A new study from the nonpartisan California Policy Lab and the UCSF Benioff Homelessness and Housing Initiative shows that a small group of people are repeatedly cycling in and out of both the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems. “Our research highlights the need for coordinated, evidence-based interventions to address these individuals’ complex needs, promote stable housing, and prevent poor health outcomes including untimely death,” said Maria Raven, MD, chief of emergency medicine at UCSF Medical Center and co-lead of the Benioff Homelessness and Housing Initiative program on adults with complex needs. The authors advocate for a more coordinated approach, such as connecting people released from the emergency room or jail with housing and continued care.

In the year since the U.S. Supreme Court made it easier for cities to remove homeless encampments, California cities have redoubled enforcement efforts. For people caught up in sweeps in cities like Berkeley, Oakland, and Vallejo, the same question echoes again and again: “Where do I go now?” “The biggest problem with criminalization...[is] that criminalization worsens homelessness,” says BHHI Director Dr. Margot Kushel. “The public should...say, ‘Why are you taking expensive efforts to worsen a problem? This problem is 40 years in the making.”

The US Supreme Court's ruling in City of Grants Pass v. Johnson will make it easier for elected officials and law enforcement authorities nationwide to fine and arrest people who are experiencing homelessness. This decision could interrupt programs that expand street medicine services and other initiatives to help people experiencing homelessness find housing. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "What’s worse, though, is we are going to lose the trust that is so essential to getting people to take their medications or stop their drug use and, ultimately, getting people into housing."

On June 28, 2024, the US Supreme Court ruled in City of Grants Pass, Oregon v. Johnson, that arresting and fining people experiencing homelessness who are camping and sleeping in public spaces does not violate their Eighth Amendment rights against cruel and unusual punishment. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, speaks with Jeffery Norris on the likely impacts in California and across the country.

An increase in San Francisco homelessness funding could sharpen focus on permanent supportive housing. The UCSF Benioff Homelessness and Housing Initiative's Cynthia Nagendra emphasized the importance of permanent supportive housing as the centerpiece of any plan for using new funds to address homelessness.

Housing status is a significant upstream determinant of access to healthcare. In this literature review, researchers identified areas of concern unique to patients experiencing homelessness with surgical disease. Researchers found that there was a gap in the surgical literature with regards to the impact of housing status on optimal surgical care. More studies are needed to accurately characterize the surgical care of patients experiencing homelessness and identify areas for care improvement.

Tobacco use remains the leading cause of preventable deaths worldwide. Despite efforts by many countries to reduce the impact of tobacco products and lower smoking rates, smoking prevalence is higher among people experiencing homelessness. The reasons are complex and go beyond individual choices, including limited awareness about quitting, restricted access to services, and previous negative experiences. Using the SEM framework, which emphasizes the policy and environmental contexts, this study offers a deeper understanding of the context of the lives women experiencing homelessness. The evidence from this study supports the implementation of gender- and age-appropriate holistic approaches to healthcare and tobacco interventions tailored to this community.

Margaret Handley, PhD, MPH, a professor in the department of epidemiology and biostatistics and medicine at the University of California San Francisco shares a letter she wrote to Science about how her past, her family, and a rare instrument relate to her current career focus on public health and homelessness. Dr. Handley wrote, "The idea of helping people stay in housing, or improving their lives as they revolve around the uncertainty of a storage locker existence, keeps me going on my research-weary days."

Recently the demographic characteristics of people experiencing individual homelessness have changed; more individuals over the age of 50 are experiencing homelessness. BHHI researchers examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with family or friends. Researchers found barriers to stay such as feelings of shame and concerns about burdening the hosts. Findings suggest that family members and friends may play an important role in supporting older adults experiencing homelessness.

