Voices of the unhoused from Santa Fe, New Mexico: A mixed methods study of health status, substance use, and community harm reduction program perspectives

Abstract

No published studies have examined the community service priorities and harm reduction perspectives of unhoused people in Santa Fe, New Mexico. We conducted a mixed methods pilot study of 56 unhoused people at community locations in Santa Fe to: (1) assess the current prevalence of chronic medical conditions and substance use; (2) highlight community service priorities; and (3) explore views of innovative community harm reduction programs. Our first hypothesis was there would be high prevalence of chronic medical conditions, for which we found high prevalence of post-traumatic stress disorder, major depression, substance use disorders, chronic pain, and hypertension. Our second hypothesis was that we would find top community service priorities of housing, food, and health care. We found long- and short-term housing and food, but not healthcare, top priorities. Our third hypothesis was that we would find mixed support for community harm reduction initiatives like managed alcohol programs and overdose prevention centers. We found positive, not mixed, support for these community harm reduction programs among Santa Fe’s unhoused. Unhoused study participants ranged in age 27–77 years, with lifetime years unhoused from less than one year to 63 years. Study limitations included small sample size, convenience sampling, and descriptive results. Policies and program initiatives supporting additional Housing First options, managed alcohol programs, and overdose prevention centers in the Santa Fe community are clearly indicated to increase engagement with this vulnerable population. Future research should focus on inclusion of the perspectives of the unhoused in the design, conduct, evaluation, and dissemination of community programs to meet the needs of the unhoused, with re-defined outcomes to include changes in quality of life, program engagement, demarginalization, and future goals and plans, beyond currently utilized health and social service program outcome measures.

Keywords:

• Harm reduction
• homelessness
• housing first
• managed alcohol program
• overdose prevention center
• safe consumption site
• substance use
• unhoused

Acknowledgements

Grateful acknowledgement to: Santa Fe unhoused survey participants who contributed their time and expertise generously; staff at the Santa Fe Interfaith Shelter and Consuelo’s Place; Chaplain Joe’s Street Outreach staff; Santa Fe Main Public Library; and Dr. Matthew Pearson of UNM Center for Alcohol, Substance Use, and Addictions for his thoughtful expertise and assistance.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was supported by IMPOWR Pilot (RM1DA055301; Witkiewitz & Pearson, mPIs) and the UNM Substance Use Disorder Grand Challenge grant. KP was supported by the NIDA Clinical Trials Network (1 UG1DA049468) and HRB and KP were supported by the National Center for Advancing Translational Science (UL1TR001449).