Coalinga State Hospital

About the facility

The state began construction on Coalinga State Hospital in the fall of 2001. According to the hospital's official Web site, CSH has 1.2 million gross square feet (gsf) of floor space. This includes 900,000 gsf for clinical services and programs, 158,000 gsf for support services, 75,000 gsf for administration, and 67,000 gsf for plant operations.

Instead of calling the population housed at CSH "patients" or "inmates," hospital policy is to call them "individuals" because they are civilly-committed. Staff are supposed to address the individuals by their last names (i.e., Mr. Jones) to maintain professional boundaries. Several SVP patients identify as Transgender and are supposed to be addressed as Miss. However many staff address patients by last name only. Being natural manipulators, many patients have been successful in using their charms to get what they want. Patients have approached hospital staff to acquire drugs, trade goods, or sex. CSH provides extensive training for all new employees on how to manage and report manipulation during New Employee Orientation (NEO) and yearly dunning Annual Review Training (ART) .

The hospital is located at the edge of the Coastal Mountain Range in the heart of California just outside the City of Coalinga. It is next to Pleasant Valley State Prison.

The land the hospital is built on is part of Pleasant Valley Prison. An agreement between California Department of Corrections and Rehabilitation and the then named California State Department of Mental Health, allowed to facility to be a stand alone facility, but to allow several outside security positions be manned by CDCR officers. These positions are the security towers, security berms, outside security patrol, staff entrance and vehicle sally port. State Hospital Police Officers also have an outside security patrol, help out at the sallyport, and conduct police, investigations, and security operations inside the secured area ("inside the wire")

The hospital uses a five-phase treatment program for SVPs that was developed when SVPs were treated mostly at Atascadero State Hospital. The rigorous program focuses on helping SVPs manage their impulses, take responsibility for their actions, and gain a realistic perspective on their crimes and victims. The hospital has recreational facilities including a gym, softball field, arts and crafts, graphic design room, woodworking opportunities, and a music room. Individuals are allowed to purchase electronic goods, rent DVDs, and other perks with a token economy system called the "By Choice" program. This system is designed to reward positive behaviors, which are designated by each individual's treatment team. Up to 100 points can be awarded per day (a bar of soap sells for 500 points in the point exchange store). The annual operating budget of CSH is $152 million (or $157,894 per individual).

Intake and occupancy

In California all prisoners convicted of sexual assault or child sexual abuse are flagged and reviewed six months prior to parole. To be classified as a SVP, an individual must have at least one identified victim, have been diagnosed with a serious mental illness (most commonly paraphilia NOS or pedophilia), and must have established a relationship with a person with the intent to cause victimization. Paraphilia NOS is a catch-all diagnosis used to describe most individuals who have committed sexual assault (i.e., rape). Prior to parole, the designation of SVP is assessed by two independent evaluators (licensed mental health professionals). If both evaluators agree that the prisoner meets the criteria, he is sent to CSH for treatment. If one agrees and the other does not, an additional two evaluators review the prisoner's history. If those final two reach agreement, the prisoner is considered a ward of the state and civilly committed to CSH.

Evaluations of current and potential "SVPs" are inconsistent, and there is no standard protocol used to determine whether those being assessed meet the criteria for confinement. Evaluators lack clinical supervision and training, and Coalinga has a significant backlog of annual evaluations that violates the rights of patients.

California law allows SVPs to be committed to the hospital indefinitely (under Jessica's Law) while they are receiving treatment. It was believed that holding the sex offenders indefinitely at the mental hospital would prevent them for committing additional sex crimes. But treatment is in short supply. Significant treatment at Coalinga is rare. Moreover, 80% of sexual offenders have refused therapy. Three-quarters of CSH's 850-plus detainees refuse to participate in a core treatment program, undermining a central piece of Coalinga State Hospital's purported mission. The vast majority refuse to participate beyond the first phase of a five-phase therapy regimen. Only 25 to 30 percent of sexually violent predators consent to participate in the active phases of California's sex offender treatment program.

Treatment is intensive, and requires admission of guilt and the use of institutionally mandated language, as well as polygraph and phallometric testing. As of November 2007, 26 of the 37 budgeted staff psychiatrist positions were vacant. Some inmates camped out to get to see a clinician. As of April 2009 the facility had released only 13 inmates in its history.

Most detainees at Coalinga have little hope that they will ever be released. Critics say California's sexually violent predator program looks more like upscale incarceration. There's a growing sense among detainees that they have been effectively railroaded into a life prison term.

"It's hopeless," said one detainee, who was sent to Coalinga after serving a prison term for committing a lewd and lascivious act. "This is a therapeutic setting, supposedly. But it's nothing more than a mock-up prison. They can call it what they want. But it's prison." Civil commitment for sexual predatory acts is, as a practical matter, a life sentence.

A federal judge ruled a similar program in Minnesota to be unconstitutional. A British High Court ruled that California's involuntary commitment law violated human rights, that the punishments violated the European Convention on Human Rights, and refused to extradite a man based on the risk that he might be committed to Coalinga.

Representation in other media

Filmmaker Louis Theroux directed a BBC television documentary based on Coalinga Hospital; it is entitled A Place for Paedophiles (2009), showing the lives of convicted pedophiles who are indefinitely incarcerated at the hospital. The one-hour program first aired on BBC Two in the United Kingdom on 19 April 2009, and in Australia in December 2012, as the seventh in a series of Theroux specials. This special will not be shown in the United States. Patient health care laws, primarily the Health Insurance Portability and Accountability Act (HIPAA), forbid the disclosure in the US of a person's illness (including mental health issues) without their consent. These laws only apply within the U.S., so that is why the show is allowed to be shown outside the U.S.