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.

California accounts for about a third of the nation’s homeless population and among this population, seniors are the fastest growing group. Research shows that living on the streets prematurely ages and sickens people. “When talking about homelessness, 50 is the new 75,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “Whether it be measures of cognitive decline, mobility, problems with function falling, all of the things that we usually think of happening to people in late life just happen to people 20 or 30 years earlier,” said Dr. Kushel. “And tragically, people also die.”

"You cannot have a healthy society with this many people living on the economic and social margins," said UCSF Benioff Homelessness and Housing Initiative director Margot Kushel, MD. "Homelessness is lethal. We’re not going to be able to solve this without solving homelessness." An analysis from 2016 to 2020 shows homeless deaths have increased in cities across the United States, and numerous negative health outcomes are associated with homelessness.

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."

San Francisco was one of the first major cities to adopt a housing-first policy: give someone a permanent place to live, provide access to robust care and resources, and positive outcomes will follow. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, “Solving the homelessness crisis will take resources and a commitment to house everyone—and then the ability to match services to the need.” While there will always be a need for emergency short-term shelter options, Dr. Kushel said, “a focus on shelter in lieu of housing is the worst of all options” because it “costs society a lot and doesn’t solve homelessness.”

Rising cost of living, demographic trends have pushed many older South Florida seniors into homelessness. To blame are rising costs, particularly for housing, that outpace many older people’s fixed incomes. Natural disasters, a lack of affordable housing and long-term economic dynamics that have disadvantaged those born between the mid-1950s and the mid-1960s also factor. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "What determines the rate of homelessness in a community is its availability or lack of availability of housing for low-income people."

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."

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."

The California Statewide Study of People Experiencing Homelessness “paints a representative picture” of homelessness and suggests policies backed by evidence, said Dr. Tiana Moore, the Policy Director at the UCSF Benioff Homelessness and Housing Initiative. “There's a lot of noise in California around who's experiencing homelessness and why,” Dr. Moore said, adding that the study pushes back against narratives that are dominating conversations right now. The study found that nine out of ten participants lost their last housing in the state. It is the largest study of its kind since the mid-1990s and the first large-scale study to use surveys as well as in-depth interviews, allowing researchers to “amplify the voices of those who are experiencing homelessness directly,” Dr. Moore said.

This news article describes ongoing efforts to vaccinate people experiencing homelessness in San Francisco against COVID. Margot Kushel, MD, is quoted regarding the earliest vaccination efforts, which BHHI helped strategize and implement on the ground with local organizations. She said it wasn’t so much fear about the vaccines that made it hard for low-income and unhoused people to get shots. “So much of it was really about access,” said Dr. Kushel. “Setting up big tents to come get vaccinated was good for a lot of people, but for others we really needed to go to where they were.”

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."

California is home to 12% of the United State's population, but makes up to half of all the country's unsheltered population. In this podcast episode of Fifth & Mission, host Cecilia Lei speaks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator, about California's largest examination of homeless adults since 1996. "This is a story of deep poverty in a state with incredibly high housing costs." said Dr. Kushel.

Little is known how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. Researchers examined the perceptions and use of telehealth, sampling from a larger longitudinal study on homeless-experienced adults in Oakland, CA. They found that the participants experienced challenges accessing the necessary technologies for telehealth.

Many older homeless adults maintain contact with family. In this qualitative study, researches examine the role of family caregiving for older homeless adults and what is its potential role as a precipitant to and exit from homelessness. The researchers found that in the sample of older homeless adults who were in contact with their family, many older homeless adults provided caregiving services to housed family members.

The United States has fewer labor protections and wage guarantees than most wealthy nations, leaving many workers vulnerable to economic hardship from job loss, reduced hours, or work-related injuries. Based on data from the California Statewide Study of People Experiencing Homelessness (CASPEH), this study shows how income disruptions—through layoffs, unstable gig work, caregiving tied to housing, illness or injury, probation and parole demands, and COVID-19-related impacts—can quickly lead to homelessness when housing costs are high and wages are low.

Nearly one-third of all Americans experiencing homelessness live in California. Starting in the fall of 2021, Aaron Shrank and Sam Comen conducted interviews and photographed unhoused people living in Los Angeles and Northern California as a companion piece to the University of California San Francisco Benioff Homelessness and Housing Initiative’s California Statewide Study of People Experiencing Homelessness to shed light on those affected. You can read a lightly condensed version of their stories. More of Comen and Shrank’s work is available at the website Unhoused CA.

People who use drugs (PWUD) commonly experience housing instability due to intersecting structural vulnerabilities. Researchers conducted a qualitative study in Vancouver, Canada's downtown eastside, interviewing PWUD who were recently evicted fron the downtown eastside. Narratives from the interviewees provided context on how the demands of the institutional circuit deepened vulnerablitities and prolonged experiences in homelessness. Researchers suggested that interventions that address survival needs and preserve agency will be necessary to mitigate risks within the institutional circuit.

Through interviews of HOPE HOME participants who reported living with family or friends, this qualitative study from BHHI researchers found that intergenerational trauma significantly a...

A large new study, conducted by the UCSF Benioff Homelessness and Housing Initiative asked people experiencing homelessness from all over California about what would have helped them avoid losing their housing. Margot Kushel, MD, the study’s principal investigator and director of UCSF BHHI, spoke with TIME about the studies key findings and recommendations. “You can’t build a homelessness prevention program only around eviction prevention. Those programs are important, but you’re going to miss a big chunk of people.” said Dr. Kushel.

There’s a lot of misinformation about homelessness in California. It is one of the most prominent problems California faces today. Using data from the California Statewide Study of People Experiencing Homelessness, this article dispels several common myths.

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 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.

During the COVID-19 pandemic, UCSF partnered with government and community groups to address racial, economic, and cultural barriers with the goal of providing equitable care to vulnerable people. The UCSF Benioff Homelessness and Housing Initiative spearheaded many of those partnerships. “The secret sauce was putting the community-based organizations in charge,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, who envisioned a program to serve people experiencing homelessness that became a national model.

People experiencing homelessness (PEH) have a high rate of tobacco use. Researchers examined factors associated with cigarette consumption and quit attempts. They found having an encounter with staff in the past week was associated with a 40% reduction in weekly consumption. The findings highlight the role of community-based pharmacists to expand smoking cessation services in homeless shelters.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, realized early in her career that the most important thing for her patients’ health was housing. Now a preeminent expert on homelessness and director of BHHI, she delves into what the COVID-19 crisis reveals about housing and health.