Social and Resource-Based Utility of Public Spaces for Individuals with Co-Occurring Disorders

Background: People with serious mental illnesses and co-occurring substance use disorders (COD) often rely on public spaces, like parks and libraries, to access tangible resources (e.g. internet access, charging stations), social support, and social capital (i.e. resources embedded in social networks) that are essential to recovery. There is little research describing these public spaces, the social networks they facilitate, nor the unique resources acquired through either. We also have a limited understanding of whether these resources can support mental health functioning, substance use reduction, or sense of community for people with COD. This study examined these spaces and the social networks they facilitate through social network and participatory mapping interviews with people who have COD. Methods: Thirty-four participants with COD were recruited from a parent study investigating the effectiveness of a substance use intervention to participate in a qualitative social network and participatory mapping interview. These semi-structured interviews examined participants’ social networks and the places where they take place as well as participants’ sense of belonging and exclusion in these places. To evaluate the relationship between social networks and space, public space utilization within social networks was measured as the proportion of a participant’s social contacts they interact with primarily in public vs. non-public spaces. The relationships between within-network public space utilization and mental health, social support, and substance use outcomes were assessed via general linear models. Models controlled for absolute network size. Grounded theory and content analysis were used to analyze qualitative interviews and participatory maps. Results. While a larger proportion of social network alters in public space was associated with less instrumental support (p=.01) and increased mental health symptoms (p=.01), it was also associated with increased meaning and purpose (p=.02). During qualitative interviews, use of public spaces co-occurred most often hobbies and entertainment, acquaintances, and friendship development. Participants described an array of public spaces, including libraries and outdoors spaces (e.g. parks, dog parks, climbing rocks, and parking lots), where they spent time. Implications. While networks more heavily based in public spaces were associated with reduced instrumental support and increased mental health symptoms, they were also associated with an increased sense of meaning and purpose. Qualitative findings further elucidated the role of public spaces in supporting the positive development of relationships. Public spaces can play an important role in compensating for absent networks through provision of opportunities for relationships and supporting hobby development.