Coalinga State Hospital

Coalinga State Hospital is a state mental hospital in Coalinga, California.

The facility opened on September 5, 2005 and was California’s newest state hospital, the first to be constructed in the state in more than 50 years. It is a maximum security civil-commitment facility built to ensure that sexually violent predators stay out of the community. Currently, the hospital houses 850 sexually violent predators (SVPs) and 100 mentally disordered offenders. The hospital previously housed fifty mentally ill prisoners from the California Department of Corrections and Rehabilitation (CDCR) and still maintains the contract and resources to house this forensic population, but the California Department of Mental Health aims to designate CSH as a civil-commitment facility only. The SVPs are men who fall under the sexually violent predator (SVP) laws (first Megan's Law and later Jessica's Law), where the men are deemed too likely to reoffend to be released and are housed indefinitely at the hospital until they are deemed no longer a danger to the community. Less than 1% of the 100,000 registered sexual offenders in the state of California fall into the SVP category. Thus, Coalinga State Hospital houses the worst of the worst.

Treatment is offered, but is not required. Approximately 1/3rd of individuals accept California's sex offender treatment. The hospital has a 1,500 bed capacity (as of August 2010 the hospital is 63% full). The median age of SVPs is 47.1 and this is expected to increase as the hospital's population continues to age.

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 address the individuals by their last names (i.e., Mr. Jones) to maintain professional boundaries. This is because many of the charms that allowed the offenders to compromise their victims are also used on hospital staff to acquire drugs, trade goods, or sex. CSH provides extensive training for all new employees on how to manage and report manipulation.

The hospital is located at the edge of the Coastal Mountain Range in the heart of California just outside the City of Coalinga, nestled up against the adjacent Pleasant Valley State Prison. Coalinga is located ten miles west of Interstate 5. It is four hours north of Los Angeles, three hours south of San Francisco, and about one hour southwest of Fresno, California's sixth largest city.

The hospital uses a five-phase treatment program for SVPs that was developed when SVPs were still mostly all treated at Atascadero State Hospital. The rigorous program focuses on helping SVPs manage their impulses, take responsibility for their actions, and see their crimes and victims from a realistic perspective. The hospital also 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 rewarded 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 with sexual assault or pedophilia crimes are flagged and reviewed six months prior to parole. To be labeled under the category of SVP an individual must have at least one identified victim, have 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 then a ward of the state and civilly committed to CSH.

Currently, California law allows SVPs to be committed to the hospital indefinitely (under Jessica's Law) as long as they are receiving 'treatment'. 70% of the 850-plus SVP individuals refuse treatment, which 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, with some inmates having to camp out waiting for a clinician to show up. As of April 2009 the facility had released only 13 inmates in its history.

Louis Theroux BBC documentary
The hospital formed the basis of a Louis Theroux BBC television documentary entitled A Place for Paedophiles, in which the lives of once convicted paedophiles are documented, whilst being indefinitely incarcerated at the hospital until further notice. The hour long programme aired for the first time on BBC Two in the United Kingdom on 19 April 2009, as the seventh in a series of Theroux specials.

A documentary designed for American audiences is currently in production by "Inside Edition."