Legal News
Jail-Diversion Guidelines Aid Social Service Policymakers
Psychiatric News
Volume 41 Number 10 page 7-74

Although local police, judicial officials, and human services personnel have increasingly focused on the goal of keeping individuals with mental illness out of the justice system over minor incidents, they have lacked, until recently, a comprehensive guide for how to implement such an effort.

Developed as part of an effort to overhaul the approach of Summit County, Ohio, to those with mental illness in the criminal justice system, the sequential intercept model provides an outline of the law enforcement and human services programs that local jurisdictions generally provide. The model then highlights where those with mental illness generally enter and exit each stage of the system.

Local officials who are beginning to assess the way they deal with people in the criminal justice system who have mental illness can use the model to identify points in the system where initial changes would have the biggest impact, such as training police in how to approach those in a mental health crisis.

Other jurisdictions further along in developing a program designated for people with mental illness can use the model to find weaknesses in their system, such as inadequate training of probation officers to monitor the medication compliance of those under court order to take medication for mental illness.

"On the face of it, this work can look like an overwhelming problem to local officials, so this just gives them a place to start," said Mark Munetz, M.D., co-author of a paper describing the model and chief clinical officer of the Summit County Alcohol, Drug Addiction, and Mental Health Services Board.

The model was described in the report "Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness" in the April Psychiatric Services.

The researchers who developed the model have worked extensively with jurisdictions to improve their interactions with mentally ill individuals at the law enforcement, adjudication, and human services levels.

The goal of the model is to ensure that most mentally ill people are intercepted at early points—such as initial detention and initial court hearing—with decreasing numbers found at each subsequent point. The model's guidelines range from the use of best clinical practices—which preclude arrest and are the best intercept—through community corrections and community support.

"We came up with a model that makes it easy for people in social services to understand how those with mental illness flow through the criminal justice system, so they know better where they can help," said Patricia Griffin, the report's co-author and senior consultant for the National GAINS Center for People With Co-occuring Disorders in the Justice System, a federally funded program that distributes mental health information.

The model is based on the belief that people with mental disorders should not enter the criminal justice system at a greater rate than people in the same community without mental disorders. The authors note that those who commit crimes unrelated to their illnesses must be held responsible, but they should not be arrested or jailed only due to their condition or the lack of appropriate treatment.

The model has already assisted several jurisdictions in which it was introduced because it provides a "big-picture view" no one official had of what happens to individuals with mental illness as they move through the legal system, said Griffin.

The model allowed rural Bucks County, Pa., to find that all of their mental health "interventions" were located at the jail and during the pretrial phase, while there was no training for police in recognizing and interacting with those with severe mental illness, she said.

Munetz said the model has also shown success in overcoming one long-standing problem by allowing all of the officials of relevant agencies to come together over a unifying document that starts the conversation on how to improve the situation for those with mental illness.

The model has helped Munetz see that the local partnerships with the greatest potential are often those between mental health professionals and parole officers, because they have the authority and proximity to ensure court-ordered medications are taken.

"Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness" is posted at<http://psychservices.psychiatryonline.org/cgi/content/full/57/4/544>.

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