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May 28, 2024

California Housing Study Offers Relevant Insight Into a Nationwide Issue

Street-level view of Dewey Square in downtown Boston, Massachusetts. Photo credit: iStock.com/APCortizasJrMedical and behavioral health disabilities coupled with inconsistent treatment make those living with these conditions the most vulnerable for housing instability. Photo credit: iStock.com/APCortizasJr

Released in June 2023, the California Statewide Study of People Experiencing Homelessness is the largest representative study of homelessness in California since the mid-1990s. In an effort to inform a more targeted approach to policy interventions on homelessness, researchers interviewed more than 3,000 people experiencing homelessness to uncover who is experiencing homelessness; what individual circumstances have led them to become homeless; and how their mental health, substance use, and chronic health issues have affected their life experiences while homeless. On March 21, 2024, Margo Kushel, director of the Benioff Homelessness and Housing Initiative and principal investigator of the study, delivered the annual John P. Dunlop Lecture at the Harvard Joint Center for Housing Studies (JCHS), “The Toxic Problem of Poverty + Housing Costs: Lessons From New Landmark Research About Homelessness.” After presenting the research findings, Kushel joined Peggy Bailey, executive vice president for policy and program development and vice president for housing and income security at the Center on Budget and Policy Priorities, and Jim O’Connell, president and founding physician of the Boston Health Care for the Homeless Program, in a panel discussion moderated by Chris Herbert, managing director of JCHS, to dive deeper into the issues raised in the research.

Health Care and Permanent Supportive Housing

The study's authors found that nearly half of those who experienced homelessness had one of four problems: current regular illicit drug use, heavy regular alcohol use, current hallucinations, or a recent psychiatric hospitalization. In addition, the respondents reported poor to fair health status, and, even though more than 80 percent of them had health insurance, most had a major chronic health condition. These medical and behavioral health disabilities, coupled with inconsistent treatment, leave those living with these conditions particularly vulnerable to housing instability. Not only should permanent supportive housing (PSH) policy prioritize the most vulnerable population, as Kushel stated, but stakeholders also need to improve the integration of PSH into the medical system.

O'Connell offered insight on this integration and the challenges he sees in Boston, where the second leading cause of death after drug overdose is chronic disease. He explains that, based on his experience with Boston Health Care for the Homeless, "trying to get the medical healthcare system to respond to the particular obstacles that people have to getting that care is really extraordinary." When the program's board members planned to transition clients to an integrated healthcare system once they secured housing, clients expressed a desire for continuity in service with familiar medical support teams. The program has responded to this need by including home visits as a medical service for people who have experienced long-term homelessness. Home visits are particularly important for those receiving mental health care, because these individuals often experience periods of stability followed by setbacks.

Increasing Housing Supply and Funding for Services

Kushel noted that, with the available data on the living conditions associated with homelessness and the successful implementation of PSH, policy experts and staff can focus on scaling existing policies that work. She specifically focused on PSH administered through the Housing First approach, which pairs housing with low barriers to entry and robust services. To improve its success rate, PSH needs a dedicated funding source to create and sustain services that meet the needs of the most vulnerable clients. Bailey agreed, noting that expanding Housing First policies reverses existing housing policies that silo the homeless system from the housing and services system. Kushel observed that, although the task is difficult, researchers and policymakers already know how to house people stably. She stated that, in addition to adequate funding, "it takes trained and appropriate staff at the appropriate ratios [and] ongoing certification, but the price of not doing it is simply too high."

Kushel observed that, when discussing the individual vulnerabilities to homelessness such as substance abuse or chronic illness, researchers and policymakers need to highlight the structural issues that contribute to homelessness, including low wages and the cost and availability of housing, which the panelists believed should be a primary focus in efforts to address the homelessness crisis. Kushel recommended that policymakers expand the Housing Choice Voucher program, which would help improve the supply of affordable housing. According to data from the National Low Income Housing Coalition, only one-quarter of extremely low-income households in California and one-third of extremely low-income households nationwide have access to affordable housing. Ultimately, the panel agreed that increasing the housing supply and expanding ongoing housing subsidies are necessary to combat homelessness. O'Connell emphasized that researchers should replicate the California study in additional cities nationwide to gain insight into these areas' particular demographics and client needs and determine the most effective interventions.

For more information about the California Statewide Study of People Experiencing Homelessness report from the Benioff Homelessness and Housing Initiative at the University of California, San Francisco, see “New Study Paints a Fuller Picture of Homelessness in California” on PD&R Edge.

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