# Sequential intercept model

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{{Short description|Psychiatric model}}
{{About||criminals' mental health treatments specifically on courts|Mental health court}}
{{Multiple issues|
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The '''Sequential Intercept Model''' clarifies five points at which standard processing of crimes can be intervened with [community-based actions](/source/Community_mental_health_service), so that individuals with [mental and psychiatric disorders](/source/Mental_disorder) would not have to further penetrate the [criminal justice system](/source/Criminal_justice).<ref name=":2" /> By understanding and using the model, communities can develop a series of strategies to increase [diversion](/source/Diversion_program) of individuals with [mental disorder](/source/mental_disorder) from the [criminal justice system](/source/Criminal_justice) and to help them receive proper [community-based treatments](/source/Community_mental_health_service).<ref name=":0" />

Traced from the early 1990s, the Sequential Intercept Model was first established in [Summit County](/source/Summit_County%2C_Ohio) through the collaboration of Munetz, Griffin and Steadman due to the trend of increasing number of criminals with [mental health problems](/source/Mental_disorder) appeared.<ref name=":2" /> [Summit County](/source/Summit_County%2C_Ohio) developed [partnership](/source/partnership)s with the National [https://www.samhsa.gov/gains-center GAINS centre] to launch programs for [community-based mental health services](/source/Community_mental_health_service).<ref name=":2" /> After the success of Summit County, the model was implemented at the regional and [state](/source/U.S._state) level starting from [Pennsylvania](/source/Pennsylvania) and continuously spread to other states with larger task force using this model to illustrate and solve related issues.<ref name=":2" /> And finally, it was used in certain policies under the [federal](/source/Federal_government_of_the_United_States) level particularly the [veteran](/source/veteran)s’ [psychological](/source/Psychology) issues and their associated [medical treatments](/source/Psychotherapy).<ref name=":2" />

As an effective conceptual tool, the Sequential Intercept Model could be applied to many real-life situations. A significant example is the application for [juvenile justice system](/source/Juvenile_court) with two intercepts within the model involved. The diversion programs at schools for students’ [behaviour management](/source/Behavior_management) would be conducted at first and [problem-solving courts](/source/Problem-solving_courts_in_the_United_States) from Intercept 3 could also be used to provide treatments for teenagers.<ref name=":5" /> Meanwhile, researchers and policymakers could also apply the methods within the Sequential Intercept Model for future use.<ref name=":2" />
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== Description ==
thumb|Flow of five points of interception within the Sequential Intercept Model|alt=|281x281px
There are five points of interception within the Sequential Intercept Model where interventions can be conducted at each point to prevent further [criminalisation](/source/Criminalization) of population with [mental illness](/source/Mental_disorder).<ref name=":0">{{Cite journal|last1=Munetz|first1=M. R.|last2=Griffin|first2=P.A.|date=2006|title=Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness|journal=Psychiatric Services|language=en|volume=57|issue=4|pages=544–549|doi=10.1176/ps.2006.57.4.544|pmid=16603751|issn=1075-2730}}</ref>

=== Intercept 1 ===
The first intercept refers to [law enforcement](/source/law_enforcement) and emergency services.<ref name=":1">{{Cite journal|last1=DeMatteo|first1=D.|last2=LaDuke|first2=C.|last3=Locklair|first3=B.|last4=Heilbrun|first4=K.|date=2013|title=Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry|journal=Journal of Criminal Justice|volume=41|issue=2|pages=64–71|doi=10.1016/j.jcrimjus.2012.09.002|issn=0047-2352}}</ref> Police officers initially make critical decisions to decide whether an individual is innocent or should be arrested, however, many complex situations have occurred within the police management for [mental health crisis](/source/Mental_health) due to lack of time and experience.<ref name=":2">{{Cite book|date=2015|editor-last=Griffin|editor-first=P.|editor2-last=Heilbrun|editor2-first=K.|editor3-last=Mulvey|editor3-first=E.|editor4-last=DeMatteo|editor4-first=D.|editor5-last=Schubert|editor5-first=C.|title=The Sequential Intercept Model and Criminal Justice|doi=10.1093/med:psych/9780199826759.001.0001|isbn=9780199826759}}</ref> That is when a program called specialised policing responses (SPRs) is developed by [law enforcement agencies](/source/Law_enforcement_agency) through collaborations with other [mental health services](/source/Community_mental_health_service) providers to prioritise transfer of people to receive [https://www.mentalhealthamerica.net/types-mental-health-treatments mental health treatments] rather than getting arrested.<ref name=":2" /> The objective of this level of intercept is therefore to provide people who have [behavioural health disorders](/source/Emotional_and_behavioral_disorders) with proper [therapies](/source/Therapy) instead of sending them into the next level of [criminal justice system](/source/Criminal_justice).<ref name=":1" />

