Resource Center

The United States is taking a sharp turn in how it addresses homelessness after a new executive order calling for more "involuntary commitment," which is a process in which mental health workers can forcibly detain and medicate people against their will. Studies have shown that the housing first model is significantly cheaper and more effective than involuntary detention. "Americans want there to be no homelessness. And this is...a formula to worsen homelessness," says BHHI Director Dr. Margot Kushel of efforts to expand involuntary detentions & withdraw funding from communities that don't comply.

Globally, tobacco use causes 8.7 million deaths annually. Approximately 50 % of formerly homeless adults in permanent supportive housing (PSH) in the United States smoke cigarettes. Secondhand smoke exposure is high in the absence of smoke-free policies. There is a need to understand attitudes toward smoke-free policies and factors associated with smoke-free home adoption attempts among PSH residents.

What does it mean to be working, but still homeless? BHHI Director Dr. Margot Kushel joined Brian Goldstone on KQED Forum to discuss hidden homelessness and what needs to change.

People experiencing homelessness have significantly lower life expectancies than the general population, and among those aged ≥ 45, tobacco-related illnesses are the leading cause of death.[1] Compared to the general population, tobacco use among people experiencing homelessness is six times higher, and the quit ratio (ratio of former to ever-smokers) is five times lower. [2],[3] We used the largest representative study of people experiencing homelessness since the 1990s to estimate tobacco use prevalence and its association with shelter status, behavioral health, and health services use among adults experiencing homelessness in California to identify opportunities to address unmet tobacco treatment needs.

In the year since the U.S. Supreme Court made it easier for cities to remove homeless encampments, California cities have redoubled enforcement efforts. For people caught up in sweeps in cities like Berkeley, Oakland, and Vallejo, the same question echoes again and again: “Where do I go now?” “The biggest problem with criminalization...[is] that criminalization worsens homelessness,” says BHHI Director Dr. Margot Kushel. “The public should...say, ‘Why are you taking expensive efforts to worsen a problem? This problem is 40 years in the making.”

As cities work to clean up homeless encampments under increasing pressure from Gov. Gavin Newsom and housed residents, RV communities present a distinct — and notoriously difficult — challenge, especially with more and more Californians taking up residence in them. UCSF Benioff Homelessness and Housing Initiative Director, Margot Kushel, found in her research that people living in RVs are reluctant to give them up for anything short of permanent housing — a dilemma when there’s little to offer. Berkeley officials designed their strategy with that in mind. To get the program to work, city staff and nonprofit outreach workers spent roughly three months coaxing residents, explaining their offer, listening to concerns and making accommodations to the shelter policies where possible. A one-dog-per-person rule stretched to allow four dogs in one room; friends were allowed to bunk together.

In January 2025, the City of Berkeley launched an innovative program to resolve the 2nd Street encampment by combining a low-barrier motel shelter with cash payments for residents’ RVs. Outreach workers built trust and tailored policies—allowing pets, partners, and friends—to boost participation. So far, 36 people and 26 animals have moved into the Capri Motel, and only three RVs remain on site. “The city designed this to really gain people’s trust and to make sure that people were not left worse off than they were when they started,” said Dr. Margot Kushel, calling the program “quite innovative.” BHHI is independently evaluating its impacts to inform future strategies.

Latine Californians represent more than one-third of the state's homeless population. Yet their experiences are too often left out of research, policy, and service design. To better understand these experiences, we examined data from the California Statewide Study of People Experiencing Homelessness. This report, based on the California Statewide Study of People Experiencing Homelessness (CASPEH), examines who experiences homelessness in the Latine community, their experiences while homeless, and offers evidence-based policy and program solutions.

The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a report that examines Latine Californians' experiences of homelessness and makes recommendations for policymakers and practitioners.

Californians experiencing homelessness have poor health, struggle to access care, and face high ER and hospitalization rates—despite high rates of insurance. In this cross-sectional, representative study of adults experiencing homelessness in California, we found poor access to health care and high rates of short-term health care utilization that reflected how homelessness is negatively associated with health care access. Predisposing contextual and need factors, including being unsheltered, using illicit drugs, and having functional impairments, were associated with reduced access to care and increased use of short-term care. These findings underscore the necessity for health care and housing interventions that are tailored to the needs of people experiencing homelessness.

Latine Californians represent more than one-third of the state's homeless population. Yet their experiences are too often left out of research, policy, and service design. The UCSF Benioff Homelessness and Housing Initiative (BHHI) held a discussion of Toward Equity: Latine Experiences of Homelessness in California, the latest report from the California Statewide Study of People Experiencing Homelessness (CASPEH) series. This webinar highlights key data on how structural anti-Latine racism, housing exclusion, and administrative barriers shape pathways into homelessness, and explores what policy, service, and community leaders can do to close equity gaps.

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.

Ending homelessness in the United States has remained stubbornly out of reach. Despite hundreds of federal, state, and local plans to end homelessness, most have ended unsuccessfully—due to a range of issues, notably insufficient resources. Homelessness persists and, in many communities, has increased because of myriad intervening factors—many of which lie outside the control of the systems tasked with solving it. This paper summarizes the evidence for effective interventions that need to be replicated and scaled.