Resource Center

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.

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.

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.

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.

Research from UCSF Benioff Homelessness and Housing Initiative reveals that most people experiencing homelessness in California are not illegal drug users—contrary to widespread public perception. These findings challenge common stereotypes and underscore the urgent need for better treatment options and housing solutions across the state. KCBS Radio news anchor Eric Thomas spoke with Margot Kushel, MD, Professor of Medicine and Chief of UCSF’s Division for Health Equity and Society, to dive deeper into the issue.

A new UCSF BHHI study challenges misconceptions about drug use among people experiencing homelessness in California. While only 37% of homeless individuals regularly use illicit drugs, lifetime use is high, and 27% began using after losing housing. The study highlights the difficulty of accessing treatment, with only 7% receiving care and 1 in 5 actively seeking help but unable to get it. Margot Kushel, MD, emphasized the complex relationship between drug use and homelessness, stating, “People are telling us that it helps them survive,” she said. “It keeps them awake and alert. They are using it either because they are traumatized, they have been assaulted, they are afraid or depressed, using it as coping to make it all go away.”

Domestic violence is a major but often overlooked driver of homelessness in Los Angeles, with 44% of unhoused women citing it as the primary cause, according to a 2023 Urban Institute survey. Yet, LA’s survivor support system is severely underfunded—only 10% of those seeking shelter secure a bed. A UCSF BHHI study found that 60% of survivors who fled abuse end up sleeping in cars, tents, or the streets, where they remain vulnerable to further violence. Experts and advocates warn that without integrating domestic violence services into homeless support systems—and vice versa—thousands will continue to face impossible choices and unsafe conditions.

A groundbreaking UCSF BHHI study challenges common perceptions about drug use among people experiencing homelessness. Researchers found that less than half of this population regularly used drugs, with methamphetamine being the most common substance, not opioids. Many respondents wanted treatment but struggled to access it, highlighting barriers to care. The study emphasizes that homelessness and substance use are interconnected and advocates for reducing barriers to treatment and prioritizing housing solutions. "We need to reduce barriers to substance use treatment, and that includes prioritizing people’s ability to return to housing,” said BHHI faculty member Ryan Assaf, PhD, MPH, the study’s lead author.

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.

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. 

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.

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.

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."

This topic brief examines who experiences pregnancy during 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 pregnant people.