=== Intercept 2 ===
The second intercept refers to post-arrest actions during initial [hearings](/source/Hearing_(law)) or [detention](/source/Detention_(imprisonment)), which offer [diversion program](/source/diversion_program)s for arrested individuals from encountering standard [trial](/source/trial) and judgement.<ref name=":1" /> For example, [probation](/source/probation) could be conducted for those individuals with [mental disease](/source/Mental_disorder) by employing experts during hearings to assess the mental conditions of the arrested people and determining the possible options for those people, such as further [https://www.mentalhealthamerica.net/types-mental-health-treatments psychological treatments] within the mental health system, instead of going to jail.<ref name=":0" />

=== Intercept 3 ===
The third intercept occurs after the initial [hearings](/source/Hearing_(law)) or [detention](/source/Detention_(imprisonment)) and is associated with jails and courts.<ref name=":1" /> According to research, people with [mental disorder](/source/mental_disorder) have higher chances of being taken into custody and are always charged with longer [incarceration](/source/Imprisonment) than people without [mental disorder](/source/mental_disorder).<ref>{{Cite journal|last1=Bradley-Engen|first1=M. S.|last2=Cuddeback|first2=G. S.|last3=Gayman|first3=M. D.|last4=Morrissey|first4=J. P.|last5=Mancuso|first5=D.|date=2010-12-01|title=Trends in State Prison Admission of Offenders With Serious Mental Illness|journal=Psychiatric Services|volume=61|issue=12|pages=1263–1265|doi=10.1176/ps.2010.61.12.1263|pmid=21123414|issn=1075-2730}}</ref> Hence, approaches within the [local community](/source/local_community), particularly [problem-solving courts](/source/Problem-solving_courts_in_the_United_States) in the condemnation process have been increasing throughout the world.<ref name=":2" /> For example, the [community court](/source/community_court)s would use the information collected from neighbourhood to find out the underlying causes of the criminals’ illegal behaviours related to [mental illness](/source/Mental_disorder) or divert those criminals from jails into [community-based](/source/Community_mental_health_service) [https://www.mentalhealthamerica.net/types-mental-health-treatments mental health treatment] to reduce the probability of the [recurrence of crimes](/source/Recidivism).<ref>{{Cite book|title=Community courts across the globe : a survey of goals, performance measures and operations|last=Karafin, Diana L.|date=2008|publisher=Criminal Justice Initiative of Open Society Foundation for South Africa|others=Open Society Foundation for South Africa.|isbn=9781920299002|location=Newlands, South Africa|oclc=727701471}}</ref> 