With cities implementing new camping bans and conducting new removals, advocates and homelessness experts are troubled by the new wave of enforcement around homelessness. In addition, temporary shelter still falls short of what is needed to move people off the street for good. “The goal should be to get everyone into permanent housing,” said Ned Resnikoff, policy manager at the University of California, San Francisco Benioff Homelessness and Housing Initiative. “If getting them sheltered doesn’t get you closer to that goal, then you actually haven’t solved anything.”

A recent book sheds light on the policy choices that caused housing prices to skyrocket in the late 1970s and early 1980s, and which may have helped to birth the modern homelessness crisis.

Programs have been created to address housing for Veterans. However, Veterans are still at high risk for unstable housing. This study aimed to determine whether interpersonal violence was associated with unstable housing among Veterans. Research from BHHI demonstrated the potential to improve health outcomes through trauma informed approaches that address mental health, substance use, and housing concurrently.

Loss of income is considered the number one factor for why Californians experience homelessness, according to new research from UCSF. The new findings highlight the idea that money is not only the main cause of the homelessness, but also a potential solution. "I think it’s really important to note how desperately poor people are, and how much it is their poverty and the high housing costs that are leading to this crisis" said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator of the landmark study.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted regarding an outbreak of COVID-19 in San Diego’s large congregate shelter, which has prompted medical professionals and advocates to renew calls to expand usage of hotel placements for unhoused people. Dr. Kushel noted that even shelters with intensive strategies to control the spread of coronavirus were unlikely to prevent outbreaks.

As a pediatrician who has focused on working with families experiencing unstable housing, BHHI faculty member Christine Ma, MD, has seen first hand how housing insecurity can damage the...

This news piece describes the complex economics surrounding homelessness. Margot Kushel, MD, director of UCSF's BHHI, emphasizes “Homelessness is a symptom of our country's failure to prioritize housing as a human right.” Highlighting the societal costs of homelessness, it underscores the urgency for comprehensive policy interventions and a paradigm shift towards viewing housing as a fundamental human need rather than a commodity.

Seniors are the fastest growing unhoused population. From 2017 to 2021, California’s overall senior population grew by 7% but the number of people 55 and older who sought homelessness services increased 84%. Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, said, "Nearly half of single adults 50 and over experiencing homelessness had never been homeless before age 50."

In this op-ed, Tom Murphy, the Senior Director of Communications for the National Alliance to End Homelessness, and Yolanda Stevens, program and policy analyst for the National Alliance to End Homelessness, call Congress to do more for older Americans facing homelessness. Older adults are the fastest-growing age demographic of people experiencing homelessness. They highlight the need to reconcile the stereotypes against older adults experiencing homelessness. "Leaders must also commit the resources to ensure that homeless systems can meet the needs of an aging population." they wrote. 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.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins Call to Mind host Kimberly Adams to talk about those who are more at risk of becoming homeless. People who are experiencing homelessness have higher untreated mental illnesses and substance use disorders than the general population. "The people in the 50s and 60s have all of the characteristics of the people we normally think of in their 70s or 80s. What we see is a lot of falls, a lot more worsening of people's cognitive abilities, of people's hearing." Dr. Kushel said.

Intimate partner violence (IPV) is a risk factor for people experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Researchers purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. They identified six primary themes regarding IPV and homelessness.

A new BHHI report sheds light an oft-misunderstood subpopulation of unhoused people.

BHHI conducted in-depth interviews with 48 people living in their vehicles in Oakland. This report sheds light on the needs and challenges of vehicle residents and provides recommendations on how the city can better serve that population.

In this op-ed, Trina Johnson PhD, MSc, postdoctoral fellow with the Benioff Homelessness and Housing Initiative, highlights how the overdose death rates for white people had fallen dramatically by but it isn't the same for Black people. These disparities have been attributed to structural determinants including inadequate access to harm reduction services, as well as a treatment system that is not designed to meet the needs of all communities. "We can create a model for equity and antiracism in addiction treatment that can inform all areas of medicine, so all patients and communities can thrive." Dr. Johnson writes.