The intersection of the criminal justice and behavioral health systems is neither a point nor a straight line. Rather, the overlap of these systems is a continuum; one in which the inflection points of systemic cross-contact can be identified and potentially addressed.
The clearest tool for identification of these points is the Sequential Intercept Model (SqIM). The development of the SqIM dates back to the late 1990s, under the guidance of Dr. Henry Steadman and his team at Policy Research Associates, Inc. According to the materials explaining the SqIM, “With funding from the National Institute of Mental Health, PRA developed the linear version of the SIM [sic] as an applied strategic planning tool to improve cross-system collaborations to reduce involvement in the justice system by people with mental and substance use disorders… to assist cities and counties in determining how people with mental and substance use disorders flow from the community into the criminal justice system and eventually return to the community.”1
And this tool was developed none too soon. With the downsizing of the psychiatric hospital system, the population of people with mental health, addiction, and co-occurring disorders held in prisons and jails ballooned. “In 1970, nearly 400,000 adults with psychiatric illnesses were housed in state and county mental hospitals, while approximately 360,000 adults were incarcerated in prisons and jails in the United States. Four decades later, by 2010, these numbers had moved dramatically in opposite directions; the census of public mental hospitals had dwindled to under 50,000 while the incarcerated population had risen steeply to more than 1.6 million on any given day. Evidence emerged that these trends could be intertwined; 44% of jail inmates and 37% of federal and state prisoners reported that a mental health professional had told them they have a mental disorder, according to a national survey of inmates published by the Bureau of Justice Statistics (BJS).”2
Linking Westchester’s Service Models to the SqIM Intercepts
In Westchester County, the SqIM is our road map. With six distinct intercept points along the justice continuum, models and tools can be, and have been, developed to connect with individuals with behavioral health needs at any point in the justice system.
Intercept 0 (Prior to Arrest): Intense behavioral health needs in the community frequently draw attention. These matters can initially be met with calls to crisis lines or calls to 911 which are diverted. In Westchester, more than 600 of the 911 call-takers have been trained in behavioral health identification and diversion. Three of the largest cities have police/clinician co-response staffing, and the county has developed both a crisis call network (an enhanced 988 phone system) and eight Mobile Crisis Response Teams, covering all of Westchester.
Intercept 1 (Law Enforcement Involvement; Arrest): Under Bail Reform, many individuals, when arrested, are given a desk appearance ticket. With planning and collaboration, this creates a window (often about 20 days) for diversion before they are arraigned. “Fresh Start” is a program run through the Department of Community Mental Health (DCMH) for low-level first-time alleged offenders who are offered a program that, if completed, results in the District Attorney declining to prosecute. OPT-In is a program for individuals charged with low-level drug possession. After arrest and before arraignment, individuals are given the opportunity, through connection to an addiction peer, to access services and also have prosecution of the charges declined.
Intercept 2 (Immediately Post-Arrest): Westchester County has several programs, old and new, to connect with individuals at the first court appearance (arraignment). Those include Treatment Alternatives for Safer Communities (TASC), which began in Westchester’s DCMH in the mid-1980s. TASC is a voluntary diversion program, court-ordered by agreement, with needs identification, treatment, and court reporting. Currently, about 60% of TASC cases are DWIs. Pre-Trial Services, operated by the nonprofit CHOICE-NY, is a contractual program through Westchester County providing predisposition support and supervision for the court-identified population not eligible for bail. At any given time, hundreds of people are assigned electronic monitoring in the county.
Intercept 3 (Court Diversion Models): There is no known correlation between diagnosis and severity of criminal charge. Simply put, it is not the diagnosis that determines the severity of the crime: often it is analogous to whether a $500 or $2,500 bicycle was stolen. In 2005, the Westchester County Court collaborated with the DA’s office, Legal Aid Society, DCMH, and the Probation Dept. to begin our Felony Mental Health Court. Individuals with serious mental health needs, many of whom also have complex substance use issues, are provided an opportunity to participate in the treatment court for 18–24 months with frequent court appearances and monitoring of services that focus on their adherence to recovery goals. Many will receive additional supportive care coordination directly from the DCMH Mental Health Alternatives to Incarceration Program (MHATI) or receive residential support through our Single Point of Access Services (SPOA). Some court participants may be employed or begin the first steps toward future employment, engage in vocational or educational programs, or volunteer in their communities during their time in the court. If successful, many will avoid a lengthy state prison sentence and a reduction of charges.
