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Some Startling New Insights On Homelessness


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2020 Jan 13, 10:17am   1,152 views  19 comments

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#causes ofhomelessnessGood morning.

(If you don’t already get California Today by email, here’s the sign-up.)

For today, my colleague Conor Dougherty spoke with Dr. Margot Kushel, a leading homelessness researcher:

Margot Kushel is having the moment she never wanted to have.

Dr. Kushel is an internist at the University of California, San Francisco. She started specializing in low-income populations shortly after graduating from the Yale School of Medicine, and has spent two decades researching the underlying causes and consequences of homelessness in relative anonymity.

Lately, however, she’s seen her profile rise, as the problem she has spent her career trying to solve has escalated.

Last year, Dr. Kushel was named director of the Benioff Homelessness Initiative at U.C.S.F., which was endowed with $30 million from Marc Benioff, the billionaire founder of Salesforce. The initiative is focused on translating proven homeless solutions into widespread adoption and continuing to research what isn’t known.


Dr. Margot KushelNoah Berger
Here’s the conversation, edited and condensed for length:

Tell me about your career and how you ended up specializing in homelessness.

When I started residency, I realized that approximately half of the inpatients we cared for were homeless. We would admit patients to the hospital, give them all this very high quality, expert medical care, and then, eventually, we would have to discharge patients back to their homelessness, meaning to outside. Patients would ask me to please not discharge them, but eventually we wouldn’t have a choice. Inevitably, a few days later, the patient would be back, often in worse shape than they had been in before. I remember thinking that there had to be a different way and decided to change my career plans.

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What was the state of understanding of homelessness when you first got started versus what we know now?

When we first started, people believed that to provide housing, people needed to go through steps. First, a shelter. Then, if they “behaved well” (didn’t use drugs, took medicines, etc.), they could get to transitional housing. If they did everything “right” then they could be offered permanent housing. As a result, only a tiny proportion of people with behavioral disabilities became housed.

Housing First turned that upside down, recognizing that when people were homeless, they couldn’t attend to their mental health or substance use needs (or anything else). This has been enormously successful, housing about 85 percent of the most complex folks. There is overwhelming and incontrovertible evidence that this works — people are housed successfully, and then the other things follow.

What are some of the myths around homelessness?

You hear people saying things like, “You can’t just house people who have addiction problems.” You can, and you must. Another is that homelessness is caused by mental health and substance use problems. We know that most homelessness is driven by economic forces. The vast majority of people who become homeless could be easily housed if there were housing that they could afford on their income. Yes, having mental health and substance use problems are risk factors. But, most people with these disabilities are housed.

[Read more about who becomes homeless and how to help them in The Times’s Your Lead series.]

What don’t we know about homelessness?

There is a lot more work to be done in homelessness prevention. We know that for some people, a small infusion of resources (cash, services) can prevent homelessness. But, for every 100 or so people at high risk, only one will become homeless. So, we need to do a better job of figuring out how we can target efforts.

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Most people who become homeless “self-resolve,” meaning they find housing. We don’t know how long that takes, and whether we could shorten it substantially by intervening. We know that for most people, long-term subsidies are the answer, but there may be people who need shorter term help. We are going to try to figure out who needs what, while working to solve the main problem, which is the shortage of extremely low-income housing.

What would it take to end homelessness?

We’ve always known that most homelessness is a result, pure and simple, of poverty: the lack of a living wage, the lack of affordable housing and the insidious impact of racism. If we don’t fix the fundamentals, we are just patching a leaking ship. And that is what has happened.

It would take an investment in creating and sustaining extremely low-income housing and efforts to increase the minimum wage and to close the existing housing gap. Right now in California there are 22 units available and affordable for every 100 households with extremely low incomes.

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Some people will have disabilities that require assistance, and we need to provide that. The V.A. has leaned in hard to the Housing First principle and has seen huge reductions. Taking a page from what the V.A. has done, we can solve chronic homelessness by fully funding permanent supportive housing.

