MAUSTON -- The older man sitting quietly by himself at a table doesn't want to give his name or answer a reporter's questions, but he readily agrees to a photograph, shot from a discreet distance.

On this recent morning at Sand Ridge Secure Treatment Center, his top priority seems to be the 1,000-piece jigsaw puzzle he's working on so intently.

And if he wants to spend the rest of the day putting it together, no one here is going to stop him.

Patients can mostly do what they want with their time at Sand Ridge, a 300-bed prison/hospital slated to double its capacity at a cost to state taxpayers of $37.5 million by 2011.

Despite the program's mission as a treatment center for convicted sex offenders, no one here has to participate in treatment -- and even the roughly 84 percent who do typically get no more than six hours a week of it, officials said.

That's up from the two hours of sex-offender treatment a week that was standard until recently. And even that, according to staff, is too much for some of them.

"Some can't focus for two hours in a row," said Steve Watters, director of Sand Ridge.

Long list of victims

Offenders are held at Sand Ridge indefinitely, after serving their prison sentences, in an expensive civil commitment program that critics note has produced relatively few releases -- including just 12 permanent discharges -- due to treatment success since it started in 1994. A total of 372 offenders have been committed over the years.

Sand Ridge data show the average patient is a white, middle-aged pedophile who has never married and has only a high school degree or its equivalent. He (all of them have been men) is likely to have a long history of sexual offenses, often with many more victims than those identified through the court process.

"For some of them, (to stop offending) would be like telling you or me to stop eating," Watters said. "There are guys here who would clearly belong to NAMBLA (the North American Man/Boy Love Association) if they could."

Watters said most patients at Sand Ridge are not among the state's most physically violent sex offenders, despite being labeled "sexually violent persons" by the state. Center records show few assaults or other criminal problems inside Sand Ridge, with just 39 incidents -- mostly minor -- since it opened in 2001.

But the patients are considered very likely to reoffend if released, Watters said, and they pose a host of challenges to treatment providers because they tend to have many problems beyond their affinity for committing sex crimes.

Many patients unreachable

For example, about 20 percent of Sand Ridge patients are either mentally disabled or have a severe mental illness such as bipolar disorder or paranoid schizophrenia. Those are major illnesses beyond the lower-level "mental disorder" -- such as pedophilia or anti-social personality -- that triggers most commitment proceedings.

Histories of drug and alcohol abuse are common.

Many patients are angry about being committed, some may have little interest in change and most have failed to respond to earlier treatment, officials said.

Also, nearly 43 percent of patients score high or very high on a test for psychopathy, which is marked by a tendency to be manipulative and dishonest. Commonly known as sociopaths, these individuals may have trouble with a treatment regimen that requires them to be truthful, self-aware and sensitive to the feelings of their victims.

All those problems explain why up to half of Sand Ridge's patients may never lower their risk enough to be eligible for supervised release, said Sand Ridge Treatment Director Dr. David Thornton. For others, release is possible but may take many years, he said.

"It's not like going to the hospital to have your appendix out," Thornton said. "It's more like trying to lose weight. It requires a lifetime of self-discipline."

Baby steps and setbacks

During a recent tour, most of the Sand Ridge patients -- some taking part in treatment classes and others just walking, talking or playing cards with friends -- seemed unfazed by visitors.

Protected by state and federal medical confidentiality laws, none of them want to give their full names, and center staff can't share specific information about them with anyone but the court system, Watters said.

In the advanced housing unit, a patient named Ed said he was making progress with his treatment after more than six years. His success has earned him a slightly nicer room, with just enough space for his TV and a keyboard he can play while he waits for his annual petition for release to be considered.

"You learn something from everything," he said. "I had a couple of downfalls. They're pretty helpful around here. It depends on how you approach it."

Like many other patients, Ed's progress wasn't linear, with setbacks for unspecified reasons. Staff said patients can be moved backward in the program for discipline problems or for not being able to master the material.

In the intermediate wing, a young patient named David was recently moved back, though he doesn't seem bothered by it.

With childlike enthusiasm, he points to the signs in his room that housing staff helped him make. They are designed to inspire him and list among his "strengths" that he is an "excellent speller" and "excellent reader."

Best treatment available

Sand Ridge staff said they believe the program is serving its purpose as long as it offers the best available treatment, regardless of whether every patient is willing or able to complete it.

