Department of Psychiatry, University of Michigan Medical School, Ann Arbor (Pinals); Policy Research Associates, Delmar, New York (Callahan).
Psychiatr Serv. 2020 Jul 1;71(7):698-705. doi: 10.1176/appi.ps.201900484. Epub 2020 Apr 2.
The sequential intercept model (SIM) is used to reduce the penetration of persons with mental illness and substance use disorders in the criminal legal system. Its framework recommends identifying individuals with mental illness at various decision points of criminal case processing, from arrest to return from incarceration, so that they can be diverted toward treatment rather than permeate deeper into the criminal justice system. Communities frequently use the model to augment and inform jail diversion services. Despite the model's widespread adoption, individuals with serious mental illness, intellectual and developmental disabilities, and disorders affecting neurocognition and behavior are often found ineligible for such diversion because their competence to stand trial (CST) warrants evaluation, which effectively pauses their criminal case processes. If found incompetent to stand trial, these people can be ordered for competence restoration treatment, creating a pathway that is different from jail diversion options. Traditional community mental health services and courts await resolution by the "forensic system" before linking these individuals to needed services, and often these linkages are lacking. This review aims to describe and demystify these forensic processes and to highlight the potential use of the SIM to decrease jail stays and maximize community service connections for individuals with some of the most impairing mental health conditions who are involved in the justice system and for whom diversion is a safe option. The authors offer specific examples of intercept opportunities at each step involved in evaluations of CST and in the competence restoration processes.
序贯拦截模型（Sequential Intercept Model，简称 SIM）用于减少患有精神疾病和物质使用障碍的人在刑事司法系统中的渗透。其框架建议在刑事案件处理的各个决策点识别出患有精神疾病的个人，从逮捕到监禁后返回，以便将他们转移到治疗中，而不是让他们更深地渗透到刑事司法系统中。社区经常使用该模型来增强和告知监狱分流服务。尽管该模型得到了广泛的采用，但患有严重精神疾病、智力和发育障碍以及影响神经认知和行为的障碍的个人通常被认为不符合这种分流的条件，因为他们的审判能力（CST）需要进行评估，这有效地暂停了他们的刑事案件处理。如果被认定为无能力接受审判，这些人可能会被命令接受能力恢复治疗，从而开辟一条不同于监狱分流选择的途径。传统的社区精神卫生服务和法院在将这些人与所需的服务联系起来之前，等待“法医系统”解决问题，而这些联系往往是缺乏的。本综述旨在描述和阐明这些法医程序，并强调 SIM 的潜在用途，以减少监狱拘留并最大程度地为参与司法系统且分流是安全选择的最具损害性精神健康状况的个人建立社区服务联系。作者提供了在 CST 评估和能力恢复过程的每个步骤中拦截机会的具体示例。
