A conceptual model for community-based strategic planning to address the criminalization of adults with mental and substance use disorders, the Sequential Intercept Model has provided jurisdictions with a framework that overcomes traditional boundaries between the agencies within the criminal justice and behavioral health systems. This article presents a new paradigm, Intercept 0, for expanding the utility of the Sequential Intercept Model at the front end of the criminal justice system. Intercept 0 encompasses the early intervention points for people with mental and substance use disorders before they are placed under arrest by law enforcement. The addition of Intercept 0 creates a conceptual space that enables stakeholders from the mental health, substance use, and criminal justice systems to consider the full spectrum of real-world interactions experienced by people with mental and substance use disorders with regard to their trajectories, or lack thereof, through the criminal justice system.
Tele-mental health (tele-MH) is an important asset in rural areas across the United States where in-person service access can be limited. This resource is even more critical now during the COVID-19 pandemic, which has increased demand for a virtual alternative to community-based mental health and substance use disorder services. Many individuals are seeking behavioral health services due to distress related to COVID-19, in addition to a new group of individuals in need of these services who have been released from jails and prisons to prevent transmission of the virus within the facilities. Jurisdictions around the country have rapidly implemented and/or expanded tele-MH to continue vital service provision. The authors conducted semistructured phone interviews with five senior-level professionals involved in tele-MH provision across four rural U.S. regions (a six-county region of western Montana; Cumberland County, Maine; Polk County, Iowa; and a 10-county region of western South Dakota) concerning tele-MH services before and since COVID-19, benefits of the expanded technology, challenges to implementation, and any data collected thus far regarding satisfaction and effectiveness of tele-MH. These examples of rural communities that have accelerated policy and programmatic changes around tele-MH may be beneficial for other communities considering tele-MH as well as serve as valuable opportunities for additional evaluation and sustainability post-COVID-19. Public Significance StatementThis article provides an overview of the particular challenges in rural community behavioral health service delivery since the COVID-19 outbreak, as well as how telemental health can assist with addressing these significant needs. The discussion includes program descriptions of four rural areas of the United States that have implemented or expanded tele-mental health in behavioral health and criminal justice system services since the outbreak, which may serve as guidance for other rural communities around the United States.
This article describes a project that generated the recommendations of a panel of experts regarding the jail as a venue for the delivery of behavioral health care services. The project was a component of the MacArthur Foundation's Safety and Justice Challenge initiative, which seeks to address over-incarceration by changing the way jails are conceptualized and used. The recommendations were grounded largely in the sequential intercept model that rests on two core principles: minimize the inappropriate penetration of persons with mental illness into the criminal justice system and recognize that the community is the unit of analysis to address criminal justice-mental health problems successfully. Other topics presented in the context of the initiative included bringing the community to scale, jail diversion, the limits of jail responsibility, and the Affordable Care Act's role in providing insurance coverage for detainees.
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