With its innocuous name, the Special Treatment Unit (STU) sounds like a hospital. It’s a building in Avenel, New Jersey, housing 441 “residents,” as it calls them. It has what state officials have described as a “comprehensive treatment program” with cognitive behavioral therapy delivered by mental health experts.

But the STU is actually a prison in all but name—it’s run by the state’s Department of Corrections and located on the grounds of the East Jersey State Prison. So-called residents live there involuntarily, often for decades on end, their lives controlled and regimented. That’s because the detainees in the STU were all convicted of sex offenses and deemed too dangerous to release, despite research showing that such assessments are often flawed.

Inside this small, harmless-sounding complex, at least eight individuals died of COVID-19 by the end of May. Two others have died since mid-March, but the causes haven’t been released. As of May 28, state officials confirmed 55 STU prisoners had tested positive, but prisoner Roy Marcum said on June 2 that he believes the number is about 70.

With at least eight deaths per 441 inmates, the STU has a higher death rate—by far—than any prison in America. Its death count is equal to that of all the prison complexes combined in California. Or all those in Arizona, Pennsylvania, or more than 14 other states, according to Bureau of Prison data. New Jersey ranks fourth in prison deaths due to the coronavirus (43 as of June 3).

Unlike in jails and prisons around the country, every individual in the STU has completed his criminal sentence. Some completed their sentences long ago and have been held in the STU since it opened in 1999. At least one of the eight people who died committed his crime more than 30 years ago, in the 1980s. Experts say America’s way of dealing with individuals convicted of sex crimes has long been cruel, unjust, and counterproductive. In the pandemic era, it’s become fatal.

Some prisoners have resigned themselves to their fate. Joshua Denisiuk, 26, was convicted for sex crimes he committed when he was just 15 and has been in the STU since 2013. He knows there is little he can do to avoid the coronavirus besides wash his hands frequently. “If I get it, I get it,” he said.

For centuries, the ideas behind a process called “civil commitment” have allowed authorities to involuntarily institutionalize individuals whom psychiatric experts believe to be incapable of caring for themselves. Beginning in the 1960s, civil commitment became used primarily to hospitalize people who were considered an imminent danger to themselves or others, for short periods.

But in 1999, New Jersey followed other states in enacting a Sexually Violent Predator Act. The law effectively permits state officials to indefinitely lock up people convicted of sex offenses who “are likely to engage in repeat acts of predatory sexual offenses.” When people around New Jersey convicted of sex offenses approach the end of their criminal sentences, the state’s attorney general can petition to hold them under the law. Once they’re in, they sometimes remain held there for the rest of their lives.

The American Psychiatric Association and many other health experts oppose civil commitment for individuals who have committed sex crimes, saying it lacks a scientific basis and violates core civil liberties. “Contemporary civil commitment measures grew out of interwoven panics concerning ‘stranger danger,’ satanic ritual abuse, and violent crime,” said the historian Paul Renfro, author of “Stranger Danger: Family Values, Childhood and the American Carceral State.” Renfro points to research showing that civil commitment does little to address sexual violence and that recidivism for sex crimes is actually lower than for other crimes.

But the Supreme Court has upheld the practice, and 20 states now have civil commitment laws for people classified by the state as sexually violent predators (SVPs), as does the federal government and the Bureau of Prisons. Approximately 5,400 individuals around the country—almost all men—are held under these laws.

As its name suggests, civil commitment is a civil procedure, not a criminal one. People held under these laws do not have the same legal rights as others in the justice system. They are held indefinitely, without potential release dates, living in limbo for years—sometimes for their entire lives. “Once you’re there, nobody wants to take a chance and release someone who’s been civilly committed,” said Russell, who requested that his last name not be used to avoid being harassed by his neighbors. He spent nine years at the STU before being released nearly a decade ago.

The underlying basis for civil commitment is the assumption that an individual who commits a sexual offense at some point in his life is an eternal risk to his community. Experts disagree.

“Nobody is a risk all the time,” said Maia Christopher, executive director of the Association for the Treatment of Sexual Abusers. Determining the risk level of individuals is critical, she added, but SVP laws are broad and severe. Once individuals are caught in the system, it’s difficult for them to get out. “There are very few ways for people to get acknowledged for positive behavior,” Christopher said.

