Resource Center

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."

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 UCSF’s 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 UCSF’s 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 BHHI's Kelly Knight, MD.

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, who envisioned a program to serve people experiencing homelessness that became a national model.

During the COVID-19 pandemic there was a 50% increase in opioid overdose deaths in the Shelter in Place (SIP) hotels for individuals experiencing homelessness in San Francisco. Community Behavioral Health Services Pharmacy partnered with SIP hotel medical staff to launch a pilot project where on-site SIP medical providers prescribed buprenor-phine (BUP) and clinical pharmacists hand-delivered BUP to SIP residents to increase BUP initiation and engagement. Researcher’s findings suggest that this system of onsite medical care with pharmacist delivery is possible and could allow for more outreach and increased ease of obtaining medications for patients.

This study from BHHI researchers describes five distinct subgroups of the highest users of the health care system in San Francisco with differential comorbidities, health care needs, and social determinants of health, spanning from patients with medical comorbidities solely using medical services to patients grappling with housing insecurity, incarceration, substance use disorder, and mental health comorbidities. Frequent users of the health care system are not a homogenous population as previously thought. This study sheds new light on how to help the most vulnerable patients and inform clinicians and care coordination teams on making sure patients get the care they need the most.