she imparted the clear message to her sons that violence against women was an important topic and that we all needed to be part of the solution – a message and belief David has incorporated within his life and shares with others through his work with CALCASA.  David leads CALCASA’s team in providing training and technical assistance on sexual abuse prevention to rape crisis centers throughout California, while also extending  CALCASA’s influence at the national level through PreventConnect, the nation’s leading online community to advance primary prevention of sexual and domestic violence (Kaufman, 2010).

PreventConnect is truly a unique resource provided by CALCASA as it is nationally focused and an example of the strength of multi-disciplinary collaboration. Supported by the Ms. Foundation for Women and the Centers for Disease Control and Prevention (CDC), PreventConnect is an online community of people who are committed to the prevention of sexual and domestic violence, and is based on the ideology that we can all learn and share together to facilitate prevention.   PreventConnect provides guidance, support, and tools to those who provide direct services within the field of sexual abuse prevention in order to increase the skills of individuals undertaking all levels of prevention work (Smallbone, 2008).  Utilizing various forms of online media to connect people and ideas, PreventConnect explores issues and highlights efforts to:

·         Stop sexual assault and relationship violence before it starts,

·         Engage communities in preventing sexual assault and relationship violence, and

·         Build upon the strengths of the rape crisis and domestic violence movements, public health and other prevention efforts to create social change.

Working within the field of sexual abuse prevention can be difficult and isolating at times – PreventConnect provides a distinct opportunity for national collaboration, support, and guidance, all things that can benefit and strengthen the many ways in which we work towards prevention of sexual abuse. PreventConnect activities include the Power in Prevention web conference series that highlights efforts to prevent child sexual abuse, as well as web conferences, blogs, wiki, and podcasts which share the voices of those doing prevention and provide resources and research, as well as experiences, about prevention work.  Additionally, as primary prevention research is in its infancy, PreventConnect is a place to collectively discuss and learn about new strategies within a multi-disciplinary arena (CDC, 2004).  Click here for information about the PreventConnect email group.

Sexual abuse is a complex public health issue that impacts us all – individuals, communities, institutions and society as a whole (ATSA, 2014).  CALCASA and PreventConnect are strong examples of an organization dedicated to addressing sexual abuse as a public health issue, thus directing our efforts on prevention of sexual violence before it is perpetrated. As a leading example of collaboration and innovation, we can all learn from the multidisciplinary opportunities CALCASA and PreventConnect provide.

For more information about the prevention of sexual abuse, please see:

·         Sexual Violence Preventionauthored by David Lee, Lydia Guy, Brad Perry, Chad Sniffen, & Stacy Mixson

·         Sexual Violence Prevention Fact Sheet (ATSA)

·         ATSA Prevention Committee – www.atsa.com/prevention-education  

Katie Gotch, MA


ATSA Fact Sheet.  Retrieved August 2014.  http://www.atsa.com/sexual-violence-prevention-fact-sheet


Centers for Disease Control and Prevention. Sexual violence prevention: beginning the dialogue.

Atlanta, GA: Centers for Disease Control and Prevention; 2004.


Kaufman, K. (2010). The prevention of sexual violence: A practitioner’s sourcebook. Holyoke, MA: NEARI Press.


Smallbone, S., Marshall, W. L., & Wortley, R. (2008). Preventing child sexual abuse: Evidence, policy and practice. Cullompton, Devon, UK: Willan Publishing.