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This topic brief examines who experiences unsheltered homelessness, how they lost their housing, their experiences during homelessness, and barriers to regaining housing. The findings highlight the urgent need for the homelessness system to advance evidence-based strategies to meet the needs of unsheltered people.

Our Encampment Prioritization Tool is designed to help communities navigate the complex landscape of homelessness. By balancing the urgent need to address encampments with the chronic shortage of housing and shelter resources, along with health and safety considerations, this tool guides stakeholders in making informed decisions. It ensures that actions prioritize housing and shelter placements over displacement, aligning with broader systemic reforms to effectively manage and resolve encampments.

Encampment resolution is a strategic approach focused on connecting unsheltered individuals to stable housing rather than displacing them through sweeps. This method employs evidence-based practices to connect people with housing solutions and prevent re-encampment, involving a wide range of stakeholders to address both the needs of the encampment residents and the community’s broader concerns.

The University of California, San Francisco Benioff Homelessness and Housing Initiative (BHHI) today released a topic brief that sheds new light on the 78% of all Californians experiencing homelessness who live in unsheltered settings (i.e. outdoors, in a vehicle, in a place not meant for human habitation). It provides policy recommendations for reducing unsheltered homelessness through a combination of prevention, shelter, and permanent housing. 

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. Researchers from the UCSF Benioff Homelessness and Housing Initiative designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions. This is the first large representative study of PEH, beyond a single county, to draw inference on a large population that did not depend on service utilization.

The gap between wages and housing prices has pushed more workers into homelessness. Increasing the number of affordable housing units is key. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Housing is the root of all safety and security. Without housing, everything else falls apart."

Since the Supreme Court's landmark ruling in City of Grants Pass v. Johnson on June 28th loosed clearance rules, 12 California cities or counties have passed camping bans, while another nine are considering them or have already given initial approval. Palm Springs stopped short of exercising all authority granted to cities, with the new ordinance complying with a previous court ruling. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We need housing. We need subsidies. We need not just affordable housing, but we need deeply affordable housing."

Before medically advised (BMA) discharge is associated with higher rates of readmission and death in other settings. In this study, researchers used multivariable logistic regression to evaluate the association between housing status and BMA discharge. Researchers found that BMA discharge is more common in patients experiencing homelessness after surgery even after adjusting for observable confounding characteristics. A deeper understanding of the drivers of BMA discharge in patients experiencing homelessness through qualitative methods is critical to promoting more equitable and effective care.

Governor Gavin Newsom’s executive order allowing state and local officials to dismantle homeless encampments has drawn mixed reactions from homelessness experts within California. he executive order calls for state agencies to remove homeless encampments from state lands, such as state parks, beaches, agency buildings, highways, and the areas beneath them. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "A lot of harm can come from sweeps, and ultimately, if you don’t offer people a real outcome, they’re just going to have to move someplace else because they can’t dematerialize; they will show up someplace else."

California’s homeless crisis is reaching unprecedented levels. In this podcast episode of Invisible People, Margot Kushel, MD, Division Chief of the UCSF Action Research Center for Health Equity, and the UCSF Benioff Homelessness and Housing Initiative, breaks down the findings of the California Statewide Study of People Experiencing Homelessness (CASPEH). Dr. Kushel said, "We need to have a maniacal focus on creating more housing."

Depression is common in adults experiencing homelessness. In this cohort study, researchers examined the association between residential status and depressive symptoms in adults 50 years or older experiencing homelessness. Researchers found that continued homelessness was associated independently with increased odds of depressive symptoms.

In this episode of KPFA Letters and Politics, host Mitch Jeserich spoke with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, about the myths and misinformation about homelessness. Dr. Kushel said, "This idea of a max exodus is simply not true. "

As the number of people experiencing homelessness in California has grown, so has the pressure on state and local leaders to improve the situation. On July 25th, 2024, Governor Gavin Newsom issued an executive order directing state agencies to clear encampments from state-owned land. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This didn’t happen overnight. … It’s hard to unwind 40 years of bad policies in four years."

Governor Newsom of California and advocates agree that the homelessness crisis is decades in the making, but opinions differ over whether Governor Newsom's conservative policy approach will help fix the issue. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There is no easy way out of this. I have deep compassion for everybody’s frustration. I’m frustrated. I want this problem to be over. I understand this is unacceptable, but I think when you’re in a hole, you need to stop digging."

More than 3,000 of the 11,500 people who died while unhoused in Los Angeles County between 2014 and 2023 were 60 and older. This crisis has grown over time. In a groundbreaking study on homelessness in California by Benioff Homelessness and Housing Initiative researchers found that nearly half of unhoused adults were age 50 and older. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They talk about how ashamed and stigmatized they feel – they know the public thinks they’re bad because they’re outside. And they just feel incredibly alone in the world."

On June 28, 2024, the US Supreme Court ruled in City of Grants Pass, Oregon v. Johnson, that arresting and fining people experiencing homelessness who are camping and sleeping in public spaces does not violate their Eighth Amendment rights against cruel and unusual punishment. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, speaks with Jeffery Norris on the likely impacts in California and across the country.

The UCSF Benioff Homelessness and Housing Initiative released a special report on Intimate Partner Violence (IPV) and homelessness. The report found that 8 percent of the unhoused experienced IPV, a more formal term for much domestic violence, including 17 percent of all women living on the streets or in homeless shelters. Domestic violence causes and prolongs homelessness. More should be done to prevent domestic violence.

How many people are experiencing homelessness in San Francisco? The annual one-night tally, or point-in-time count (PIT), counted about 8,300 people experiencing homelessness. However, there is another metric that counts how many people accessed San Francisco's homelessness services. Using that measure, there were at least 20,100 people experiencing homelessness in 2023. Experts recommend that counties should pair the PIT count with other sources of data. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They’re two different methodologies that are serving different purposes. And together they give us a fairly (accurate) picture of what's going on."