Illustration of the Intercept Points

 

Explanation of the Illustration (Not part of print brochure)

The Sequential Intercept Model provides a conceptual framework for communities to organize targeted strategies for justice-involved individuals with serious mental illness. Within the criminal justice system there are numerous intercept points — opportunities for linkage to services and for prevention of further penetration into the criminal justice system. This linear illustration of the model shows the paths an individual may take through the criminal justice system, where the five intercept points fall, and areas that communities can target for diversion, engagement, and reentry.

The five intercept points are:

• Law enforcement
• Initial Detention/Initial Court Hearings
• Jails/Courts
• Reentry
• Community Corrections

At Intercept 1 (Law Enforcement) a community can target interventions for law enforcement and emergency services since the pathway starts with the community. 911 and Local Law Enforcement are represented in the illustration at Intercept 1. Arrest connects Intercept 1 with Intercept 2 (Initial Detention/Initial Hearings) where a person is placed into custody by law enforcement and transported to initial detention. Initial detention is not necessarily the jail, it may be a stand-alone intake center or a secure holding area within a police station or court. Within the second intercept, initial detention and the first court appearance represent two opportunities for communities to intercept people with mental illness. A person in initial detention may move to a specialty court or to initial detention.  Once in initial detention a person may have their case transferred to a specialty court or to pretrial detention in the jail. A person in jail may have their case transferred to the specialty court from the regular criminal court. Along with the specialty court and jail, the other major point for intercepting people at Intercept 3 (Jails/Courts) is dispositional court. Diversion interventions, for example, may take place at any point up to the formal disposition. Dispositional court and specialty court connect to jail/reentry and prison/reentry in Intercept 4(Reentry). They also connect with the community at Intercept 5 (Community Corrections). At Intercept 5 jail/reentry and prison/reentry connect with the community, parole for prison/reentry, and probation from jail/reentry. Meanwhile, arrows moving from probation to jail/reentry and from parole to prison/reentry represent an additional target: people who are released to community corrections but who violate the terms of supervision.

Action for Service-Level Change at Each Intercept

At Intercept 1: Law Enforcement

• 911: Train dispatchers to identify calls involving persons with mental illness and refer to designated, trained respondents

• Police: Train officers to respond to calls where mental illness may be a factor

• Documentation: Document police contacts with persons with mental illness

• Emergency/Crisis Response: Provide police-friendly drop off at local hospital, crisis unit, or triage center

• Follow Up: Provide service linkages and follow-up services to individuals who are not hospitalized and those leaving the hospital

• Evaluation: Monitor and evaluate services through regular stakeholder meetings for continuous quality improvement

At Intercept 2: Initial Detention/Initial Hearings

• Screening: Screen for mental illness at earliest opportunity; initiate process that identifies those eligible for diversion or needing treatment in jail; use validated, simple instrument or matching management information systems; screen at jail or at court by prosecution, defense, judge/court staff or service providers

• Pre-Trial Diversion: Maximize opportunities for pretrial release and assist defendants with mental illness in complying with conditions of pretrial diversion

• Service Linkage: Link to comprehensive services, including care coordination, access to medication, integrated dual disorder treatment (IDDT) as appropriate, prompt access to benefits, health care, and housing; IDDT is an essential evidence-based practice (EBP)

At Intercept 3: Jails/Courts

• Screening: Inform diversion opportunities and need for treatment in jail with screening information from Intercept 2

• Court Coordination: Maximize potential for diversion in a mental health court or non-specialty court

• Service Linkage: Link to comprehensive services, including care coordination, access to medication, IDDT as appropriate, prompt access to benefits, health care, and housing

• Court Feedback: Monitor progress with scheduled appearances (typically directly by court); promote communication and information sharing between non-specialty courts and service providers by establishing clear policies and procedures

• Jail-Based Services: Provide services consistent with community and public health standards, including appropriate psychiatric medications; coordinate care with community providers

At Intercept 4: Reentry

• Assess clinical and social needs and public safety risks; boundary spanner position (e.g., discharge coordinator, transition planner) can coordinate institutional with community mental health and community supervision agencies

• Plan for treatment and services that address needs; GAINS Reentry Checklist (available from http://www.gainscenter.samhsa.gov/html/resources/reentry.asp) documents treatment plan and communicates it to community providers and supervision agencies – domains include prompt access to medication, mental health and health services, benefits, and housing

