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California passed the Community Assistance, Recovery, and Empowerment (CARE) Act in 2022 to provide behavioral health and housing services to individuals with psychotic spectrum and schizophrenia disorders who are deemed unable to care for themselves. This policy brief from the Benioff Homelessness and Housing Initiative at UCSF and the California Policy Lab uses anonymized data to estimate how many San Franciscans in a database of individuals who have contact with the urgent and emergent care system may be eligible for referral to CARE Court and describe their service needs.

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.

Over 70% of people experiencing homelessness report current tobacco use, compared to 14% in the general population. One of the structural barriers that hinder cessation attempts among people experiencing homelessness is inadequate access to health care and other smoking cessation services. Researchers in this study aimed to explore tobacco use behaviors and factors influencing acceptability of engaging in a clinical trials. Researchers found that participants had attempted to quit smoking, and were interested in engaging in clinical trials as a method to quit smoking.

In this op-ed, DeForrest (DeDe) Hancock, a UCSF Benioff Homeless Housing Initiative Lived Expertise Advisory Board member, tells her story about experiencing homelessness. She writes, [when] “I was homeless, 2009 to 2016, I came to believe that we are all ordinary people simply each living out the scripts of our lives. Some of our scripts include life-challenges which provide lived experience to build the expertise and skills for survival.”

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."

Long-acting injectable antiretroviral therapy (LAI-ART) is approved for treatment-naive or experienced people with human immunodeficiency virus (HIV; PWH). The researchers performed the first LAI-ART demonstration project to include PWH unable to achieve or maintain viral suppression due to challenges adhering to oral ART at San Francisco's Ward 86. Researchers found preliminary short-term effectiveness of the treatment. More data on LAI-ART in hard-to-reach populations are needed.

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. 

This interview with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, discusses a viral video of a San Francisco art gallery owner spraying an unhoused woman with a hose, and what his actions and residents' subsequent reactions reveal about the responses to homelessness in San Francisco. Dr. Kushel said that conversation about the video, "is indicative, in some ways, of the state of our discourse around homelessness that we continue to blame the individuals who are experiencing homelessness for what has been a really widespread societal failure."

The complex care evidence base continues to grow, but meaningful involvement of people with complex needs in the research process is lacking. Hemal Kanzaria, MD, Associate Professor of Emergency Medicine at University of California San Francisco spoke with The Better Care Playbook to learn more about how involving people with lived experience in research can help strengthen the complex care evidence base. Dr. Kanzaria said, "The partners are working together in every one of those steps and recognizing the skill set that everyone's bringing to it. That makes the work better than anyone could do by themselves."

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 the UCSF 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 the UCSF Benioff Homelessness and Housing Initiative.