For everyone else, we need to focus on increasing the supply of extremely low-income housing by building very low-income housing, preserving what exists, and providing sufficient vouchers (right now, only a quarter of households who qualify get them).

It has been profoundly dispiriting to see, for so many years, the issues of housing affordability/living wage, and homelessness ignored on the federal level. And, it has been hard to see the disconnect in people’s mind between housing and homelessness.

Comments 1 - 19 of 19        Search these comments

1   Ceffer   2020 Jan 13, 10:30am  

This is what happens when you study your own co-dependance and agendas in depth while ignoring what is right in front of your nose with variations of denial. 'The homeless are a tabula rasa upon which I can sky-write my own illusions, delusions and aspirations rather than actually looking at them!"

Missing: WHO THE FUCK ARE THESE PEOPLE, WHERE DO THEY COME FROM, WHY ARE THEY HERE, WHAT IS THEIR DETAILED HISTORY AND MIGRATION PATTERN? WHERE DO THEY GET THEIR DRUGS AND MONEY FROM?

None of these 'insanely altruistic' screeds ever answer the a priori questions, they just go into multiple orgasm LibbyFuck rantings of the predictable and useless kind.

There are no 'insights' into homeless here because there is no anthropologic analysis or data of who, what , where, why etc. just the 'presumption of innocence and misfortune' with no requirement for personal recognizance or responsibility.
2   Reality   2020 Jan 13, 10:32am  

If all universities and colleges receiving government R&D funding or government sponsored education loans have to move their campuses out of the cities, the urban housing shortage would be instantly resolved.
3   MisdemeanorRebel   2020 Jan 13, 10:40am  

Most homeless is caused by Drug Addiction, untreated severe Mental Disorders, and Alcoholism.

Very, very few homeless are from job loss/low income. Most people who find themselves in such a situation quickly escape; but unfortunately since Leftists refuse to deal with the central issues of Addiction and Insanity, it's very hard for legit impoverished people - esp. working class men - to get the temporary assistance they need to get up on their feet.

You don't need to be a weatherman to know which way the wind blows and you don't need to be a social scientist, after talking to/observing a dozen or so homeless in any urban area, to ascertain the core underlying issue.
4   MisdemeanorRebel   2020 Jan 13, 10:42am  

Also, there is literally NO HELP for temporarily displaced FAMILIES, not involved with a natural disaster.

All the Communist Run Homeless Shelters separate married couples and especially Men from Children, and by Cloward-Pliven design, encourage divorce to access temporary aid.
5   Ceffer   2020 Jan 13, 10:44am  

"Making A Good Bureaucratic Living Off The Homeless For Dummies".

Poor them. Poor me. What a World. Gimme money, money, money to throw at the problem after my cut.
6   RWSGFY   2020 Jan 13, 3:06pm  

Same startlingly old bullshit.
7   Shaman   2020 Jan 13, 3:22pm  

It’s amazing how this guy’s “revelations” are always 20-50 years old and completely irrelevant to the current situation.
Hey! Let’s interview a woman who has made her living for 30 years crying about the homeless and see if she cries about the homeless and asks for more money!
8   NuttBoxer   2020 Jan 14, 7:58am  

WHAA!? People don't make the choice to be homeless!?!?

So going by someone who studies homeless for a living, it sounds like the rise in homelessness directly correlates to our economy being in the shitter, despite everyone saying there's no bubble.

But sure, say it's all drugs and alcohol, that way you can sleep at night...
9   RWSGFY   2020 Jan 14, 7:59am  

NuttBoxer says
our economy being in the shitter


By what measure?
10   NuttBoxer   2020 Jan 14, 8:03am  

The_Weeping_Ayatollah says
By what measure?


Seriously? I just said it. You want others? Zero manufactured goods, dollar that has lost 90% of it's value, bubble's in every dollar denominated asset(housing, stocks, bonds, etc), Record number of people out of work(after six months of unemployment they drop off all federal stats), tech "startups" that have been around for 5+ years and never turned a profit, VC's throwing money at anything with a pulse...
11   socal2   2020 Jan 14, 8:53am  

NuttBoxer says
But sure, say it's all drugs and alcohol, that way you can sleep at night...


