Scoping the challenges and opportunities for a public health diversion pathway for substance use in a county district in England:a qualitative frame analysis [version 1; peer review: awaiting peer review]

<b>Background</b><br/>Substance and alcohol use are well-established drivers of crime, anti-social behaviour, and harm, necessitating a comprehensive public health approach. Diversion schemes play an important role in engaging people entering or within the criminal justice system, whose crimes are linked to substance use. However, the emergence of public health diversion schemes has been slow. This study scopes the challenges and opportunities for a multiagency public health pathway to prevent substance use harm in Nottinghamshire, UK.<br/><br/><b>Methods</b><br/>Senior and frontline staff from diverse agencies were purposefully sampled for interviews based on their involvement in pathway development and/or implementation. 25 semi-structured interviews were conducted during a 12-month delivery period, involving local government public health, police, and treatment providers. A frame analysis investigated differences in perspectives regarding public health, the meaning of prevention, and pathway design.<br/><br/><b>Results</b><br/>Pathway development requires balancing two sets of oppositional frames: public health vs. public safety and custody vs. community. While agencies’ stated commitment to public health presented an opportunity, intervention points across the custody suite and community setting could not be optimised during the delivery period. Operational siloes, resource constraints, and role congruency issues linked to contrasting understandings of prevention and role expectations frustrated progress. As such, a ‘reactive’ approach based in the custody suite took precedence over a ‘proactive,’ community-centred approach.<br/><br/><b>Conclusions</b><br/>Multiagency public health solutions are challenging to develop amid contrasting understandings of public health, role expectations, and resource constraints. There is a need for national-level multi-agency discussions to develop a shared understanding of a public health approach to diversion, including understanding the role and contribution of frontline police staff. Future research should engage service-users in pathway design and aim to establish optimal agency roles and processes for coordinating interventions across custody suites and community settings.