In 1990, the state of Washington passed a law that allows for the civil commitment of sex offenders. Civil commitment, as it relates to sex offenders, is when a state retains custody of an individual, found by a judge or jury to be a "sexually dangerous person," by involuntarily committing the person to a secure mental health facility after the offender's prison sentence is done. The state of Washington law requires the state to prove that such offenders suffer from a mental abnormality or personality disorder that would make them likely to engage in predatory acts of sexual violence unless they are confined. The law allows for civil commitment after an offender completes a prison sentence for his or her crime(s). Since 1990, 19 states have passed similar legislation, and in 2006, Congress passed legislation ( P.L. 109-248 ) that allows the Attorney General to civilly commit federal inmates who are found to be sexually dangerous persons. Every state has "civil commitment" laws that allow for the involuntarily hospitalization of people with serious mental illness. Generally speaking, people can be civilly committed when they are a danger to others. When a person's symptoms begin to remit, the individual is discharged and typically referred to aftercare services. Hospital stays for individuals under a civil commitment order for mental illness rarely exceed 30 days. However, in this report, "civil commitment" refers to civil commitment laws targeted at the hospitalization or commitment to a secure institution of "sexually violent persons" after they are released from prison. With respect to sex offenders, civil commitment laws allow states, and now the federal government, to civilly commit sexually dangerous persons. For the most part, discussions about sexually dangerous persons treat sex offenders as a homogenous group, sometimes making a distinction between "rapists" and "child molesters." However, sex offenders are a heterogeneous group of offenders; under many state statutes, sex offenses range from rape to child molestation to exhibitionism. An issue for Congress is whether civil commitment is a sustainable policy for dealing with sexually dangerous persons, or whether there is a different way to manage this population effectively. The issue of civil commitment raises a series of concomitant questions: How much do civil commitment programs cost? How dangerous are sex offenders? Is sex offender treatment effective? Can sexually dangerous persons be defined and identified? Are there less restrictive alternatives for managing sex offenders? This report begins with an outline of the history of civil commitment laws, followed by a review of two cases, Kansas v. Hendricks and Kansas v. Crane , in which the Supreme Court addressed constitutional issues involving civil commitment. This review is followed by a summary of the recently enacted legislation governing the federal civil commitment program. The report then discusses research on sex offender recidivism and treatment. It concludes with an evaluation of some of the issues surrounding civil commitment. This section describes the history of civil commitment laws in the United States, two Supreme Court rulings on the constitutionality of civil commitment programs, and a description of the federal civil commitment program. With respect to sexually dangerous persons, current civil commitment laws are a reincarnation of what are generally referred to as "sexual psychopath" laws. Beginning in the 1930s, states started to enact sexual psychopath laws, which grew out of the rehabilitative ideal that characterized the American criminal justice system at the time. By the mid-1960s, more than half of the states in the country had enacted some form of sexual psychopath laws. Sexual psychopath laws reflected the growing belief that sexual psychopaths could be identified and treated. The influence of psychiatry on sexual psychopath laws can be seen in the four presumptions on which the laws were based: (1) sexual psychopaths are distinguishable from generic sex offenders, (2) individuals commit sex offenses because of mental disease, (3) mental diseases are treatable and curable, and (4) mental health professional can successfully predict who will commit sex crimes in the future. Sexual psychopath laws were designed to offer alternatives to prison for sex offenders and to prevent further harm to other members of society by incapacitating the offender. After a court found an offender to be a sexual psychopath, the offender was sent to a mental health facility for control and treatment in lieu of imprisonment and punishment. Sexual psychopath laws targeted offenders who were not seriously mentally ill (thus, not making them candidates for traditional civil commitment) but who were believed to have a "psychopathic personality" that caused their criminal behavior. Starting in the 1970s, many of the sexual psychopath laws were repealed, modified, or abandoned. Many states eventually abolished sexual psychopath laws because of criticism from the Group for the Advancement of Psychiatry (GAP) and the American Bar Association's (ABA's) Criminal Justice Mental Health Standards. Such criticism contended that labeling offenders as sexual psychopaths lacked scientific merit, the treatment of sex offenders was ineffective, and the prediction of future offending was suspect. In 1977, GAP stated that First and foremost, sexual psychopath and sexual