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."

In this op-ed, Dalma Diaz, MA, a health equity fellow at the California Health Care Foundation, highlights the increase in people experiencing homelessness among the Latinxs. Despite the rising rental costs and displacement, more than two thirds of Latinx said they are not worried about experiencing homelessness in California, and yet research has shown that Latinxs are more likely than other ethnic groups to experience first time homelessness. Ms. Diaz writes, "Let us not return to the apathy, silence, or whatever it was before the pandemic that kept us on the sidelines of the homelessness crisis. It’s up to us, now, to do the work in coalition, and make the change for future generations." 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.

New commentary from BHHI faculty Dr. Maria Raven, published in JAMA Network Open, examines what recent findings on VA mobile medical units (MMUs) reveal about outreach, healthcare use, and evaluation in care for veterans experiencing homelessness.

In the United States there has been a simultaneous rise of mass incarceration and homelessness. Both of these phenomena are driven by the same structural factors, housing being the most important. Researchers present evidence-based approaches to improve housing strategies for reentry populations, prevent homelessness among those in community supervision, and rehouse members of the reentry community experiencing homelessness.

This commentary coauthored by BHHI faculty describes how a coalition of Bay Area community organizations, academic institutions, and public health departments collaborated to provide high-risk populations with Covid-19 testing and vaccination, and also took the opportunity to connect them with other essential services.

This UCSF study compared infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States. In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness.

Depression is common in adults experiencing homelessness. In this cohort study, researchers examined the association between residential status and depressive symptoms in adults 50 years or older experiencing homelessness. Researchers found that continued homelessness was associated independently with increased odds of depressive symptoms.

Without proper precautions and actions, the virus "could spread like wildfire," warned Margot Kushel, MD, director of the University of California, San Francisco Center for Vulnerable Populations.

Margot Kushel, MD, director of the University of California, San Francisco Center for Vulnerable Populations, shared her concern that the coronavirus outbreak will be dangerous in other ways for the homeless even if they don’t get sick. “My fear,” she said, “is that this will be used as another way to further stigmatize an already stigmatized and challenged population.”

This UCSF study reported the public health response to a COVID-19 outbreak in a San Francisco shelter where 67% of residents and 17% of staff tested positive for SARS-CoV-2. The researchers describe the limited utility of case investigation, person-based contact tracing and symptom screening, and the benefits of mass testing in outbreak response.

Researchers and advocates say much is unknown about how the pandemic has affected the estimated half-million people without housing in the Untied States. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, discussed how obtaining good data on the homeless population is difficult because hospitals and death certificates don’t track housing status. While she was hesitant to draw conclusions about how the pandemic has affected homeless people overall, she said, “This may be an example where being outside and unsheltered, just in terms of COVID, maybe let people be at lower risk. But again, we just don’t really know.”

Margot Kushel, MD, spoke with ABC7News about how the novel coronavirus is especially dangers for people experiencing homelessness. People in close proximity on sidewalks and in tents, inside shelters, or even living in shared spaces, like SROs, are extremely vulnerable to communicable diseases. "We know that people who experience homelessness experience death rates that are extraordinarily higher than they otherwise would be if they were housed,” explained Dr. Kushel, “and our fear is that it could come to bear in this [crisis] as well." 

Housing First—especially permanent supportive housing for people with complex needs—helps people stay housed and reduces reliance on emergency systems. BHHI Director Dr. Margot Kushel discusses the potential fallout of cutting back on these proven approaches with the Guardian.

Volunteers, on a clear night in San Francisco, count the number of people who are unhoused on the streets. Groups of people were assigned specific areas, and write down whether a person is confirmed, suspected, or if no one on the block is unhoused. The point-in-time count is nationwide. However, the counts are not perfect and some groups are undercounted. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "Homeless families do everything they can to stay out of the public eye because they are really worried, for good reason, that their children will be taken from them."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted regarding lower vaccination rates in people experiencing homelessness in the Bay Area, where multiple outbreaks and rising case rates in homeless shelters have experts concerned. "You have to be able to trust science, you have to be able to trust the health care system, you have to be able to trust the people you’re around," said Dr. Kushel. "And I think people who are homeless often have had a lot of trauma and a lot of reasons to not trust those systems."

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, was quoted in the San Jose Mercury News discussing rollout of COVID vaccines for people experiencing homelessness. The Benioff Homelessness and Housing Initiative team recently surveyed unhoused people in Oakland and San Francisco and found they were more likely than the general population to want the vaccine.

Homeless people are among the most vulnerable populations in the COVID-19 pandemic, yet they’re largely invisible during this crisis. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, called the pandemic “a crisis within a crisis,” noting that most homeless people are usually in poorer health and, with widespread closures, had lost access to services providing food, water, and shelter.

In this qualitative study, UCSF BHHI researchers found that providing mobile testing, incentives, and trusted community members for outreach mitigated barriers to COVID-19 testing and v...

Through ‘United in Health D10 Unhoused,’ UCSF offered free COVID-19 testing for anyone experiencing homelessness in District 10. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, led the effort in partnership with the United Council of Human Services (Mother Brown’s Kitchen), Bayview Hunters Point Community Advocates, and Southeast Community Council, as well as SFDPH.