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In this op-ed, Marguerita Lightfoot, PhD, MA, Associate Dean for Research at the OHSU-PSU School of Public Health, calls attention to youth experiencing homelessness in Sacramento. She outlines the higher rate of mental health-related hospitalization among youth, with almost 70% of youth experiencing homelessness reported experience depression and anxiety. Dr. Lightfoot also highlights the resources and programs that would help. "Every person experiencing homelessness needs help. But youth are too often treated as adults, and do not receive the tailored, developmentally appropriate services they require." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, explains how homelessness in California is a housing issue. Others often blame California's homelessness problems on high rates of mental health and substance-use problems, but the data tells a different story. Dr. Kushel writes, "It has taken decades for California to develop its housing crisis, and it will take many years to fix it. Making the wrong diagnosis and prescribing the wrong solution won’t end the crisis." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Leslie W. Suen, MD, MAS, an assistant professor of medicine in the UCSF Division of General Internal Medicine at San Francisco General Hospital, highlights the lack accessibility of the most effective evidence-based treatment for opioid use disorder in California. She outlines the effectiveness of methadone treatment to help people with opioid use disorder, and how Californians restrictions regarding methadone create unnecessary barriers to care. "If having to go to a clinic every day for medication isn’t onerous enough, California tacks on additional state laws that make staying in methadone treatment even more challenging for patients" said Dr. Suen. This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, spoke with Jaden Jefferson about the need for affordable housing and the UCSF BHHI California Statewide Study of People Experiencing Homelessness. A major finding of the study was that homelessness doesn't affect everyone equally, communities of color are disproportionately vulnerable to being displaced into homelessness, especially Black, Latinx, and Indigenous Californians. One reason that is the case is "when we look at the history of housing in this country, what we see is that our neighborhoods were actually built through racial covenants between the government and realtors in the form of what we now call redlining", said Dr. Ponder.

Advocates for people experiencing homelessness refer to sidewalk planters as “hostile architecture” meant to push the homeless population out of sight. The tactic is not new, residents, business owners, and the city have used architecture to prevent encampments on the street. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I get why people don’t want this suffering in our neighborhoods, I really do, but because we feel so overwhelmed by the hard work we need to do to solve this crisis, people start to lose hope."

Billions have been spent to solve the homelessness crisis in California. However, while zoning laws, law enforcement and services for mental health and addiction all play a part in the solution, several state and local leaders believe only an enormous investment from the federal government can help solve this crisis; more funds are needed for rental assistance or other direct aid. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said "I fear that it’s going to require Congress to move on the big picture."

In this Politifest 2023: California's Biggest Challenges, Voice of San Diego's senior investigative reporter Lisa Halverstadt talks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the causes of homelessness. Dr. Kushel discusses the landmark study, the California Statewide Study of People Experiencing Homelessness, that BHHI released in June. "It turns out people who experience homelessness stay where they are. This is a homegrown problem. We can talk for the reasons for that problem, but it's, it's certainly not people rushing into our state to, to enjoy being homeless here" said Dr. Kushel.

Unhoused people made up almost half of heat-related deaths in Los Angeles County last year, though they represent less than 1% of the population. In Sacramento County, the death rate among people experiencing homelessness in 2021 from hypothermia was 215.5 times higher than the county rate overall. California's climate and housing crises are colliding. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "Folks experiencing homelessness are on the bleeding edge of the health crises that are happening with extremes of temperature."

On this weeks episode of As Prescribed, Alice Wertz spoke with Margot Kushel, MD, a professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF about the aging homeless population. Older people who experience homelessness tend to have health problems more commonly found in people who are in their 70s or 80s. Recent research has shown that about 48% of adults experiencing homelessness were 50 and above. "They really were hanging on every month, scraping by, barely able to make the rent,” said Dr. Kushel. “And sometime after the age of 50, something happened. And what was really interesting about these folks, as they could kind of pinpoint the moment when things fell apart.” she added.

