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California state lawmakers say they need more tools to help get people experiencing homelessness into treatment, debating the use of involuntary commitments. Homelessness is caused by a lack of affordable housing, not mental illness. “The problem of homelessness is that people don't have housing. If you had all the treatment in the world and you didn't have the housing, we would still have this problem,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

California is trying to tap federal health care funding to cover rent for homeless people and those at risk of losing their housing. Yet, health care experts say that, while six months of rent can be a bridge while people wait for permanent housing, there’s a bigger obstacle: California’s affordable housing shortage. “We can design incredible Medicaid policies to alleviate homelessness and pay for all the necessary supportive services, but without the adequate housing, frankly, it’s not going to work,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative.

As San Francisco works to launch the CARE Court program, even some supporters are skeptical it will have a big impact on tragedies unfolding on the streets, arguing there aren’t enough treatment beds, housing, and intensive case managers. Maria Raven, MD, an author of the study who is chief of Emergency Medicine at UCSF Medical Center and co-leads the Benioff Homelessness and Housing Initiative COORDINATE HOME program, said there’s not enough permanent supportive housing. She hoped the report could start a conversation between the state and the city on how to fill gaps—"Otherwise it’s just going to be another program that doesn’t really have any impact."

Manny's organized a four-part series on understanding homelessness in San Francisco. In part one, the host spoke with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, about the root causes of homelessness in San Francisco to demystify the realities and complex factors that keep people homeless. Dr Kushel said, "The difference in community level of homelessness is entirely trackable by the availability of housing for the lowest income households."

Violence against people who lack housing "is astronomically higher than we see in other populations," explains Margot Kushel, MD. "We know from studies that when people obtain housing, no matter what type of housing it is, over the next six months they are at dramatically less risk of experiencing violence."

As part of the National Low Income Housing Coalition's (NLIHC) Housing First Promotes Health call in February 2023, Margot Kushel, MD, director of the UCSF Benioff Housing and Homelessness Initiative, shared research on how housing improves health outcomes.

Seniors are the fastest growing unhoused population. From 2017 to 2021, California’s overall senior population grew by 7% but the number of people 55 and older who sought homelessness services increased 84%. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "Nearly half of single adults 50 and over experiencing homelessness had never been homeless before age 50."

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.