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.

This study from BHHI researchers describes five distinct subgroups of the highest users of the health care system in San Francisco with differential comorbidities, health care needs, and social determinants of health, spanning from patients with medical comorbidities solely using medical services to patients grappling with housing insecurity, incarceration, substance use disorder, and mental health comorbidities. Frequent users of the health care system are not a homogenous population as previously thought. This study sheds new light on how to help the most vulnerable patients and inform clinicians and care coordination teams on making sure patients get the care they need the most. 

This UCSF study examined deaths among people experiencing homelessness in San Francisco from 2016 to 2018. Although heart disease and cancer are the first and second causes of death for California’s general population, the leading causes of homeless deaths were acute intoxication (unintended overdose) and trauma (including homicide and suicide rates over triple that of the US general population). The authors advocate that these differences in cause-specific mortality should inform death prevention efforts within the homeless population differently than the general population.

This study from UCSF BHHI researchers examined deaths among people experiencing homelessness in San Francisco during the first year of the COVID-19 pandemic. They found 82% of 331 deaths were associated with drug overdose, not COVID-19 infection. Traumatic injury, including homicide and suicide, was the second most common cause of death. This research highlights a need for strategies that address both homelessness and drug use, including housing, evidence-based treatment of opioid addiction, and overdose prevention programs.

People with multiple, complex health and housing needs frequently receive fragmented care because the providing systems operate independently. The California Policy Lab at UC Berkeley and the UCSF Benioff Homelessness and Housing Initiative worked with partners in San Francisco’s public health and criminal legal systems to link together ten years of data from the physical health, behavioral health, housing, and criminal legal sectors.