Are you saying drugs and alcohol play no part? You used to live in San Diego - right? Did you ever walk through the bum camps downtown or Mission Valley? Lots of drunk and high people mixed in with mental people who should be institutionalized.

Why do we only see massive homeless populations in States and Cities that incentivize this type of behavior with free needles and no enforcement of petty crimes and vagrancy?

Alabama has some extremely poor communities, but you don't see their major cities taken over by the drug addicts and shit all over the streets.
12   Ceffer   2020 Jan 14, 10:36am  

In Santa Cruz, a lot of the co-dependence is about keeping the drug pipelines open for chronic or part time users, or the non-addicted users. Many users are not addicted (yet) and still "function", and some will never become end stage addicts without any ability to work or support themselves through any way but crime. Some are just sappy relatives of users who defend their family's social dysfunction.

Faux sympathy for the 'homeless' is about sympathy for drug use for the active market's larger population, not for the homeless themselves. Homeless are the walking dead tip of the user iceberg, and an inconvenient embarrassment for the broader base of users. So, yes, when people "defend" the homeless in various inappropriate sympathetic ways, you have to wonder what is in their hookah or bottle. Users will say or do anything to protect their drugs, and everything that goes along with them.

People who are addicted/drug/alcohol dependent can still have homes and jobs. A lot of the crips and shut ins are only crips and shut ins because they get their drugs from the social services pushers and instead of getting out, just stay in and use.

You see a lot of the homeless and 'old hippies' who aren't homeless walking with a characteristic gait, like their drug use has caused some level of Parkinsonism. You can spot the chronic users from a long distance away because of this slightly bent stiff, shuffling gait

"Hey, I dip and chip, but I'm not like THOSE people!"
13   NuttBoxer   2020 Jan 15, 6:41am  

socal2 says
Why do we only see massive homeless populations in States and Cities that incentivize this type of behavior with free needles and no enforcement of petty crimes and vagrancy?


SF is an outlier. And California also happens to have some of the best weather for living outdoors, Alabama does not. I see a good number of homeless in Phoenix as well. Just because a homeless person drinks, does not mean alcohol causes homelessness. If someone has mental problems, but they have money, they rarely go homeless because they can afford treatment, or their family can afford to take care of them.

I do think there has been a rise in mental disorders that directly correlates to poor diet, but again, with enough money, anything is treatable.
14   FuckTheMainstreamMedia   2020 Jan 15, 7:17am  

People with “behavioral disabilities” can’t “earn” housing?

Sure they can. It’s called prison.
16   Shaman   2020 Jan 15, 7:28am  

NuttBoxer says
it sounds like the rise in homelessness directly correlates to our economy being in the shitter, despite everyone saying there's no bubble.


The economy, by ANY measure, has not been this good in 70 years! And yet the homelessness rates have been rising in step with the plethora of help wanted postings. At some point, (unless you are paid to think differently as is this social worker) you have to admit that these people are homeless because they want to be homeless, without the restrictions on their activities that come with maintaining a residence and a job.

I just can not feel sorry for such people. They choose that lifestyle every single day.
It’s a free country!
17   RWSGFY   2020 Jan 15, 7:48am  

NuttBoxer says
SF is an outlier. And California also happens to have some of the best weather for living outdoors, Alabama does not.


LOL. Explain homeless infestation in Portland, Seattle and Vancouver then.
18   Tenpoundbass   2020 Jan 15, 7:56am  

People who hit hard times and can't get a job or make ends meet. That end up on the verge of being homeless with no hope in sight. Become criminals, they don't become homeless. Long term homelessness and the people who are comfortable with their situation, are all mental and drug issues. Even the example of sane people that fall no hardtimes, even if they don't turn to crime. They will find a way to get off the streets, even if they have to salvage scraps, and work as day labors.
19   NDrLoR   2020 Jan 15, 9:10am  

The_Weeping_Ayatollah says
LOL. Explain homeless infestation in Portland, Seattle and Vancouver then
The logical end to progressiveism.

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