Implementing Wet Services in Montréal for Highly Vulnerable People Experiencing Homelessness who Use Alcohol

Context: People experiencing homelessness and alcohol dependence are highly marginalized as they struggle to access various health and social services. This study is part of a broader feasibility study on the implementation of "wet services" in Montréal, Canada. Methods: Four focus groups were conducted with 20 participants working in the field of homelessness. The objectives of this study were to gather their perspectives on the need for wet services in Montréal, define the main purpose of such services, and identify the key factors promoting their success. Results: All participants felt that wet services could meet several critical needs of many people experiencing homelessness in Montréal, and most argued that they should also be implemented without delay. According to most participants, these services should be grounded in a harm reduction philosophy, take a low-threshold approach and be accessible to the target population at all times. Participants argued that wet services should primarily aim to offer a safe place to consume alcohol whilst also serving as a place where people experiencing homelessness could meet their basic needs, reconnect socially, and access various health and social services. However, participants cited a number of financial, logistical, and organizational constraints, such as control-related mechanisms (e.g., eligibility criteria, rigid bylaws, or the institutionalization and medicalization of services), which they feared could stand in the way of achieving the objectives of wet services or perpetuate the exclusion of people experiencing homelessness. To avoid these potential problems, most participants felt that wet services should be delivered by well-established and well-funded community-based organizations, accompanied by a variety of partnership arrangements, including those with health services. Conclusion: This qualitative study contributes to the growing body of evidence on alcohol-related harm reduction services. Its findings may serve to inform the eventual implementation of wet services in Montréal and in other locations.