=== Intercept 4 ===
The fourth intercept aims to facilitate successful [re-entry](/source/Prisoner_reentry) into the society after the release from jails by experiencing proper [mental illness](/source/Mental_disorder) management from [community-based](/source/Community_mental_health_service) interventions and hence reduce the rates of [recidivism](/source/recidivism).<ref name=":2" /> In fact, it is common for population with [mental health disorder](/source/Mental_disorder) to fail to follow the conditions of [probation](/source/probation) and result in being rearrested into the prisons.<ref name=":2" /> Therefore, models within this stage of intervention could be used to guide the successful [re-entry](/source/Prisoner_reentry) process for those with [mental health issues](/source/Mental_disorder) . Take the example of the ACTION approach, by promoting systematic communication and collaboration, providers are well educated about the behaviours, experiences and needs for offenders with [mental illness](/source/Mental_disorder).<ref name=":3">{{Cite journal|last1=Vogel|first1=W. M.|last2=Noether|first2=C. D.|last3=Steadman|first3=H. J.|date=2007|title=Preparing Communities for Re-Entry of Offenders with Mental Illness: The ACTION Approach|journal=Journal of Offender Rehabilitation|language=en|volume=45|issue=1–2|pages=167–188|doi=10.1300/J076v45n01_12|s2cid=142666156|issn=1050-9674}}</ref> They would also know about how services from communities could significantly contribute to the promotion of [criminal justice](/source/criminal_justice).<ref name=":3" /> A cross-systems map is therefore developed and implemented to guide successful [re-entry](/source/Prisoner_reentry) of [mental disorder](/source/mental_disorder) criminals into the community.<ref name=":3" />

=== Intercept 5 ===
The fifth intercept refers to [community-based](/source/Community_mental_health_service) corrections and support, with an emphasis on community control of individuals with [mental illness](/source/Mental_disorder) after [imprisonment](/source/imprisonment).<ref name=":0" /> According to [https://www.bjs.gov/ Bureau of Justice Statistics], at year-end 2016, 4.5 million people in the [United States](/source/United_States) were under community [supervision](/source/supervision) or [probation](/source/probation).<ref>{{Cite web|url=https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6188|title=Bureau of Justice Statistics (BJS) - Probation and Parole in the United States, 2016|website=www.bjs.gov|access-date=2019-05-06}}</ref> Due to increasing number of this type of population, community [probation](/source/probation) and [parole](/source/parole) programs are designed to increase these individuals’ participation in [mental health treatment](/source/Psychotherapy). These mandatory treatments would therefore reduce the possibility of failure of [probation](/source/probation) and reduce the number of individuals returning to the prisons again after releasing from [incarceration](/source/incarceration).<ref name=":0" />

== Development ==
The development of the Sequential Intercept Model could be traced back to early 1990s when [Summit County](/source/Summit_County%2C_Ohio) in Ohio, United States realised that there were increasing population with [mental health problems](/source/Mental_disorder) arrested and there was also increasing demand for [mental health](/source/mental_health) related services in jails and prisons.<ref name=":4">{{Cite journal|last1=Munetz|first1=M. R.|last2=Grande|first2=T. P.|last3=Chambers|first3=M. R.|date=2001|title=The incarceration of individuals with severe mental disorders|journal=Community Mental Health Journal|volume=37|issue=4|pages=361–372|issn=0010-3853|pmid=11482753|doi=10.1023/A:1017508826264|s2cid=7637596}}</ref> Due to the lack of appropriate method to deal with this issue, in 1999, the [Summit County](/source/Summit_County%2C_Ohio) developed collaboration with the National [https://www.samhsa.gov/gains-center GAINS Centre] to initiate a CIT program, which provided police officers necessary trainings on dealing with [mental health issues](/source/Mental_health) and raised awareness for responders about the alternatives of [community-based treatments](/source/Community_mental_health_service) for arrested people with mental illness.<ref name=":2" />

Two years after the effective implementation of CIT program in [Summit County](/source/Summit_County%2C_Ohio), the Sequential Intercept Model (SIM) had spread to the state level with the five south-eastern countries in Pennsylvania working together using SIM as a tool to address the [criminalisation](/source/Criminalization) of people with [mental disorder](/source/mental_disorder).<ref name=":2" /> Then at the same year, Munetz gave a speech about how this model works in a systematic way with multiple levels involved and the five intercepts that follow the process of the [criminal justice system](/source/Criminal_justice) were identified.<ref name=":4" /> With the exact identification of the process of the SIM, larger task force started to use this model in [criminology](/source/criminology) and [psychology](/source/psychology) areas. By discussing about the status of each intercept in each country in monthly meetings, the task force established common understandings towards the connection between [mental illness](/source/Mental_disorder) and [community treatment](/source/Community_mental_health_service), and then started its attempts in different regions and states.<ref name=":2" />