In this op-ed, Dalma Diaz, MA, a health equity fellow at the California Health Care Foundation, highlights the increase in people experiencing homelessness among the Latinxs. Despite the rising rental costs and displacement, more than two thirds of Latinx said they are not worried about experiencing homelessness in California, and yet research has shown that Latinxs are more likely than other ethnic groups to experience first time homelessness. Ms. Diaz writes, "Let us not return to the apathy, silence, or whatever it was before the pandemic that kept us on the sidelines of the homelessness crisis. It’s up to us, now, to do the work in coalition, and make the change for future generations." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Homelessness hasn’t necessarily become worse, but it is more visible—especially in CA cities. This is due to a combination of factors, including rising number of people who experience homelessness and living nearly full time one the street, increased real estate development in some cities, and police action in prohibiting and forcing the relocation of people experiencing homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homelessness has become more obvious without necessarily becoming worse. It's much more in your face than it was before."

In this op-ed, Zena Dhatt, a Qualitative Research Project Manager at the Benioff Homelessness and Housing Initiative, calls for action to decriminalize drug use. She outlines that hyper-policing and escalation of drug war policies will not resolve the increasing rates of overdose or people experiencing homelessness. Ms. Dhatt writes, "Prison and jail cells should not be an alternative to housing or treatment." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

Oregon is one of several states betting on housing and outreach programs using Medicaid funds. Officials hope that by keeping people from experiencing medical crises that lead to repeated emergency room visits, Oregon will save enough money to pay for increased housing costs. California is also working to implement a program similar to Oregon's, spending more than $100 million a year on housing from its Medicaid budget. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative said, "I know that if I could get my patients who are experiencing homelessness housing, we could make everything else work better".

The UCSF Benioff Homelessness and Housing Initiative (BHHI) recently released a report on the largest representative study of homelessness in the United States since the mid-1990s—the California Statewide Study of People Experiencing Homelessness. BHHI study staff administered nearly 3,200 questionnaires and conducted 365 in-depth interviews with adults experiencing homelessness in California to better understand the characteristics and experiences of adults experiencing homelessness, precipitants of homelessness, barriers and facilitators to regaining housing, and opportunities to better prevent and end homelessness. Our presenters, Margot Kushel, MD, Kara Ponder, PhD, Tiana Moore, PhD, and Sage Johnson discussed key findings from the study, reviewed evidence-based policy recommendations, and answered questions from attendees.

West Virginia leads the nation in overdose deaths per capita, presenting a paradox to people who believe that drug use is to blame for the increase in people experiencing homelessness in cities. People who lose housing are more likely to increase their drug and alcohol use. Furthermore, experiencing both homelessness and drug addiction lengthens the time it takes to solve each problem. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "People conflate these crises. They are related but they are far from one and the same."

In this op-ed, Ryan Assaf, PhD, MPH, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights the common misconception among many Californians that substance use is the primary cause of people losing their housing. He outlines that drug use is correlated with the length of time someone is homeless and the extremity of their living conditions. Dr. Assaf calls for a housing first approach, writing, "Regardless of an individual’s drug use, policymakers and advocates should prioritize getting people experiencing homelessness into safe, secure and stable housing." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

In this op-ed, Lourdes Johanna Avelar Portillo, PhD, a postdoctoral fellow with the Benioff Homelessness and Housing Initiative, underscores the importance of providing access to water and sanitation services to people who are experiencing homelessness. She explains how the lack of water and other hygiene services can create added barriers among those experiencing homelessness, increasing stigmatization, as well as an increase risk in public health. Dr. Protillo writes, "the need for public access to water, sanitation and hygiene services is not just for people experiencing homelessness — it’s important to everyone." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

This paper describes the qualitative component of a large mixed method study, the California Statewide Study of People Experiencing Homelessness. The qualitative study consisted of seven sub-studies across eight counties, each exploring different dimensions of homelessness. BHHI researchers recruited participants from the overall sample, a statewide representative sample of adults experiencing homelessness recruited in eight counties, based on their responses to questions from the survey interviews. The researchers' mereological study design presents an approach for developing complex qualitative policy studies across a range of topic areas.