Welcome to the introductory blog post of the Benioff Homelessness and Housing Initiative, which describes what to expect from future posts.

West Virginia leads the nation in overdose deaths per capita, presenting a paradox to people who believe that drug use is to blame for the increase in people experiencing homelessness in cities. People who lose housing are more likely to increase their drug and alcohol use. Furthermore, experiencing both homelessness and drug addiction lengthens the time it takes to solve each problem. Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, said, "People conflate these crises. They are related but they are far from one and the same."

Understanding the experiences of people experiencing homelessness is logistically difficult. The UCSF Benioff Homelessness and Housing Initiative conducted an ambitious study, where researchers sought to reflect the experiences of all people aged 18 and older experiencing homelessness in California. The study's findings provide evidence that the lack of housing services is a meaningful barrier to health care and income benefits. "I was really surprised by how little people thought it would have taken to prevent their homelessness. Do we know if people are overly optimistic? Sure, they might be. But I sort of believe people are experts in their own lives and people really felt that, had they interrupted that cycle, they could have hung on, but once they became homeless everything else fell apart." said Margot Kushel, MD, the the study's principal investigator and director of UCSF’s Benioff Homelessness and Housing Initiative.

Bakersfield focused its efforts on a specific goal in 2015, to reach functional zero chronic homelessness, and by January 2020, it hit the mark. Access to quality data was essential to knowing every person experiencing homelessness, but also cooperation among agencies and strong engagement from the healthcare system was key to achieving this goal. Unfortunately, Bakersfield could not sustain functional zero homelessness. It was hard to secure affordable units. Margot Kushel, MD, professor of medicine and director of the Benioff Homelessness and Housing Initiative at UC San Francisco, said "The rates of homelessness and the ability for people to exit homelessness really has everything to do with the availability and affordability of housing for low-income folks." This is the second installment of a 4 part series exploring solutions to homelessness in California.

Many people talk about California’s homeless community as a monolith, yet the state has distinct homeless populations. The makeup of California's homeless population is more varied than the public assumes. A new statewide study released by UCSF Benioff Homelessness and Housing Initiative helps provides more clarity to the causes and consequences of homelessness in California, debunks common myths, and recommends policy changes to shape programs in response.

California is home to 12% of the United State's population, but is home to nearly one-third of the nation’s people experiencing homelessness. A landmark study by the UCSF Benioff Homelessness and Housing Initiative took an intimate look at the root causes of homelessness. The research team included people who were formerly or are currently unhoused residents in California. In this podcast episode of What Next, host Mary Harris speaks with Claudine Sipili a co-chair of the CASPEH Lived Expertise Advisory Board. "And the older I get, the more I get to a place where I’m seeking understanding, like this point of intersection where I’m connecting with another human and helping them see what I see" said Claudine.

Over the past year, Nicole Santa Cruz, and her colleagues Ruth Talbot, Asia Fields, Maya Miller investigated how cities have sometimes ignored their own policies and court orders, which has resulted in them taking homeless people’s belongings during encampment clearings. Marc Dones, policy director of the UCSF Benioff Homelessness and Housing Initiative, said, if officials, alongside case managers and health care professionals, worked with unhoused people over weeks, rather than days, before sweeping an encampment to help them get inside, they wouldn’t be separated from their belongings and their possessions wouldn’t need to be stored in warehouses.

In this op-ed, Maya Vijayaraghavan, MD, MAS, director of the UCSF Smoking Cessation Leadership Center, calls for contingency management to reduce tobacco and substance use. She emphasizes that the US is grappling with two interwoven crises of addiction, tobacco use, and opioid and stimulant-related overdoses. Contingency management is underutilized because of legal, logistical, and philosophical reasons. "Through integration, these technical assistance centers could increase opportunities to utilize such effective treatment in community settings." Dr. Vijayaraghavan writes. 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 Supreme Court ruling in City of Grants Pass, Oregon v. Johnson, lets lawmakers impose fines and jail time on people experiencing homelessness who are sleeping outside. This decision will provide more clarity to state and local leaders about legal steps they can take to clear out encampments. However, advocates say that the ruling will enable lawmakers to effectively criminalize the state of being unhoused.  Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "It's expensive, it's inhumane, and actually there are real solutions that do work."

It’s a common belief about homeless people in California: they move here from other places because of the state’s tolerance, mild weather, and generous services. But according to a recent UCSF study, at least 90% of those experiencing homelessness lived in California before losing their housing and 75% are in the same county they used to live in. In the largest study of its kind in nearly three decades, researchers talked to thousands of participants about their experiences to find out what factors pushed them over the edge into homelessness. The real story, researchers found, has more to do with the state’s poverty, inequality, and high housing costs. Talking about the study findings, UCSF BHHI Director and study author Margot Kushel, MD, and BHHI LEAB representatives, Jesica Giannola and Robynne Rose-Haymer, were guests on KQED Forum's ongoing series about homelessness in the Bay Area.