thumb|121x121px|Federal level implementation of the Sequential Intercept Model
Finally, the SIM was also implemented at the federal level with the [https://www.va.gov/ U.S Department of Veterans Affairs] using the SIM in its policies to prevent the [veteran](/source/veteran)s with [mental illness](/source/Mental_disorder) from entering deeper into the [criminal justice system](/source/Criminal_justice).<ref name=":6">{{Cite journal|last1=Blue-Howells|first1=Jessica H.|last2=Clark|first2=Sean C.|last3=van den Berk-Clark|first3=Carissa|last4=McGuire|first4=James F.|date=2013|title=The U.S. Department of Veterans Affairs Veterans Justice Programs and the sequential intercept model: Case examples in national dissemination of intervention for justice-involved veterans.|journal=Psychological Services|language=en|volume=10|issue=1|pages=48–53|doi=10.1037/a0029652|pmid=22924802|issn=1939-148X}}</ref> For instance, a program called [https://www.va.gov/homeless/vjo.asp Veterans Justice Outreach] was developed to collect information needed for veterans’ [medical treatment](/source/Therapy) and communicate the related information with local courts and jails so that the experts in VA could ensure veterans’ access to [healthcare services](/source/Healthcare_industry) as soon as possible.<ref name=":6" />

== Application ==
=== Juvenile justice system ===
The Sequential Intercept Model (SIM) has not only been applied to adults, it could also be used in the [juvenile justice system](/source/Juvenile_court) associated with its [community-based](/source/Community_mental_health_service) actions.<ref name=":5">{{Cite journal|last1=Heilbrun|first1=K.|last2=Goldstein|first2=N. E.S.|last3=DeMatteo|first3=D.|last4=Newsham|first4=R.|last5=Gale-Bentz|first5=E.|last6=Cole|first6=L.|last7=Arnold|first7=S.|date=2017|title=The Sequential Intercept Model and Juvenile Justice: Review and Prospectus: SIM and juvenile justice|journal=Behavioral Sciences & the Law|language=en|volume=35|issue=4|pages=319–336|doi=10.1002/bsl.2291|pmid=28612513}}</ref> There are two intercepts within the model that are involved.

The first intercept could be conducted at schools along with the [diversion program](/source/diversion_program)s before arrest.<ref name=":5" /> In the past, the schools would often [expel](/source/Expulsion_(education)) or suspend the children and teenagers who disobeyed the school rules, such as fighting with others, and sometimes even reported these students to the [police department](/source/Police).<ref>{{cite journal | last1 = Wilson | first1 = H | year = 2014 | title = Turning off the School-to-prison Pipeline | journal = Reclaiming Children and Youth | volume = 23 | pages = 49–53 }}</ref> To make this situation better, the SIM could be applied to implement [diversion program](/source/diversion_program)s on these students, for instance, after-school programs designed for management and promotion of well behaviour.<ref name=":5" /> These [diversion program](/source/diversion_program)s would help analyse the potential reasons of the students’ bad behaviours, such as [genetically](/source/Genetics) related [mental health issues](/source/Mental_disorder), and provide them with proper treatment instead of sending the students directly to receive [law punishments](/source/Criminal_law).<ref name=":5" /> One of the most successful examples of this level of intercept is the establishment of [http://phildiversion.org/ The Philadelphia Police School Diversion Program] started in 2014, whose aim was to decrease the number of students who are arrested in Philadelphia schools because of inappropriate school behaviours and provide them with proper [school-based treatment](/source/School_Based_Prevention_Programs) so they would improve their behaviour and avoid going to [jails](/source/Prison).<ref name=":5" />

