The Centre for Homelessness Impact May 2024 Research Network Meeting features presentations from Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, Beth Watts-Cobbe, PhD, a senior research fellow at the Institute for Social Policy, Housing, and Equalities Research at Heriot-Watt University, and Niamh Flannigan, Implementation Lead at the Centre for Homelessness Impact, highlighting landmark pieces on research and policy. Dr. Kushel presented on the California Statewide Study of People Experiencing Homelessness. Dr. Kushel said, "We need to build housing, create housing at every price point, but particularly for those with extremely low income."

Maria Raven, MD, Chief of Emergency Medicine at UCSF and a faculty advisor at BHHI, was quoted in this piece about a UCSF study about Project Welcome Home showing that permanent supportive housing can help keep chronically homeless people with severe health and substance-abuse issues housed. Margot Kushel, MD, coauthored the study.

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. Researchers administered structured interviews including assessments of health, history of homelessness, social support, and life course. They found that compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Further research on the newly homeless individuals and cohabiters in this cohort may elucidate more clearly the trajectories of these different phenotypes of homelessness.

In the state of California, the three major utility companies, have nearly doubled electricity rates over the last decade. With growing increase in energy demands, the rising utility costs are pushing families already at the margins to the brink of homelessness. Many people are forced to making an impossible choice. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I think recognizing energy insecurity as a contributor to this crisis, this is the next frontier that we need to really worry about."

The proportion of single homeless adults over the age of 50 is increasing. In this longitudinal cohort study, researchers examined the prevalence of and risk of falling in a cohort of older homeless adults. Researchers interviewed participants every 6 months for 3 years. They found a high prevalence of falls. Participants reported a prevalence of falls higher than older adults with a mean age of 78 in the general population. Researchers recommended identifying people at high risk of falls reducing unsheltered homelessness.

How many people are experiencing homelessness in San Francisco? The annual one-night tally, or point-in-time count (PIT), counted about 8,300 people experiencing homelessness. However, there is another metric that counts how many people accessed San Francisco's homelessness services. Using that measure, there were at least 20,100 people experiencing homelessness in 2023. Experts recommend that counties should pair the PIT count with other sources of data. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "They’re two different methodologies that are serving different purposes. And together they give us a fairly (accurate) picture of what's going on."

California's 'housing first' rule prohibits the use of housing funds on drug-free or sober housing facilities. However, there is growing support for changing policies to favor tolerance of drug use in housing for people experiencing homelessness. San Francisco supervisors announced a new plan to prioritize drug-free housing options for people who experience homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "You want to make sure that any relapse is not punished with homelessness, because to do so may turn something that is in fact a short backward step into a deep fall."

Join CHCF in Sacramento on Wednesday, March 12, 2025 for a briefing about these supports and their importance for helping people move from homelessness to housing. The briefing will begin with an overview of how homelessness impacts a person’s health by Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UCSF. She will draw from the landmark California Statewide Survey of People Experiencing Homelessness. Following the presentation, Michelle Schneidermann, MD, director of people-centered care at CHCF, will moderate a discussion about the role Medi-Cal is playing in California’s homelessness response and how that role can be strengthened and improved through critical partnerships across the health, homelessness, and housing sectors.

In this op-ed, Marguerita Lightfoot, PhD, MA, Associate Dean for Research at the OHSU-PSU School of Public Health, calls attention to youth experiencing homelessness in Sacramento. She outlines the higher rate of mental health-related hospitalization among youth, with almost 70% of youth experiencing homelessness reported experience depression and anxiety. Dr. Lightfoot also highlights the resources and programs that would help. "Every person experiencing homelessness needs help. But youth are too often treated as adults, and do not receive the tailored, developmentally appropriate services they require." This op-ed was published as part of the Public Voices Fellowship in partnership with The OpEd Project and funding from the California Health Care Foundation.

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. "

This podcast episode tackles some of the most common myths about homelessness. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, is among the guests who discuss why it’s harder to get housed than people think, explain how most people who are homeless are not suffering from mental illness or substance abuse, and highlight how anyone can experience homelessness. The hosts also interview two people with lived homelessness experience.

In San Diego County, more than one-third of renters over 65 spend the majority of their income on rent. Along with a shallow rental subsidy pilot program, San Diego County is also working on adding more affordable housing units. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "The truth of the matter is that if we don't spend these small amounts of money we’re spending it on the back end but for really bad outcomes."

Maria Raven, MD, spoke about a new UCSF Benioff Homelessness and Housing Initiative study that found 331 homeless San Franciscans died during the first 12 months of the coronavirus pandemic—more than double any previous year. Acute drug toxicity was the leading cause of death. Traumatic injuries, including suicide and homicide, were the second most common, followed by chronic medical conditions. Interventions like shelter-in-place hotels may have helped mitigate deaths due to COVID-19 and related health conditions, but lockdowns and increased isolation may have compounded other risks.

UCSF BHHI director Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, says solving homelessness shouldn’t be just one neighborhood or community’s responsibility. “Everyone wants homelessness solved but people are worried. They have concerns and to be honest, neighborhoods block the things they most need, which is if they had housing in their neighborhood they would have fewer people facing homelessness,” Dr. Kushel said.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in the San Francisco Chronicle saying she hopes the city continues to focus on more permanent solutions to homelessness, such as housing vouchers and rent subsidies, over group shelters.

This feature article reports on overdose mortality in the city's supportive housing program, the cornerstone of an effort to help people rebuild their lives after bouts of homelessness. "Anything that can create community and safety and wellness in these settings is going to make a difference," says UCSF Benioff Homelessness and Housing Initiative's Kelly Knight, MD.

The popular book suggests that substance use, mental illness and moral permissiveness are more to blame for California's homelessness crisis than housing unaffordability. But that argument is based on flawed reasoning and a misunderstanding of the available evidence.

Drug overdose has increased in the U.S. since the COVID-19 pandemic began in 2020. In San Francisco, single-room occupancy (SRO) tenants are more likely to dive of opioid overdose than non-SRO residents. The SRO project aimed to reduce fatal overdoses in SROs. In this eight month ethnographic field work, researchers found that the SRO project increased awareness, access to, and understanding of naloxone, as well as, supporting the privacy and autonomy of tenants regarding their drug use.