In this op-ed, Maria Raven, MD, MPH, associate director at the Benioff Homelessness and Housing Initiative, outlines the issues with California's new law forcing people into drug treatment. She explains how emergency departments have treated people with severe alcohol disorder, but emergency departments are already filled with countless of patients. Dr. Raven writes, "SB43 is already creating confusion. It empowers law enforcement officers and others to bring more patients to our already crowded department on involuntary psychiatric holds for severe substance use alone, thinking we will provide a path to conservatorship. However, that path breaks down if a patient has decision-making capacity once no longer intoxicated." 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.

A proposal to spend $12 billion to end homelessness in California is "a really good start, but can't be the end," said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative. Project Homekey was remarkable because of how it was approved and running just months after it was announced. But solving homelessness is not possible without addressing housing affordability, which is pushing thousands of Californians onto the street each year. “That’s fundamentally at the heart of the problem,” Dr. Kushel said.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted about California’s Project Roomkey and Project Homekey, including their prospects to make a lasting impact on homelessness across the state. “(Roomkey) really grabbed those who were at the highest risk of doing poorly and got them to safety,” said Dr. Kushel.

Housing First focuses on getting people into permanent housing and offering them support services. A 7-year randomized trial of chronically homeless individuals found those in the housing-first group spent 90% of their nights housed and made less use of psychiatric emergency services and more use of outpatient mental health services compared to the control group. “The experiment intentionally sought to try housing first for the very most complicated patients—those who society says are most hard to house—and it worked,” said study co-author Margot Kushel, MD, who directs the UCSF Benioff Homelessness and Housing Initiative.

In this op-ed, Maria Raven, MD, explains why involuntarily hospitalizing people experiencing homelessness doesn't work. She writes, "Hospital emergency departments have long been the re...

Oregon is one of several states betting on housing and outreach programs using Medicaid funds. Officials hope that by keeping people from experiencing medical crises that lead to repeated emergency room visits, Oregon will save enough money to pay for increased housing costs. California is also working to implement a program similar to Oregon's, spending more than $100 million a year on housing from its Medicaid budget. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative said, "I know that if I could get my patients who are experiencing homelessness housing, we could make everything else work better".

In this cohort study, UCSF BHHI researchers found that most older homeless-experienced adults needed caregiving assistance and few received such assistance. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term care needs due to untreated disabilities.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, spoke about Oakland’s new shallow subsidy program, which will help 200 low-income households pay rent for 18 months by sending money directly to their landlords. The UCSF Benioff Homelessness and Housing Initiative will evaluate the impact the program has on families to determine whether people who received subsidies were more likely to remain housed than those who did not.

Little is known about chronic pain in older adults experiencing homelessness. In this cross-section, population-based study, researchers interviewed 350 homeless individuals aged 50 years and older to assess factors associated with chronic moderate to severe pain. Overall, 46.8% reported chronic moderate to severe pain. Researchers suggest clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.

Patients with prolonged hospitalizations often require alternative levels of care (ALC) and there stays strain hospital capacity and patient flow. This study aimed to descriptively compare prolonged ALC and short ALC. Researchers found that patients with prolonged ALC were more likely to be older and have experienced homelessness. Furthermore, prolonged ALC patients were more likely to be admitted for acute care and had greater psychosocial complexity.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted about upcoming changes to hotel programs for unhoused people. With California’s Project Roomkey winding down, hotels for Bay Area residents experiencing homelessness are slated to close. Despite uncertain prospects for keeping people housed in the future, “Project Roomkey has played a huge role in decreasing the disasters in the Bay Area,” said Dr. Kushel, including slowing the spread of COVID-19.

Researchers examined whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization among older homeless adults. Using population-based sampling methods, the study enrolled 350 homeless adults aged 50 and older in Oakland, California. They found that childhood adversities are associated with poor mental health outcomes among older homeless adults. Researchers recommend screening for childhood adversities should be undertaken by all providers who care for older homeless adults.

Globally, tobacco use causes 8.7 million deaths annually. Approximately 50 % of formerly homeless adults in permanent supportive housing (PSH) in the United States smoke cigarettes. Secondhand smoke exposure is high in the absence of smoke-free policies. There is a need to understand attitudes toward smoke-free policies and factors associated with smoke-free home adoption attempts among PSH residents.

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. 

There is public skepticism when politicians promise to solve a crisis, and then little progress gets made. Los Angeles Mayor Karen Bass's policies have given new hope, but an increase in violence against people experiencing homelessness has pushed more into despair. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "I do really worry that it’s become normalized in public discourse to speak about people experiencing homelessness as, like, a problem for those who are not homeless — as opposed to fundamentally a massive societal failure that’s left usually older, vulnerable people terrified and totally unprotected."

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.

There is an overrepresentation of Black people in people who experience homelessness in California. A recent special report released by the UCSF Benioff Homelessness and Housing Initiative on Black Californians' experiences homelessness highlights the systemic racism. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "This didn’t just happen by accident and it didn’t just happen because there were a few bad people. This was organized." Dr. Kushel further adds in regards to reparations, "That feels like a conversation that, if we are being honest, we need to have."