• Identify required community and correctional programs responsible for post-release services; best practices include reach-in engagement and specialized case management teams

• Coordinate transition plans to avoid gaps in care with community-based services

At Intercept 5: Community Corrections

• Screening: Screen all individuals under community supervision for mental illness and co-occurring substance use disorders; link to necessary services

• Maintain a Community of Care: Connect individuals to employment, including supportive employment; facilitate engagement in IDDT and supportive health services; link to housing; facilitate collaboration between community corrections and service providers; establish policies and procedures that promote communication and information sharing

• Implement a Supervision Strategy: Concentrate supervision immediately after release; adjust strategies as needs change; implement specialized caseloads and cross-systems training

• Graduated Responses & Modification of Conditions of Supervision: Ensure a range of options for community corrections officers to reinforce positive behavior and effectively address violations or noncompliance with conditions of release

The Sequential Intercept Model

Developed by Mark R. Munetz, MD, and Patricia A. Griffin, PhD, the Sequential Intercept Model provides a conceptual framework for communities to organize targeted strategies for justice-involved individuals with serious mental illness. Within the criminal justice system there are numerous intercept points — opportunities for linkage to services and for prevention of further penetration into the criminal justice system. Munetz and Griffin (2006) state:

The Sequential Intercept Model … can help communities understand the big picture of interactions between the criminal justice and mental health systems, identify where to intercept individuals with mental illness as they move through the criminal justice system, suggest which populations might be targeted at each point of interception, highlight the likely decision makers who can authorize movement from the criminal justice system, and identify who needs to be at the table to develop interventions at each point of interception. By addressing the problem at the level of each sequential intercept, a community can develop targeted strategies to enhance effectiveness that can evolve over time.

The Sequential Intercept Model has been used as a focal point for states and communities to assess available resources, determine gaps in services, and plan for community change. These activities are best accomplished by a team of stakeholders that cross over multiple systems, including mental health, substance abuse, law enforcement, pre-trial services, courts, jails, community corrections, housing, health, social services, and many others.

Three Major Responses for Every Community

Three Major Responses Are Needed:

• Diversion programs to keep people with serious mental illness who do not need to be in the criminal justice system in the community.

• Institutional services to provide constitutionally adequate services in correctional facilities for people with serious mental illness who need to be in the criminal justice system because of the severity of the crime.

• Reentry transition programs to link people with serious mental illness to community-based services when they are discharged.

The Sequential Intercept Model has been used by numerous communities to help organize mental health service system transformation to meet the needs of people with mental illness involved with the criminal justice system. The model helps to assess where diversion activities may be developed, how institutions can better meet treatment needs, and when to begin activities to facilitate re-entry.

The GAINS Center

The CMHS National GAINS Center, a part of the CMHS Transformation Center, serves as a resource and technical assistance center for policy, planning, and coordination among the mental health, substance abuse, and criminal justice systems. The Center’s initiatives focus on the transformation of local and state systems, jail diversion policy, and the documentation and promotion of evidence-based and promising practices in program development. The GAINS Center is funded by the Center for Mental Health Services and is operated by Policy Research Associates, Inc., of Delmar, NY.

To Contact Us

CMHS National GAINS Center
Policy Research Associates
345 Delaware Avenue
Delmar, NY 12054
Phone: 800.311.GAIN
Fax: 518.439.7612
Email: gains@prainc.com
Web: http://www.gainscenter.samhsa.gov

Sources

CMHS National GAINS Center. (2007). Practical advice on jail diversion: Ten years of learnings on jail diversion from the CMHSNationalGAINSCenter. Delmar, NY: Author.

Council of State Governments Justice Center. (2008). Improving responses to people with mental illnesses: The essential elements of a mental health court. New York: Author.

Munetz, M.R. & Griffin, P.A. (2006). Use of the Sequential Intercept Model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.

Osher, F., Steadman, H.J., & Barr, H. (2002). A best practice approach to community re-entry from jails for inmates with co-occurring disorders: The APIC model. Delmar, NY: National GAINS Center.

http://www.consensusproject.org
http://www.reentrypolicy.org
http://www.mentalhealthcommission.gov
http://www.mentalhealthcommission.gov/subcommittee/Sub_Chairs.htm