This interview with Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, discusses a viral video of a San Francisco art gallery owner spraying an unhoused woman with a hose, and what his actions and residents' subsequent reactions reveal about the responses to homelessness in San Francisco. Dr. Kushel said that conversation about the video, "is indicative, in some ways, of the state of our discourse around homelessness that we continue to blame the individuals who are experiencing homelessness for what has been a really widespread societal failure."

What rarely gets talked about in the news are the myths about why someone becomes, or continues to be, homeless. Speaking with Voice of San Diego, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, dispelled assumptions about the correlation between mental illness and homelessness. She explained, "What really determines whether an area — a city, a state, a country — has more homelessness or less homelessness is not how much mental health or substance use problems there are. It actually has much more to do with whether housing there is affordable. So even within our own country, we see that areas with the highest substance use and mental health problems don’t always have the highest homelessness. And in fact, they usually don’t. The areas that have the highest homelessness are the areas with the biggest disconnect between what housing costs and what people make."

In this Politifest 2023: California's Biggest Challenges, Voice of San Diego's senior investigative reporter Lisa Halverstadt talks with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative, about the causes of homelessness. Dr. Kushel discusses the landmark study, the California Statewide Study of People Experiencing Homelessness, that BHHI released in June. "It turns out people who experience homelessness stay where they are. This is a homegrown problem. We can talk for the reasons for that problem, but it's, it's certainly not people rushing into our state to, to enjoy being homeless here" said Dr. Kushel.

California has 12% of the US's population, but makes up roughly half of the nation's unsheltered homeless population. In late June, the UCSF Benioff Homelessness and Housing Initiative released a landmark report on the state of homelessness in California. In this episode of the Ezra Klein Show, Ezra speaks with the Atlantic writer, Jerusalam Desmas, about the reports core findings, what we know about homelessness, and what solutions exist to address it.

An event in San Francisco called “Public Health is Public Safety,” brought together a dozen experts from homelessness services, policy, research, and jail health services backgrounds. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed a successful “housing first” study conducted in Santa Clara, which found that simply providing housing to people who most needed it helped reduce emergency room visits and allowed people the chance to get mental health services.

Ending homelessness in the United States has remained stubbornly out of reach. Despite hundreds of federal, state, and local plans to end homelessness, most have ended unsuccessfully—due to a range of issues, notably insufficient resources. Homelessness persists and, in many communities, has increased because of myriad intervening factors—many of which lie outside the control of the systems tasked with solving it. This paper summarizes the evidence for effective interventions that need to be replicated and scaled.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed the economic forces driving homelessness along with how increasing the supply of extremely low-income housing could prevent it. “The vast majority of people who become homeless could be easily housed if there were housing that they could afford on their income."

Researchers at UCSF just released the findings of a statewide study that’s the most comprehensive look at homelessness in nearly three decades. NBC Bay Area’s Raj Mathai spoke to Margot Kushel, MD, the study’s principal investigator and director of the UCSF Benioff Homelessness and Housing Initiative, for some insight. "People experiencing homelessness in California are Californians," said Dr. Kushel. "People just couldn't keep up with the incredibly high cost of housing. We need to up our game in prevention to keep people from losing their housing in the first place."

In this op-ed, Cheyenne Garcia, senior research analyst at the Benioff Homelessness and Housing Initiative, calls for colleges to step up in helping students who experience homelessness. She outlines the how the school breaks disrupts the lives of students, as not every student has a place to go once classes are over. "The chronic stress of finding short-term housing break after break and year after year can take a toll on the mental and physical health of already stressed students." Ms. Garcia writes. 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 perception of people experiencing homelessness is often based on anecdote. On this episode of UCLA Housing Voice podcast, Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, joins host Shane Phillips to talk about the California Statewide Study of People Experiencing Homelessness, and what it says about who experiences homelessness, why they become homeless, their experiences while living without housing, and barriers to re-entering stable housing. As the conversation moved to mental health, substance use disorder, and people experiencing homelessness, Dr. Kushel said, "People in those in depth interviews, talk to us really clearly, that while they might have been using these drugs before they became homeless, they're using them while homeless was a coping strategy."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was interviewed about BHHI’s work with Community Health Outreach Workers and community organizations to deliver COVID-19 testing to unhoused people. “A lot of the lessons we learned will resonate very clearly, not just for COVID, but for any public health outreach, whether it’s vaccination campaigns, bringing health care services to people, or doing work on sexually transmitted infections and overdose prevention,” Dr. Kushel said.

30 percent of homeless population lives in California. A comprehensive new study finds half of all unhoused adults in California are older than 50 years of age, and that people of color are disproportionately affected. Ali Rogin spoke with Margot Kushel, MD, director of UCSF’s Benioff Homelessness and Housing Initiative and lead investigator about the new landmark study. "This is really, I think, the story of homelessness in the last few decades, the proportion of people over 50 has skyrocketed" said Dr. Kushel.

In San Diego, people 55 and older make up at least 29% of the people experiencing homelessness. The seniors experiencing homelessness face tough choices with many of them on a fixed income and unable to afford housing costs in the city. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "When talking about homelessness, 50 is the new 75."