Voices of the unhoused from Santa Fe, New Mexico: health status, substance use, and community harm reduction views

Background:  New Mexico experienced the largest percent increase of homeless people and second highest increase in US (United States) state homelessness rates between 2022 and 2023. Together with its third highest poverty rate, highest rates of alcohol-related deaths, and second highest rates of drug overdose deaths in the United States, New Mexico has also seen rising deaths among unhoused people in its capital city of Santa Fe since 2021, with up to 10% of unhoused people dying each year. Little is known regarding the current lived experience of the unhoused of Santa Fe related to their current health status, community service priorities, and community-based harm reduction program perspectives. Methods: We conducted a mixed methods study of 56 unhoused people at community locations in Santa Fe, New Mexico. Eligible survey participants were at least 18 years of age and self-identified as unhoused. Using convenience sampling, potential participants were approached in the community by the research team at congregate and non-congregate homeless shelters, at the public library, and at large with a street outreach team in Santa Fe, with permission of staff involved at each site. The survey measured demographics, chronic medical and mental health conditions, substance use, healthcare utilization and barriers, and health social service program priorities. Most survey questions were close-ended and quantitative, but open-ended questions related to perspectives of various community harm reduction services generated qualitative data. Results: Unhoused study participants ranged in age from 27-77 years, with lifetime years unhoused from less than one year to 63 years. Key quantitative findings include high prevalence of post-traumatic stress disorder, major depression, chronic pain, hypertension, and polysubstance use, with long- and short-term housing and food as top community service priorities. Qualitative findings included positive support for community harm reduction initiatives such as managed alcohol programs and overdose prevention centers. Study limitations included small sample size, convenience sampling, and exclusion of youth under age 18. Conclusions: 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 which prioritizes housing and supports community harm reduction services. 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.