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In the state of California, the three major utility companies, have nearly doubled electricity rates over the last decade. With growing increase in energy demands, the rising utility costs are pushing families already at the margins to the brink of homelessness. Many people are forced to making an impossible choice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I think recognizing energy insecurity as a contributor to this crisis, this is the next frontier that we need to really worry about."

An increase in the number of deadly attacks on people experiencing homelessness has coincided with a spike in people experiencing homelessness in the US. What concerns many is that the attacks occur regularly and without notice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This violence is happening every day, just outside of our vision."

The perception of people experiencing homelessness is often based on anecdote. On this episode of UCLA Housing Voice podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Shane Phillips to talk about the California Statewide Study of People Experiencing Homelessness, and what it says about who experiences homelessness, why they become homeless, their experiences while living without housing, and barriers to re-entering stable housing. As the conversation moved to mental health, substance use disorder, and people experiencing homelessness, Dr. Kushel said, "People in those in depth interviews, talk to us really clearly, that while they might have been using these drugs before they became homeless, they're using them while homeless was a coping strategy."

There is public skepticism when politicians promise to solve a crisis, and then little progress gets made. Los Angeles Mayor Karen Bass's policies have given new hope, but an increase in violence against people experiencing homelessness has pushed more into despair. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I do really worry that it’s become normalized in public discourse to speak about people experiencing homelessness as, like, a problem for those who are not homeless — as opposed to fundamentally a massive societal failure that’s left usually older, vulnerable people terrified and totally unprotected."

Violence against people experiencing homelessness has increased. In Los Angeles, three people experiencing homelessness were killed. The killings are a stark reminder that those experiencing homelessness are profoundly vulnerable. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The public is often very frightened of people who experience homelessness. But what they don’t realize is that people experiencing homelessness are frightened all the time."

A record number of seniors are burdened by high housing costs. A new report from University's Joint Center for Housing Studies sounds the alarm as the US population ages rapidly. The number of seniors who will qualify for federal housing subsidies will continue to grow. The report also notes that more people over the age of 50 are losing housing for the first time. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Increasingly, the story of homelessness among adults is going to be older adults living in poverty, who are spending what should be their retirement years in the streets."

Veteran homelessness has dropped about 55% in the United States, while it has remained relatively stagnant amongst the general population. The US government has reached a consensus and has offered a wide range of programs to limit homelessness or factors that put people at risk for experiencing homelessness. The VA’s Supportive Services for Veteran Families (SSVF), the Department of Housing and Urban Development’s (HUD) Veterans Affairs Supportive Housing (VASH) program are the foundation to the efforts. Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, said "I think it gives us a blueprint of exactly what we need to do."

People experiencing homelessness are at an increased danger of dying. A recent study by the National Bureau of Economic Research showed a 40-year-old person experiencing homelessness has a similar risk of death as a 60-year-old person with housing. Previous studies have also found that people who experience homelessness have a greater mortality risk. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re letting people die because we’re not fixing the underlying crisis."

There are over 1 million emergency department visits for non-life-threatening alcohol intoxication each year, many of which are people experiencing homelessness. In this op-ed, Shannon Smith-Bernardin, PhD, MSN, RN, assistant professor of nursing, answers questions about sobering centers, the utilization of sobering centers, and the health impact of sobering centers. Dr. Smith-Bernardin writes, "Sobering centers provide an opportunity for patients to build a consistent relationship with a health care professional who is specifically trained in addiction and trauma-informed care."