offender statutes can best be described as approaches that have failed. The discrepancy between the promises in sex statutes and performances have rarely been resolved.... The notion is naive and confusing that a hybrid amalgam of law and psychiatry can validly label a person a "sex psychopath" or "sex offender" and then treat him in a manner consistent with a guarantee of community safety. The mere assumption that such a heterogeneous legal classification could define treatability and make people amenable to treatment is not fallacious; it is startling. There was growing intolerance for the idea of treating sex offenders after a series of treated and released sex offenders committed additional sex crimes. Beginning in the 1970s, states started to adopt a more traditional criminal justice model for managing dangerous sex offenders, such as incarcerating sex offenders instead of placing them under the supervision of mental health institutions. Starting in the 1990s, some states passed legislation reminiscent of the old sexual psychopath laws. In 1990, Washington became the first state to pass a new sexual predator civil commitment law. Other states passed similar legislation since that time. As of June 2007, 19 states have sexual predator civil commitment laws. Each state had its own impetus for passing its civil commitment law, but generally speaking, the reasons for enacting such laws are similar. In many states, the laws were passed in response to a particularly heinous sex crime. The change in the 1970s and 1980s in most states from an indeterminate to a determinate sentencing structure allowed some sex offenders to be released from prison after a relatively short period of incarceration. There was also a growing change in societal attitudes and behavior towards violence against women. In addition, general civil commitment laws were considered inadequate to confine sex offenders who were considered dangerous. General civil commitment laws required proof of serious mental disorder (such as schizophrenia) and recent behavior indicating that the individual was dangerous. Many states could not commit sex offenders under general civil commitment laws because the state could not demonstrate that such offenders (1) had a medically recognized mental disorder and (2) had engaged in recent behavior that proved that they were dangerous (the population in question was usually incarcerated, which limited offenders from engaging in sexually dangerous behavior). Generally, civil commitment laws that target sexually dangerous persons have a similar structure. They require (1) proof of a past course of sexually harmful conduct, (2) a current mental disorder or "abnormality," (3) a finding of risk of future sexually harmful conduct and, (4) some connection between the mental abnormality and the danger. Although similarities exist between the old sexual psychopath laws and civil commitment laws, they vary in some key aspects. Rather than providing an alternative to imprisonment, civil commitment laws require sex offenders to be committed after they complete their terms of incarceration. Also, civil commitment laws do not require an allegation or proof of recent criminal, dangerous, or inappropriate behavior or deteriorating mental state before the state can seek commitment. Civil commitment laws have been both politically and legally contentious because they allow sex offenders to be confined after their criminal sentence is completed. Moreover, some members of the psychiatric community have challenged the validity of the legislatively created definition of "mental abnormality." For example, the Washington State Psychiatric Association (WSPA) testified before the Washington State Legislature when it was considering civil commitment legislation. One psychiatrist who testified on behalf of the WSPA noted that a psychiatrist's definition of "mental disorder" includes the loss of contact with reality, confusion, loss of reason, and hallucinations. Some sex offenders, however, do not demonstrate any of these behaviors. According to the WSPA, the issue is not "mental disorders," but rather "abnormal behavior." Persons who have committed more than one sex offense are assumed to be depraved or sick, or to have some type of mental abnormality or personality disorder that makes them likely to re-offend. Several offenders have attempted to challenge their civil commitment in court. Civilly committed offenders argue that civil commitment laws are unconstitutional because they allow offenders to be committed after they have completed their sentences, even if they do not suffer from a medically recognized mental disorder. Two legal challenges to civil commitment laws have made it to the United States Supreme Court, Kansas v. Hendricks and Kansas v. Crane . In Kansas v. Hendricks , the Supreme Court considered constitutional challenges to the Kansas Sexually Violent Predator Act, which was enacted to address the issue of repeat sexual offenders. Although Kansas law already contained a provision for the confinement of the "mentally ill," the Kansas legislature found that this statute was inadequate in its application to sex offenders. According to the Act's preamble: [A] small but extremely dangerous group of sexually violent predators exist who do not have a mental disease or defect that renders them appropriate for involuntary treatment pursuant to the [general involuntary civil commitment statute]....