Each fall, the center is visited by a treatment advisory board it created that closely reviews operations and is made up of sex-offender experts from North America and Europe, including Bob Hare, a professor of psychology at the University of British Columbia and considered the world's foremost expert on sociopaths, Watters said.

The board serves as a sort-of national accrediting board for Sand Ridge in the absence of any official body to set standards or oversee such treatment, despite its growing use in 19 states.

Center staff appear to take the advisory board's recommendations seriously. The bump up in treatment hours, for example, was the board's idea.

To be considered officially "in treatment" at Sand Ridge -- which is the only way most of these men stand a chance of ever being released -- a patient must take 15 hours of "meaningful activities" a week, including any specific sex-offender treatment.

Other classes cover substance abuse, occupational therapy and practical skills designed to prepare patients for life on the outside, including how to balance a checkbook or follow a recipe, said Lloyd Sinclair, the associate treatment director.

Getting to the source

In its sex-offender treatment, Sand Ridge uses a form of therapy aimed at helping patients understand where their deviant thinking comes from, staff said, so they can correct it and learn to make proper choices.

For many patients, Thornton said, committing sex crimes is a perverse crutch for anything that goes bad in their lives, their knee-jerk response to feeling sad, hopeless or frustrated.

"Many of these guys have lived very miserable lives," Thornton said. "Sex offending was the only thing they enjoyed."

As part of therapy, many patients also take common depression drugs because they can damp down negative moods and reduce sexual desire. A few patients -- just three to five, Watters said -- have been chemically castrated at their own request.

Doctors are reluctant to allow the procedure because the testosterone-lowering drugs used have serious physical side effects, including significant osteoporosis, Thornton said. It also ceases to be effective if a person stops taking the drugs, and even on the drugs, offenders could still commit assaults with an object, he noted.

Staff gauge progress in a variety of ways, including having patients submit to polygraph tests and using an instrument known as a penile plethysmograph to measure physical arousal.

Complete community

Beyond therapy, the center offers patients a small gym and library, a chapel and rooms for music and crafts.

Outside, they can use a walking track and baseball diamond, along with large swaths of yard for gardening, a very popular hobby that will lose space during the planned expansion. Physical exercise is important, Watters said, especially with an aging patient population afflicted by cancer and cardiac illnesses.

The center also has a 25-bed skilled care unit to house very old or very sick patients. It boasts the only rooms with air-conditioning.

Many patients -- 91 percent -- also work up to nine hours a week at jobs around the center including kitchen worker, custodian and tailor. Sinclair said having to show up for work at a set time and follow instructions is good training for the patients, who are paid up to $2.50 an hour.

Located on a 65-acre site, Sand Ridge is a self-contained operation, with 430 employees including therapists, psychologists, food service workers, nurses, teachers and a dental hygienist.

Sharon Patrick, a social worker in the State Public Defender's Appellate Division in Madison, said staff members at Sand Ridge are "well-meaning" and doing the best they can in a tough situation.

But Patrick, who also serves on Sand Ridge's steering committee, opposes the commitment program, saying most patients should be released to live and work in the community under strict supervision.

"If anything, they're over-socialized (at Sand Ridge)," she said. "We really need them to be contributing. We're providing these guys with a free lunch here. And my worry is that the longer they're in this institution, the less they're going to want to get out."

Similarly, Richard Ganzel, the father of a former Sand Ridge patient now in prison on a parole violation, said he believed commitment was just an excuse to keep offenders locked up.

"It makes people happy to get (sex offenders) out of sight, to warehouse them somewhere," said Ganzel. "They're spending so doggone much money on these programs and what are they getting out of it? Very, very little."

Thornton disputed that criticism, maintaining that the treatment program can produce "substantial changes" leading to release for patients who are "genuinely motivated to change."

"Is it easy to produce? No," he said. "Is it possible? Yes."

Committed to Limbo: Treating high-risk sex offenders

A two-part series:

Sunday: Since 1994, the state has spent millions of dollars a year confining and treating some of the state's worst sex offenders after prison. Yet, just 12 have met conditions for release through treatment. Is it worth it?

Today: Success in treatment is the ticket out. But the patients can't be forced to participate in therapy -- often don't.