In addition, the [problem-solving courts](/source/Problem-solving_courts_in_the_United_States) within Intercept 3 are crucial and adaptable in the [juvenile justice system](/source/Juvenile_court). The primary objective of [juvenile court](/source/juvenile_court)s is to reintegrate teenagers to certain sentences or punishment; however, these courts are turning more [punitive](/source/Punishment) without taking into consideration of the individuals’ [behavioural health problems](/source/Mental_health), which would seriously influence the future behaviour of these criminals.<ref>{{Cite journal|last=Mears|first=D. P.|date=2002|title=Sentencing Guidelines and the Transformation of Juvenile Justice in the 21st Century|journal=Journal of Contemporary Criminal Justice|volume=18|issue=1|pages=6–19|doi=10.1177/104398620201800102|s2cid=144058691|issn=1043-9862}}</ref> To ensure a more valid [juvenile justice system](/source/Juvenile_court), [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3807871/ juvenile mental health courts] (JMHCs) are applied to divert youngsters with [mental illness](/source/Mental_disorder) from the standard [trial](/source/trial) and instead provide them with proper [mental illness treatment](/source/Treatment_of_mental_disorders) within the community.<ref>{{Cite book|title=Juvenile diversion : programs for justice-involved youth with mental disorders|last=Skowyra, Kathleen.|date=2006|publisher=National Center for Mental Health and Juvenile Justice|oclc=227323758}}</ref> By developing close [partnership](/source/partnership)s with local [mental health services agencies](/source/Community_mental_health_service), JMHCs have managed to illustrate [mental illness](/source/Mental_disorder) issues and have tried to reduce the possibility of [recidivism](/source/recidivism) of these youths.<ref>{{Cite journal|last=Levin|first=Aaron|date=2012-03-02|title=MH Courts for Youth Show Promise but Need Study|journal=Psychiatric News|volume=47|issue=5|pages=4a|doi=10.1176/pn.47.5.psychnews_47_5_4-a|issn=0033-2704}}</ref> JMHCs also emphasise on the participation of youths’ family members so that teenagers who committed crimes can receive guidance from the closest people around them and are more likely to become better in the future.<ref>Cocozza, J. J., & Shufelt, J. L. (2006). ''[https://scholar.googleusercontent.com/scholar?q=cache:wDDxJJw8-rMJ:scholar.google.com/+Juvenile+mental+health+courts:+An+emerging+strategy.&hl=en&as_sdt=0,5 Juvenile mental health courts: An emerging strategy]''. Delmar, NY: National Center for Mental Health and Juvenile Justice.</ref>

== Future directions ==
=== Extension of the use of the Sequential Intercept Model ===
The initial emphasis of the Sequential Intercept Model (SIM) is on individuals who suffer from serious [mental and behavioural health problems](/source/Mental_disorder), however, it is possible for SIM to extend to other populations, such as [veteran](/source/veteran)s and teenagers who experience [substance use disorder](/source/substance_use_disorder) as well as people who suffer from [intellectual disabilities](/source/Intellectual_disability).<ref name=":2" /> Under effective cross-systems collaboration and management, such as the Cross-Systems Mapping workshops where collaborative communication and understanding were undertaken for direct guidance into the [criminal justice system](/source/Criminal_justice), the SIM could provide options of [community treatments](/source/Community_mental_health_service) instead of standard [incarceration](/source/Imprisonment) for increasing number of individuals with [behavioural health problems](/source/Emotional_and_behavioral_disorders) or [substance use disorder](/source/substance_use_disorder).<ref name=":2" /> 