In New Jersey, as elsewhere, so-called SVPs are kept in separate facilities from prison detainees. “They don’t consider you prisoners, but they treat you like prisoners,” said William Moore, who was in the STU for 15 years before being released in 2014 at age 65. The state does not have to prove beyond a reasonable doubt that an individual will commit a sex crime in the future—authorities just need to present “clear and convincing evidence” to a judge.

Some of the detainees, like Denisiuk, were convicted of crimes as children. He doesn’t participate in the treatment that is offered. He said his lawyer advised him against it, warning him that anything an individual said to a therapist or staff member in the facility can be used against him in a hearing. Rather than incriminate himself by saying the wrong thing, he hopes his case is resolved in court, and that he is eventually freed, since he already completed the sentence for the sexual assault he committed as a teenager more than 10 years ago.

People in civil commitment are at heightened risk of contracting the coronavirus because of age and poor health conditions. “We know that the death rate from COVID is higher among older individuals, and civil commitment disproportionately affects older individuals,” said Mike Mangels, a public defender who represents the STU residents. Since people in civil commitment have already served their sentences—sometimes lengthy—they are older on average than other incarcerated people. Since the pandemic started, they are afraid for their lives. “They have to watch as some of the people they have known for 10 years or more, in some cases, are carted out, never to be seen again,” he said.

Marcum, a 56-year-old who has been in the STU since 2000, told The Appeal and Type Investigations that as of last Saturday, 29 detainees were in isolation because they had tested positive for COVID-19. Detainees are now locked in their cells for more than 23 hours per day, he said, but for weeks state officials prohibited them from even wearing masks. Hand sanitizer was considered contraband until recently, according to detainees and news reports, and testing was slow and haphazard. “For a week I was getting a call just about every day that another person had died,” said Mangels, the public defender.

Liz Velez, a spokesperson at New Jersey’s Department of Corrections, said residents are not locked down and leave their cells for showers, phone calls and “passive recreation” such as playing board games and reading. “The STU [is] located in the northern region of the state—the region hardest hit by the pandemic.” Velez said. “Across all our facilities we’ve implemented various virus mitigation strategies from enhancing sanitization, ensuring access to sanitation products like soap and hand sanitizer, along with CDC education on proper hygiene and we also distributed masks to all inmates, residents and employees.”

The STU follows social distancing guidelines and anyone testing positive for the virus is placed in medical isolation with a well-trained team, she said, noting that the department was also providing on-site testing to residents and state DOC employees.

But concerns about the STU long predate the coronavirus. In 2016, detainees there filed a class-action lawsuit against authorities, alleging that conditions at the facility were “punitive.” Detainees “are entitled to considerate treatment” but were instead treated like “criminals whose conditions of confinement are designed to punish,” the suit noted, citing examples such as infrequent family visits and little or no educational, vocational or recreational activities.” Detainees, it added, “are being denied meaningful mental health care treatment that gives them a realistic opportunity for their conditions materially to improve.”

In response to COVID-19, group treatment programs in the STU, and around the country, have been canceled or scaled back. New Jersey’s Department of Human Services, which runs the mental health treatment at the STU, did not respond to a request for comment by publication time. But according to detainees, the most common form of treatment in the facility, group therapy, has been canceled since mid-March, which means individuals in civil commitment cannot even work to be among the few deemed worthy of release.

As of 2016, only 15 percent of prisoners at the STU were ever released. The rest exist in purgatory, made worse by the threat of coronavirus. “People are scared,” Marcum said. He is still hopeful that one day he’ll be released. “Less so as the years go by.”

Residents of the STU are eligible for furloughs in the community, but Velez said “no such trips have been scheduled during the pandemic to minimize exposure in the community.”

“It would be one thing to lose the few freedoms we have if what they did was effective—but what they did was clearly pretty ineffective,” Marcum said.

Unlike those incarcerated in prison or jail, the identities of people in civil commitment are unavailable to the public. The names of the eight people at the STU whose deaths were confirmed to be related to COVID-19 have not been released. They existed there anonymously, some for decades, and they died just as anonymously.

“We called it the ‘Pine Box Release Program’—because the only way you were leaving it was in a box, dead,” said Russell, the former prisoner released in 2011. He still has friends there, men who have been there for decades. He’s hoping they’ll one day be released, alive. But in the age of the coronavirus, he isn’t counting on it.