Examining Prosecutors' 2020 Framework on Prosecution and Public Health

Background and Purpose: The United States is in the midst of a poorly understood public health crisis. Americans with mental health and substance use disorders needs of all kinds are neglected, stigmatized, or inadequately supported by health and safety systems which can more effectively optimize successful human development and outcomes. Improving access and coordinating interventions across systems will prevent premature death, injury, long-term disability, and many other threats to achieving equity, public safety, and wellbeing. The nation’s response to health needs too often defaults to the criminal justice system. This reliance upon justice system intervention for unaddressed health needs has yielded racial and economic disparities, poor health and safety outcomes, and at a tremendous cost to individuals and the community at large.

Methods: Following a participatory based research approach, a national network of prosecutor offices was formed representing politically and regionally diverse jurisdictions. These offices engaged in bimonthly meetings identifying research and innovation priorities. Then, a virtual convening was held over two days in which half of the convening was reserved for qualitative data collection. Interviews and focus groups were conducted with 22 prosecutors. The interviews were recorded and transcribed and then analyzed for themes. Two coders analyzed the data and met to discuss discrepancies in findings. Member checking was used to confirm the thematic results and three subsequent meetings were held with participants to review study findings. Prosecutors reviewed study results and generated a 2020 framework for prosecution and public health.

Results: Prosecutors described 35 program elements and outcomes of prosecutorial diversion that they felt were necessary in order for their jurisdiction to approach prosecution from a public health framework. The elements and outcomes they articulated were geared toward solving the following problems: overreliance on incarceration; restricting individual liberty; technical violations; the default use of the criminal justice system for responding to behavioral health crises; stigma and hopelessness; negative consequences to families; and prosecutors championing restorative justice. This paper reviews the 35 program elements and outcomes that they proposed to aforementioned problems. In addition, prosecutors identified over 20 areas of research that they would prioritize and then ranked the top five areas. These top five included (1) examine the cost-benefit of prosecutorial diversion programs on savings to the community public health and public safety; (2) implement ways to document change in individuals’ social, psychological, and occupational wellbeing; (3) examine what is considered short term and long term failure and success of prosecutorial diversion programs; (4) identify a profile or characteristics of participants that are good fit for diversion programs; and (5) empirical document and publicly share the human success stories of diversion programs.

Conclusions and Implications: In the United States public health, public safety, and economic wellbeing are inextricably intertwined. A resolution to this crisis demands more therapeutic approaches to behavioral health and a rebalancing of community investment. Where justice system involvement has already begun, diversion into programs outside of the criminal system could be available, favoring the earliest interventions and preventing further contact with the system wherever possible.