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PAGE 62 Community members were concerned about substance use among adults, too, noting the safety concern when people openly use substances in public spaces, particularly public transportation. One said “The only way we can have safe community events or have safe public transportation, or really just care about the safety of members of the community in general is if…there’s no open substances.” Participants spoke to the complexity of factors contributing to substance use, and the difficulty in addressing substance use when people aren’t ready for treatment. One provider discussed their experience working with this population: “They have substance use disorders and mental health (conditions). And you do want to connect them…I do connect them to rehab programs through the Alameda County ACCESS line. But it’s all depending on their change readiness, sometimes they’re not open to wanting to stop use. Sometimes it’s… something’s triggering them. It could be family housing, it’s something that they use to cope. A lot of our patients…started using substances at a very young age, or they’re currently using right now, or they were also in remission but they relapsed due to the pandemic.” There is a general consensus about a lack of available services in the Tri-Valley, including those that are education and prevention focused. “We don’t have enough services in general. We certainly don’t have enough substance abuse or substance use education support services.” There is also a lack of local treatment services for individuals using or addicted to substances. When asked about service gaps within the Tri-Valley one service provider responded: “I would say residential or non-residential (services) for substance use and abuse…that’s kind of a challenge finding those kinds of resources. We were looking the other day and it seemed like we had to look elsewhere in the county for that, depending on what the client’s resources were. So that seemed like a bit of a challenge.” Participants also highlighted the specific need for harm reduction programs and services: “It’s something that we don’t really talk about here in the Tri-Valley as much, but a lot of our population have substance use disorder, and it’s primarily methamphetamine. We don’t have any harm reduction programs like the city has and there’s no needle exchange program.” Substance use is a cross-cutting issue, with several participants acknowledging the connections with being unhoused and mental health conditions, with substance use often serving as a form of self- medication for undiagnosed or untreated mental health disorders. “What we’ve noticed is that a lot of people we come across in the street have substance abuse issues. You know, there’s a variety of issues, but ultimately, everything leads back to mental illness. And if they’re not getting that help…it’s going to be very hard for them to resolve any other issue they have. Because ultimately, that’s what it comes down to.” Findings from this Needs Assessment about the often overlapping needs of substance use, mental health (including lack of services), and housing, and connections between safety and substance use are reinforced by findings from the Alameda County Needs Assessment.14 Safety Concerns were raised about the extent to which community members felt safe. This encapsulated psychological safety, with a connection to and implications for mental health, and physical safety, with concerns about crime and violence. Overall, there was a perception that both violent and non- violent crime had increased in the Tri-Valley. One individual said: “Crime is a concern. Quality of living is deteriorating with the crimes that are becoming more and more intense. You know more and more of this kind of crime is happening in our everyday life. We don’t feel safe.” This cross-cutting theme, as one participant indicated, was spread across the region: EASTERN ALAMEDA COUNTY HUMAN SERVICES NEEDS ASSESSMENTSS Page 120 of 554