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In this op-ed, Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF, highlights the frequency people experiencing homelessness are exposed to violence. Across the country, people are viewing the presence of people experiencing homelessness on public transportation as a thread, leading efforts to remove individuals sleeping on public transportation. "Throughout literature, sleep has been a metaphor for death. But, in real life, sleep should mean neither death nor arrest. We need to focus on real solutions — increasing housing affordability and the services that allow people to thrive — instead of demonizing tired, frightened people" Dr. Kushel writes.

America’s homeless population swelled to its highest level in recorded history in 2024 according to an annual count of individuals living in emergency shelters, transitional housing or on the streets. California continues to have the largest homeless population of any state — 187,084 in 2024 — and the highest rate of unsheltered people, according to the U.S. Department of Housing and Urban Development’s point-in-time estimate released Friday, December 27, 2024. However, California's increase of 3.1% from 2023 was smaller relative to other states.

Over the past year, Nicole Santa Cruz, and her colleagues Ruth Talbot, Asia Fields, Maya Miller investigated how cities have sometimes ignored their own policies and court orders, which has resulted in them taking homeless people’s belongings during encampment clearings. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, if officials, alongside case managers and health care professionals, worked with unhoused people over weeks, rather than days, before sweeping an encampment to help them get inside, they wouldn’t be separated from their belongings and their possessions wouldn’t need to be stored in warehouses.

Since their introduction in 2009 under President Barack Obama, vulnerability surveys have aimed to assess the eligibility of homeless individuals for housing assistance. However, recent findings suggest that these surveys may inadvertently perpetuate racial disparities, particularly affecting Black homeless populations. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "If you’re a White person, the more likely you are to rank higher than if you’re a Black person, so you’re more likely to get selected for housing."

Vulnerability questionnaires were created to determine how likely a person is to get sick and die while experiencing homelessness, and the system has been widely adopted during the past decade to help prioritize who gets housing. National homelessness experts and local leaders say such personal questions exacerbate racial disparities in the ranks of the nation’s unhoused, particularly as more people experiencing homelessness compete for scarce taxpayer-subsidized housing amid a deepening affordability crisis. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "This whole system was piloted on this older White population in Boston, so it does a poor job of capturing the needs of Black folks, who don’t tend to be as sick as White folks — they’re more broke."

The first safe parking site in Los Angeles County opened up November 2024 in the Crenshaw neighborhood. People living in RV's around LA now have the opportunity to move with their oversized vehicles into a gated secure parking lot on county property. The county will operate the site and all residents must own the RV they're living in. The goal is to move people living at the safe parking site into permanent supportive housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "People were not willing to give up their RV for an option that they knew would in a short period of time leave them worse off than they were currently. "

Body camera footage of pregnant homeless woman puts Kentucky's street camping ban in the spotlight. Kentucky is among several states that passed bans on street camping and it recently got a glimpse of how it works in a video showing police giving a citation to a homeless woman going into labor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "You add the stresses of homelessness, the sleep deprivation, the fear, the shame, the stigma, the lack of access to health care and you really are escalating the risk for the mom."

A growing number of people, many of them older and homeless, are freezing to death during winter. In 2023, 166 Californians died from hypothermia, double the number who died in 2015. People who experience homelessness are particularly susceptible to hypothermia because so many older, vulnerable adults live outside, where they are exposed to the weather. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "A changing climate, more temperature extremes, more soaking rains — people are older and thus unable to even tolerate it, so they get much sicker, faster."

More than 650,000 people experienced homelessness on one night in January 2024, up 12% from 2022. In this episode of On Point, host Meghna Chakrabarti speaks with Nicole Santa Cruz, ProPublica reporter, Mike Johnston, mayor of Denver, CO, and Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, about the rise of homelessness and encampment sweeps.

Since the US Supreme Court ruled in the case of City of Grants Pass v. Johnson in June 2024, there has been an increase in the number of encampment sweeps. After the ruling, Governor Newsom of California issued an executive order directing state and local officials to dismantle homeless encampments. Street medicine services have never been more important as they provide lifesaving services by resupplying vital medication or medical supplies, hospitalizing patients with severe mental or physical health conditions, and finding medical respite care facilities. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, "It is very straightforwardly the case that displacement costs more than a lot of other strategies that we could use."

Angelenos exiting the carceral system often fall into homelessness due to barriers to housing and employment. In this episode of HOMELAND, a 10-episode series that brings clarity to the homelessness crisis, host Ben Kay speaks with Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, and experts to explore the intersection of homelessness and incarceration and ask a simple but profoundly human question: Do we believe in second chances?

Substance use and homelessness have become synonymous in recent years. But what is the actual relationship between the two? Does problematic substance use cause homelessness or does homelessness increase someone's use of substances? In this episode of HOMELAND, a 10-episode series that brings clarity to the homelessness crisis, host Ben Kay speaks with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and other system and healthcare leaders to discuss how homelessness and substance use interact, dive into how the U.S. has historically addressed substance use, and explore if there’s a better way forward.

As the homeless crisis has deepened in cities across the country, many have pointed to untreated mental health as a root cause of the crisis. But what is the relationship between mental health and homelessness? In this episode of HOMELAND, a 10-episode series that brings clarity to the homelessness crisis, host Ben Kay speaks with Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and other experts to explore this central question as we seek to better understand the connection between human thought and action.

City of Los Angeles officials are finally confronting a question that has seemed too big to answer: How much would it actually cost to get every person living on the street today indoors and make sure that no one languished there for years again? A new report states that it would cost $21.7 billion over a decade to end homelessness in LA. Margot Kushel, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I would rather live in a place that spent its money on allowing people to live in community with choice and autonomy over their lives."

This research letter discusses the experience of violence during homelessness, its impact on health, and recommendations for intervention. In the California Statewide Study of People Experiencing Homelessness, 38% of participants experienced violence during their current homelessness episode, and 74% of participants reported experiencing violence at some point in their lives. These results highlight the need to address violence against people experiencing homelessness through safer housing options, trauma-informed care, and long-term violence prevention strategies.

Most people experiencing homelessness in California do so in unsheltered settings, such as outdoors or in vehicles. This webinar is about the causes and consequences of unsheltered homelessness. Margot Kushel, MD, moderated a conversation with Marc Dones, Ashley Meehan, MPH, and Carter Hewgley, discussing recommendations and solutions for addressing unsheltered homelessness in a way that preserves health, dignity, and civil rights for those experiencing it.