California’s homelessness crisis is a homegrown problem that is deepening amid a shortage of affordable housing and emergency shelter, and it’s often the brutal conditions of living on the street that trigger behavioral health problems, such as depression and anxiety, researchers found in a comprehensive study on homelessness. The new findings show that at least 90% of adults who are experiencing homelessness in the state became homeless while living in California. “This idea that homeless people are rushing into California is just not true,” said Margot Kushel, a physician who treats homeless people, and the lead investigator of the study for the UCSF Benioff Homelessness and Housing Initiative. “There’s so much myth-making around this magnet theory that people who are homeless flock to California, but this is our own problem.”

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. 

Public policy and common perception have long tied the road to homelessness with mental illness and drug addiction. But a new study—the largest and most comprehensive investigation of California’s homeless population in decades—found another cause is propelling much of the crisis on our streets: the precarious poverty of the working poor, especially Black and brown seniors. “These are old people losing housing,” said Margot Kushel, MD, the lead investigator on the study and the director of the UCSF Benioff Homelessness and Housing Initiative.

This toolkit offers guidance for researchers, advocacy groups, non-profit organizations, government agencies and others interested in, or currently engaging in, meaningful community-eng...

Deciding to live with intimate partner violence (IPV) instead of choosing a shelter is a complex decision. The UCSF Benioff Homelessness and Housing Initiative recently released a special report on IPV and homelessness. Anita Hargrave, MD, assistant professor at UCSF and co-author on the report, said, "Intimate partner violence can precipitate homelessness for many people, and is particularly dangerous for those that are at the economic margins."

The California Statewide Study on People Experiencing Homelessness researchers included people who were formerly or are currently experiencing homelessness. In this op-ed, Claudine Sipili, one of the Lived Expertise Advisory Board co-chairs, writes about the landmark study and her experience participating with the project. She writes, "Throughout the study, the board members’ guidance helped create a safe and dignified space for survey participants to share their experiences openly. By involving individuals with lived experience, we gained deeper insights into the complexities of homelessness."

As a board member of the UCSF Benioff Homelessness and Housing Initiative (BHHI) Lived Expertise Advisory Board that played a major role in the design and implementation of the California Statewide Study of People Experiencing Homelessness, my participation on the project was deeply influenced by my personal experience of homelessness. Having faced the challenges and uncertainties associated with housing instability firsthand, I have dedicated myself to making a positive impact and working towards finding lasting solutions for those facing similar struggles.

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.

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.

People experiencing homelessness are at an increased danger of dying. A recent study by the National Bureau of Economic Research showed a 40-year-old person experiencing homelessness has a similar risk of death as a 60-year-old person with housing. Previous studies have also found that people who experience homelessness have a greater mortality risk. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "We’re letting people die because we’re not fixing the underlying crisis."

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."

In this retrospective observational cross-sectional study of patients in the Trauma Quality Improvement Program (TQIP), researchers looked to determine if there was significant practice variability in adoption of alcohol and drug screening of injured patients among hospitals participating in TQIP. Researchers found that overall rates of recommended alcohol and drug screening of injured patients were low and varied significantly between hospitals.

A new study from UCSF Benioff Homelessness and Housing Initiative and the San Francisco Department of Public Health describes how San Francisco rapidly scaled a hotel-based isolation and quarantine (I/Q) system of care for people experiencing homelessness during the COVID-19 pandemic. Researchers found the program safely delivered integrated medical and behavioral health support to more than 1000 individuals outside the hospital setting, while helping to preserve hospital capacity.

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.

Hospital emergency departments (ED) are on the frontlines of serving people experiencing homelessness, and this report investigated what ED data can reveal about homelessness in California. Hospitals operated by counties and the University of California reported higher shares of ED visits by people experiencing homelessness. Linking discharge data with homeless services programs can offer insights into how people engage with programs and help provide better resources to evaluate the programs and investments aimed at improving the lives of Californians experiencing homelessness.

A comprehensive new study finds the vast majority of the California's unhoused residents lived in the state before losing their housing. The goal of the report was to take a systematic approach to understanding the causes of homelessness and potential solutions instead of relying on the emotional responses the crisis can trigger, said study author Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. “What we were trying to do is take the rhetoric down a bit, and using really scientific best practices, to get a handle on not only who was experiencing homelessness but what was happening in their lives before they became homeless,” Dr. Kushel said.

Most people experiencing homelessness in California are not regular drug users — and for some, substance use begins or worsens after losing housing. Some use drugs to stay awake and safe, coping with the trauma and danger of life without shelter. At the same time, many who want treatment can’t get it. This paper uses data from the California Statewide Study of People Experiencing Homelessness to show a comprehensive, representative look at substance use, overdose risk, and unmet treatment needs among people experiencing homelessness in California.

 Traumatic injury is a major cause of morbidity for people experiencing homelessness (PEH), however, injury patterns and subsequent hospitalization among PEH have not been studied on a national scale. In this national retrospective observational cohort study, researchers evaluated whether differences in mechanisms of injury exist between PEH and housed trauma patients in North America and whether the lack of housing is associated with increased adjusted odds of hospital admission. Researchers found that injured PEH had a significantly adjusted greater odds of hospital admissions.

A landmark study by UCSF Benioff Homelessness and Housing Initiative (BHHI) paints a different picture on people experiencing homelessness in California. Researchers at BHHI sought to capture the experiences of all people aged 18 years and older who experience some form of homelessness in California. "It took a lot of time and was a lot of work, but we wanted to be able to show policymakers what this issue looks like instead of just giving them more numbers to look at," said Margot Kushel, MD, the study’s principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative.

Hosted by the California Partnership to End Domestic Violence (the Partnership), lead researcher Anita Hargrave, MD, UCSF BHHI Policy Director Tiana Moore, PhD, and CPEDV staff dove deeper into policy recommendations and solutions that arose from the California Statewide Study of People Experiencing Homelessness (CASPEH) findings on the intersection of intimate partner violence and homelessness. The webinar featured an in-depth discussion of local and state opportunities, as well as funding and programmatic policy recommendations for advocates, policymakers, and other decision-makers.

A special report on the relationship between intimate partner violence and homelessness in California by the UCSF Benioff Homelessness and Housing Initiative, found that 1 in 5 women who become homeless in California flee their homes to escape violence. Participants described the need to plan their exit in advance and to accumulate resource; however, of those who experienced intimate partner violence in the 6 months prior to homelessness, only 12% sought help from a domestic violence organization. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Some people honestly had no idea what is a domestic violence shelter. Other people told us when they had to run, they had to run. They didn’t have time to figure out where to find a shelter."

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.

With modern home prices out of reach for many California residents on fixed incomes, older adults have become the fastest-growing segment of the unhoused population across the state, according to new research from UCSF. California makes up 30% of the nation’s unhoused population and is home to half of all the country’s unsheltered population, according to the landmark study, which looks at how people in the Golden State become unhoused, experience homelessness, and exit homelessness. Nearly half of all unhoused adults in the study were age 50 or older, and Black and Native American residents were “dramatically overrepresented,” the study shows. “The results of the study confirm that far too many Californians experience homelessness because they cannot afford housing,” said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator of the landmark study.

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.”