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California's homeless emergency stems from a lack of housing, but it is also a public health emergency. Governor Gavin Newsom has had the state government invest billions in public funds to directly address the crisis. Governor Newsom has put homelessness crisis front and center with a variety of multi-prong strategies. Margot Kushel, MD, who directs UCSF’s Benioff Homelessness and Housing Initiative, said, "There’s almost nothing as destructive to health as homelessness, and there’s very little that the health care system can do to make up for it."

Paul's Place, a four story building that will provide needed services, temporary housing, and permanent supportive housing to those experiencing homelessness, opens its doors in Davis, California. In regards to combining multiple types of housing under one roof, Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative said, "I don’t see it as a particularly big red flag, I think that that is true in any shelter or in any permanent supportive housing building: There are going to be people at different points on their journey."

As part of the National Low Income Housing Coalition's (NLIHC) National HoUSed Campaign call in January 2023, Maria Raven, MD, of the University of California, San Francisco, and Mark Fleming, PhD, of the University of California, Berkeley, shared findings from their new report on the association of shelter-in-place (SIP) hotels with health services among people experiencing homelessness during the COVID-19 pandemic. 

This interview with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, discusses a viral video of a San Francisco art gallery owner spraying an unhoused woman with a hose, and what his actions and residents' subsequent reactions reveal about the responses to homelessness in San Francisco. Dr. Kushel said that conversation about the video, "is indicative, in some ways, of the state of our discourse around homelessness that we continue to blame the individuals who are experiencing homelessness for what has been a really widespread societal failure."

The complex care evidence base continues to grow, but meaningful involvement of people with complex needs in the research process is lacking. Hemal Kanzaria, MD, Associate Professor of Emergency Medicine at University of California San Francisco spoke with The Better Care Playbook to learn more about how involving people with lived experience in research can help strengthen the complex care evidence base. Dr. Kanzaria said, "The partners are working together in every one of those steps and recognizing the skill set that everyone's bringing to it. That makes the work better than anyone could do by themselves."

A new report estimates California could end homelessness by 2035 if it spent at least $8.1 billion every year on the problem. Margot Kushel, MD, director of the UCSF Benioff Housing and Homelessness Initiative said, “The main way to solve homelessness is through housing.” She pointed out that research shows California is short by 1 million affordable and available housing units for extremely low-income renters—those making less than 30% of area median income. “By shrinking that deficit, we will reduce homelessness,” she said. “It will take a sustained investment by federal, state and local governments to do it.”

Housing First focuses on getting people into permanent housing and offering them support services. A 7-year randomized trial of chronically homeless individuals found those in the housing-first group spent 90% of their nights housed and made less use of psychiatric emergency services and more use of outpatient mental health services compared to the control group. “The experiment intentionally sought to try housing first for the very most complicated patients—those who society says are most hard to house—and it worked,” said study co-author Margot Kushel, MD, who directs the UCSF Benioff Homelessness and Housing Initiative.

This feature article reports on overdose mortality in the city's supportive housing program, the cornerstone of an effort to help people rebuild their lives after bouts of homelessness. "Anything that can create community and safety and wellness in these settings is going to make a difference," says UCSF Benioff Homelessness and Housing Initiative's Kelly Knight, MD.

San Francisco and California have been reckoning with the issue of housing instability for years, but additional complexities arise as people experiencing homelessness grow older. In this Grand Rounds, Margot Kushel, MD, one of the world’s leading experts on homelessness, discusses the drivers and precipitants of homelessness and the health consequences of aging in the homeless population. Dr. Kushel is a professor of medicine and directs both the UCSF Center for Vulnerable Populations and the UCSF Benioff Homelessness and Housing Initiative.

During the COVID-19 pandemic, UCSF partnered with government and community groups to address racial, economic, and cultural barriers with the goal of providing equitable care to vulnerable people. The UCSF Benioff Homelessness and Housing Initiative spearheaded many of those partnerships. “The secret sauce was putting the community-based organizations in charge,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, who envisioned a program to serve people experiencing homelessness that became a national model.