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Homelessness and behavioral health issues (mental health and substance use) are intertwined. The UCSF Benioff Homelessness & Housing Initiative held a webinar about this complex bidirectional relationship, along with solutions to this crisis. Margot Kushel, MD, Claudine Sipili, Darrell Steinberg, JD, and Stephanie Welch, MSW, discussed findings from the California Statewide Study of People Experiencing Homelessness (CASPEH), highlighted key policy recommendations, and answered audience questions. Marc Dones moderated the webinar.

Behavioral health challenges both contribute to and are exacerbated by homelessness. To better understand behavioral health and homelessness, we examined data from the California Statewide Study of People Experiencing Homelessness. Our latest report examines the relationship between homelessness, substance use, and mental health, providing critical insights for policymakers, program leaders, Continuum of Care leaders, and healthcare systems.

The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a report that examines the issues of homelessness and behavioral health (substance use and mental health) and makes recommendations for policymakers and practitioners.

Join CHCF in Sacramento on Wednesday, March 12, 2025 for a briefing about these supports and their importance for helping people move from homelessness to housing. The briefing will begin with an overview of how homelessness impacts a person’s health by Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF. She will draw from the landmark California Statewide Survey of People Experiencing Homelessness. Following the presentation, Michelle Schneidermann, MD, director of people-centered care at CHCF, will moderate a discussion about the role Medi-Cal is playing in California’s homelessness response and how that role can be strengthened and improved through critical partnerships across the health, homelessness, and housing sectors.

A new UCSF BHHI study challenges common perceptions about homelessness and drug use in California, revealing that only 37% of surveyed unhoused Californians use drugs regularly, while 25% have never used them at all. Methamphetamine, not opioids, is the most commonly used drug, often as a means to stay alert while living on the streets. The study also highlights the complex relationship between addiction and homelessness—while drug use can increase the risk of losing housing, “Homelessness itself increases drug use because people use it as a coping strategy,” said Margot Kushel, MD. With homelessness on the rise and only 7% of respondents in treatment, experts stress that expanding affordable housing and accessible treatment options is crucial to addressing both crises.

KTVU's Heather Holmes and Frank Mallicoat talk to Marc Dones, Policy Director of the Benioff Homelessness and Housing Initiative, about the challenges unsheltered people face and what research says about barriers to resources.

Research from UCSF Benioff Homelessness and Housing Initiative reveals that most people experiencing homelessness in California are not illegal drug users—contrary to widespread public perception. These findings challenge common stereotypes and underscore the urgent need for better treatment options and housing solutions across the state. KCBS Radio news anchor Eric Thomas spoke with Margot Kushel, MD, Professor of Medicine and Chief of UCSF’s Division for Health Equity and Society, to dive deeper into the issue.

A new UCSF BHHI study challenges misconceptions about drug use among people experiencing homelessness in California. While only 37% of homeless individuals regularly use illicit drugs, lifetime use is high, and 27% began using after losing housing. The study highlights the difficulty of accessing treatment, with only 7% receiving care and 1 in 5 actively seeking help but unable to get it. Margot Kushel, MD, emphasized the complex relationship between drug use and homelessness, stating, “People are telling us that it helps them survive,” she said. “It keeps them awake and alert. They are using it either because they are traumatized, they have been assaulted, they are afraid or depressed, using it as coping to make it all go away.”

Domestic violence is a major but often overlooked driver of homelessness in Los Angeles, with 44% of unhoused women citing it as the primary cause, according to a 2023 Urban Institute survey. Yet, LA’s survivor support system is severely underfunded—only 10% of those seeking shelter secure a bed. A UCSF BHHI study found that 60% of survivors who fled abuse end up sleeping in cars, tents, or the streets, where they remain vulnerable to further violence. Experts and advocates warn that without integrating domestic violence services into homeless support systems—and vice versa—thousands will continue to face impossible choices and unsafe conditions.

A groundbreaking UCSF BHHI study challenges common perceptions about drug use among people experiencing homelessness. Researchers found that less than half of this population regularly used drugs, with methamphetamine being the most common substance, not opioids. Many respondents wanted treatment but struggled to access it, highlighting barriers to care. The study emphasizes that homelessness and substance use are interconnected and advocates for reducing barriers to treatment and prioritizing housing solutions. "We need to reduce barriers to substance use treatment, and that includes prioritizing people’s ability to return to housing,” said BHHI faculty member Ryan Assaf, PhD, MPH, the study’s lead author.

In 2024, for the second year in a row, a record number of people in the U.S. experienced homelessness on a single night, according to the U.S. Department of Housing and Urban Development (HUD). The homelessness crisis is fueled by skyrocketing housing costs, which have put homes out of reach for hundreds of thousands of people. Nearly half of renters spend more than 30 percent of what they make on housing, according to the Census Bureau. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They’re not spending it on food. They’re not spending it on health care. They’re not putting it away for a rainy day."

Rising cost of living, demographic trends have pushed many older South Florida seniors into homelessness. To blame are rising costs, particularly for housing, that outpace many older people’s fixed incomes. Natural disasters, a lack of affordable housing and long-term economic dynamics that have disadvantaged those born between the mid-1950s and the mid-1960s also factor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "What determines the rate of homelessness in a community is its availability or lack of availability of housing for low-income people."

In this op-ed, Trina Johnson PhD, MSc, postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights how the overdose death rates for white people had fallen dramatically by but it isn't the same for Black people. These disparities have been attributed to structural determinants including inadequate access to harm reduction services, as well as a treatment system that is not designed to meet the needs of all communities. "We can create a model for equity and antiracism in addiction treatment that can inform all areas of medicine, so all patients and communities can thrive." Dr. Johnson writes.

The scale of devastation wrought by the deadly wildfires in Pacific Palisades and Altadena has been unimaginable. Entire neighborhoods have been wiped out, homes reduced to smoldering ruins, and acres of hillside consumed by relentless flames. In this episode of Life Examined, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins authors George Bonanno, PhD and Carolyn Korsmeyer, PhD to talk with host Jonathan Bastian about trauma, resilience, and why our homes are integral to who we are . Dr. Kushel said, "You have that physical safety, hopefully, that acceptance for who you are, and you can just be you. And there are very few other places where that is true."

In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, highlights the frequency people experiencing homelessness are exposed to violence. Across the country, people are viewing the presence of people experiencing homelessness on public transportation as a thread, leading efforts to remove individuals sleeping on public transportation. "Throughout literature, sleep has been a metaphor for death. But, in real life, sleep should mean neither death nor arrest. We need to focus on real solutions — increasing housing affordability and the services that allow people to thrive — instead of demonizing tired, frightened people" Dr. Kushel writes.

America’s homeless population swelled to its highest level in recorded history in 2024 according to an annual count of individuals living in emergency shelters, transitional housing or on the streets. California continues to have the largest homeless population of any state — 187,084 in 2024 — and the highest rate of unsheltered people, according to the U.S. Department of Housing and Urban Development’s point-in-time estimate released Friday, December 27, 2024. However, California's increase of 3.1% from 2023 was smaller relative to other states.