=== Research implications ===
On one hand, research on the sharing of basic information related to [community-based treatment](/source/Community_mental_health_service) alternatives is necessary.<ref name=":2" /> To ensure effective operations of [diversion program](/source/diversion_program)s, it is important to share information about individuals who received [mental health treatments](/source/Treatment_of_mental_disorders) in one of the intercepts of the SIM.<ref name=":2" /> However, the information collected and shared is often inappropriate or misleading since it is based on the restrictions of certain [federal law](/source/federal_law)s and it is not supported by enough evidence.<ref name=":2" /> This requires further research on relevant issues that would possibly occur when dealing with [mental disorder](/source/mental_disorder) people in the [criminal justice system](/source/Criminal_justice), for instance, the limitations or disadvantages of the information sharing when [interventions](/source/Psychological_intervention) and related programs are conducted during the process of the use of the SIM.<ref name=":2" /> By researching on the shared information, the programs and [interventions](/source/Psychological_intervention) within the SIM would turn out appropriately to ensure the balance between [privacy rights](/source/Right_to_privacy) and [community safety](/source/Public_safety).<ref name=":2" />  Research conducted by Anne Hays Egan for Presbyterian Healthcare Services analyzed a growing body of data from the Vera Institute of Justice, U.S. Substance Abuse Mental Health Agency (SAMHSA), LEAD National Support BUreau, and the Drug Policy Institute, which demonstrates that recidivism is substantially decreased when diversion, alternative sentencing, and transition from jail to community are accoompanied by intensive case management and recovery supports, affordable housing, and living wage employment. <ref>{{Cite web |last=Egan |first=Anne Hays |date=2019 |title=Rock the Intercepts |url=https://onbaseext.phs.org/PEL/DisplayDocument?ContentID=PEL_00949861 |website=Presbyterian Healthcare Services}}</ref>  

On the other hand, it is useful to  conduct research on the costs and benefits of [community-based treatment](/source/Community_mental_health_service) options.<ref name=":2" /> For further development of the programs and intercepts within the SIM, consistent [funding](/source/funding) from outside parties is required.<ref name=":2" /> But the information regarding costs of community [diversion program](/source/diversion_program)s is not enough and it does not take into consideration of the [public safety](/source/Public_security) issues, which would contribute to lack of support for the ongoing implementation of [diversion program](/source/diversion_program)s and [interventions](/source/Psychological_intervention) towards the [criminal justice system](/source/Criminal_justice).<ref name=":2" />

=== Policy implications ===
The use of the SIM implies changes of policy in the related areas. One of the most significant examples is the Cross-Systems Mapping (CSM) workshops, which implement practices of [community-based treatments](/source/Community_mental_health_service) for criminals with [mental disorder](/source/mental_disorder) using [collaborative](/source/Collaboration) understandings towards the connection between [criminal justice](/source/criminal_justice) and [mental health](/source/mental_health).<ref name=":2" /> The CSM workshops promote interactions between [judiciary](/source/judiciary), [law enforcement](/source/law_enforcement), [probation](/source/probation), [mental health](/source/mental_health) and [community treatment](/source/Community_mental_health_service), which enables the authority to change policy by cross-mapping the whole system using the SIM.<ref name=":2" /> Furthermore, the SIM can have considerable impact on the [judicial](/source/Judiciary) or [law-making](/source/Law) courts by illustrating a conceptual framework that emphasises on the [reform](/source/reform) of individuals with [mental illness](/source/Mental_disorder) with a more focused law towards [community-based treatment](/source/Community_mental_health_service) instead of [imprisonment](/source/imprisonment).<ref name=":2" />

The SIM was included in the 21st Century Cures Act. Furthermore, the Bureau of Justice Assistance made SIM a priority for Justice and Mental Health Collaboration Program grants.

== See also ==

* [criminal justice](/source/criminal_justice)
* [Rehabilitation (penology)](/source/Rehabilitation_(penology))
* [Forensic psychology](/source/Forensic_psychology)
*[Forensic psychiatry](/source/Forensic_psychiatry)
*[Forensic psychotherapy](/source/Forensic_psychotherapy)
* [Crime analysis](/source/Crime_analysis)
* [criminology](/source/criminology)
* [law enforcement](/source/law_enforcement)

== References ==
<references />

Category:Crime
Category:Psychiatric models

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Adapted from the Wikipedia article [Sequential intercept model](https://en.wikipedia.org/wiki/Sequential_intercept_model) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Sequential_intercept_model?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.