A senior policeman has suggested that we are prosecuting too many people for watching images of child abuse.

Simon Bailey, the chief constable of Norfolk Police who leads on child abuse for the Association of Chief Police Officers (Acpo), says most people who look at indecent images of children online do not go on to abuse children.

He thinks it makes more sense to give these people access to medical treatment rather than dealing with them in the courts.

The implication is that they are suffering from a mental illness and can be helped or even cured by doctors.

Predictably, some people are angry about the prospect of treating people who watch child abuse like patients rather than criminals.

But could Mr Bailey be right?

 The analysis

There are really two big questions here: is everyone who looks at child abuse images online (experts hate the phrase “child pornography”) a paedophile?

And if we are talking about paedophilia, is it a medical condition that will respond to treatment?

The risk

Mr Bailey has said that between 16 and 50 per cent of people who have viewed indecent images of children are likely to carry out “contact abuse” of children.

Acpo told us that figure comes from a systematic review of existing academic research. They haven’t made their analysis public.

But there are other academic reviews of the evidence out there.

Canadian expert Michael Seto found that recidivism rates for internet sex offenders were low. Looking at nine groups of convicted internet sex offenders after an average of three-and-a-half years, 3.4 per cent had been rearrested, charged or convicted with a new internet offence and 2.1 per cent went on to abuse a child.

Of course some offences will go unrecorded, but the data “belie the idea that online child pornography offenders are very high risk to reoffend”.

Professor Seto noted: “In particular, first-time child pornography possession-only offenders appear to be very low risk of sexual recidivism.”

Proof of paedophilia?

The paper also states that not everyone who looks at child abuse images is actually a paedophile.

Looking at extreme material could be “just one part of a pattern of risky behaviour” or a symptom of wider addiction to internet pornography.

Heather Wood, a consultant adult psychotherapist at the Portman Clinic, a NHS centre in London that treats sex offenders, agreed that many people who look at abuse images start off using adult pornography heavily before seeking out more and more extreme websites.

She said it is “absolutely not the case at all” that everyone who looks at child abuse images has a pre-existing sexual interest in children.

While some people who look at images will want to act out their fantasies in reality with a child, others “wouldn’t dream” of doing so, she said.

Stop it Now! – a helpline offering advice to people who have sexual thoughts about children – reports that the numbers of people who call about online offending have gone up more than tenfold in 10 years.

Director Donald Findlater told us most people who end up looking at child abuse images online start with adult pornography.

“From my experience, of those who come to police attention, I would say that for seven out of 10 of them, their journey did not start with child images.”

What is paedophilia?

According to the US Diagnostic and Statistical Manual of Mental Disorders, paedophilia is a psychiatric illness – a “paraphilic disorder”.

And clinicians around the world try to treat paedophiles, using various psychological techniques and even drugs designed to dampen sexual impulses.

But what if paedophilia is a permanent sexual orientation, not an illness. Will attempts to cure people of their urges be doomed to failure?

The most compelling evidence for this position comes from the work of Canadian psychiatrist Dr James Cantor.

He thinks paedophiles are physically different from other people. MRI scans reveal they have less white matter in certain regions of the brain.

It sounds bizarre, but the data suggests that paedophiles are more likely to be short, to not be right-handed, to have a low IQ and to have suffered a childhood head injury.

All of this points towards that a minority of people may be born with a hard-wired sexual interest in children – “a medical condition, rather than a moral failing”, according to Prof Cantor.

But clinicians who work with paedophiles say the reality may be more complicated.

Dr Wood told us: “My view is that we have got stuck with a dichotomous notion of paedophilia – someone either is or isn’t a paedophile.

“What the internet has made absolutely clear is that it is a much more variable phenomenon. Some people can have what we might call fleeting paedophilic interests in a mostly adult sexual orientation.

“I think that for some people it is more like a sexual orientation. It is unlikely to change completely, though people can be helped, through treatment, not to act out their fantasies.

“Then there are some people who have much more transient or fleeting paedophilic interests. There are people who can be helped considerably in treatment – people who are distressed about it and don’t want to be a paedophile.”

The verdict

We can’t exactly check Mr Bailey’s figure of 16 to 50 per cent of people looking at child abuse images online going on to molest a child. But from the research that we have seen, that number might be on the high side.

So there might be a risk-based argument for not prosecuting everyone caught looking at child abuse images (the moral argument is a different matter).

But what do we do with them instead? The jury is still out on whether paedophilia is an illness that can be cured.

Psychologists say they can help people with a sexual interest in children, though it’s striking that most of the talk is of teaching people to control their urges rather than “cure” them of those feelings in the first place.

If we agree that treatment on the NHS is a good idea, we will need a lot more investment in specialist services.

Stop It Now! offers in-house advice and support to growing numbers of convicted and potential offenders.

But for people who need intensive therapy, NHS services are patchy.

The Portman Clinic is so unusual that it takes patients from around the country and “we desperately need more” places like it, according to Heather Wood.