The Misdemeanor Wellness Hub Court began in 2023. It allows any identified individual in any municipal court facing misdemeanor charges to have their case transferred to one specific court’s calendar. It serves defendants with mental health or co-occurring needs. Similar supports are provided as in the felony part. Adherence to their individualized treatment plans and successful completion within six months to one year will result in a dismissal of charges or a violation.
The 9th Judicial District, of which Westchester is a part, also offers specialized diversion courts for youth/emerging adults, drugs, and veterans.
Intercept 4 (Reentry): Incarcerated individuals returning to the community face a myriad of challenges. Services and supports leading to housing, reacclimating in the community, and employment are crucial. Every point on the social determinants of health is impinged when a person with behavioral health needs is incarcerated.3 Westchester County, in partnership with DCMH and the County Jail, focuses on reentry services for those returning from the jail. This includes our award-winning CORE (Community Oriented Reentry) program where individuals participate in groups focusing on such areas as wellness, spirituality, successful recovery, music, art, and creative writing; the St. John’s Riverside Hospital’s Solutions addiction program; and the Lives Forward Program,4 as well as discharge planning services coordinated through the jail pre-release staff and/or Wellpath clinicians, Westchester Department of Social Services, and community partners. Our Transitional Managers provide direct connections to longer-term community supports starting at the time of release, often transporting individuals to DSS directly, assisting with obtaining prescribed medications, getting to intake appointments for treatment or housing interviews, checking in with parole or probation, or attending follow-up court dates.
Intercept 5 (Community Corrections – Probation and Parole): On any given day, twice as many people are serving their time on probation or parole than are actually incarcerated.5 To help address the needs of those returning on parole, DCMH and its nonprofit partner “Family Services of Westchester” operates the “Reentry Task Force.” As a network of collaboration, nearly 50 different community organizations work together to help support and serve those returning from state prison. Further, many of the services provided in Intercept 3 are available to those with community correction sentences. The person-centered services offered to individuals can include case management, treatment supports, employment readiness, financial literacy, educational supports, and parenting supports.
Over the past few years, DCMH has developed several corollary tools to support these efforts. First, we have the “RICI” list (Repository for Integrated Criminalistic Information) match. The RICI list is a state-mandated, county-maintained daily list of individuals arrested in the previous 24 hours. In Westchester, our IT Department created software to run that list against our database of individuals served by DCMH programs. Every morning, select DCMH leadership and service staff receive an email of all those we are serving, or have served, who have been arrested in the last day. This is extremely useful for case management, service adjustment, and planning purposes.
DCMH has also expanded our Single Point of Access (SPOA) program to embed a SPOA outreach staff person with County Department of Social Services Adult Protective Services (APS). In Westchester, law enforcement, among many others, refer individuals believed to be abused or neglected to APS. By partnering mental health with APS, individuals’ overlapping needs and concerns are addressed from first service contact.
Additionally, DCMH has created an Intellectual/Developmental Disability (IDD) “Boundary Spanner.” The role is a case manager who works with individuals with IDD needs to initiate eligibility (if necessary) and connect, or reconnect, people to the services they need – in any behavioral health system. Our Boundary Spanner works with referrals from the community, including individuals in our shelters, unsheltered, and justice-involved – even in the county jail as part of pre-release.
In 2025, Westchester’s behavioral health diversion models served nearly 4,000 people.
Joseph A. Glazer, Esq., is Deputy Commissioner, and Michelle Hart, MA, is Program Director, at the Westchester County Department of Community Mental Health. For more information, visit mentalhealth.westchestercountyny.gov.
Footnotes
- prainc.com/wp-content/uploads/2018/06/SIM-Brochure-2018-Web.pdf
- pmc.ncbi.nlm.nih.gov/articles/PMC12392395/
- pmc.ncbi.nlm.nih.gov/articles/PMC3735170/
- behavioralhealthnews.org/westchester-county-develops-lives-forward-program-providing-dual-certification-mh-and-addiction-peer-training-to-currently-justice-involved-individuals/
- www.prisonpolicy.org/reports/correctionalcontrol2023.html
