People don’t usually become homeless suddenly. It’s often a chutes and ladders process, except with lots of chutes and hardly any ladders. And there’s a period right before they slide into having nowhere to live, during which, many experts believe, a couple of well-placed nets might be able divert them from being forced to sleep on the streets, in their cars, or other places that are not meant as homes.
A large new statewide study done by the University of California, San Francisco Benioff Homelessness and Housing Initiative takes a closer look at that period just before homelessness, by asking a representative sample of almost 3,200 homeless people from all over the state about the chutes they fell into, and what would have helped. (Marc and Lynne Benioff, funders of the UCSF initiative, are also co-chairs and owners of TIME.) The study, published on June 20, was conducted between October 2021 and November 2022, and is the largest of its kind since the 1990s.
Some of the findings of the California Statewide Study of People Experiencing Homelessness, or CASPEH, were unsurprising: in the state with the nation’s largest homeless population, people are unhoused because they don’t have enough money, and their lives and health and safety get much worse after homelessness strikes—a quarter of all participants had experienced sexual violence at some point. But some of the report’s data runs counter to popular perception: most homeless people were not from out-of-state, contrary to the myth that people lacking housing move there because of the weather and policies, for example, and 40% of them were contending with homelessness for the first time.
The study also interviewed more than 300 of the participants in depth to get a more finely grained image of their situation and particularly the events that immediately preceded their misfortune. We asked the study’s lead author, Dr. Margot Kushel, a doctor and professor of Medicine at UCSF, to answer four questions about what the study found.
What Is the Link Between Homelessness and Mental Health?
The prevalence of mental illness and substance use among those experiencing homelessness is clear, but Kushel cautions that the vast majority of mental illness among the study participants is anxiety and depression. It’s likely the lack of resources exacerbates those conditions, rather than the illness causing the homelessness, she says.
“I think that the driving issue is clearly the deep poverty, that the median [monthly] household income for everyone in the household in the six months before homelessness was $960, in a state with the highest housing costs in the country,” she says. Other studies have noted that the end of pandemic stimulus payments and rising inflation has led to rents outpacing wages. The study notes that in 2023, California had only 24 units of affordable housing available for every 100 extremely low-income households.
Nevertheless, Kushel also noted that treatment for substance addiction needed to be more available. Citing figures from the study, she notes that “one in five people who had a substance use problem while they were homeless wanted treatment, and couldn’t access it. That number should be zero.” Similarly the study found that two thirds of participants had mental health issues currently and only 18% were receiving any treatment. “That should be 100%,” says Kushel.
Where Were Homeless People Living Before?
There are three main places from which people tumble into homelessness: an institution like a prison, jail or drug treatment facility; a residence to which they had some legal connection, such as a mortgage or a lease; and a residence owned by somebody else, such as a family member or a friend.
The report suggests solutions include more—and more effective—halfway houses for formerly incarcerated people, and more— and more effective—eviction-prevention programs so people don’t lose the housing they have. But neither of those is going to help the large number of people whose penultimate stop is a relative’s or friend’s home. “You can’t build a homelessness prevention program only around eviction prevention,” says Kushel. “Those programs are important, but you’re going to miss a big chunk of people.”
Kushel points out that people who live with relatives and friends—and don’t have their name on the lease or mortgage—can’t, for example, provide a a notice of eviction. Their hosts are under no obligation to provide the 30-days notice that landlords have to provide. “That’s just not how it works,” says Kushel. “If you have no legal rights, your brother can kick you out at 3am if he wants to.” In response, the study suggests mediation services or other programs that can move more swiftly to catch people before they have to move out suddenly, as well as pilot programs for shared housing or for stipends to friends or relatives who open their homes.
Why Did They Have to Leave Their Last Place?
Many people fall into what Kushel calls a “doom loop” of homelessness, where they have jobs, but those jobs don’t quite pay enough for them to be able to cover their expenses, so they lose their homes. Then they move into a family or friend’s home, which puts that living situation under pressure. “We’re talking about 10 people living in a one-bedroom apartment,” says Kushel. The chaotic sleeping, hygiene, and transport arrangements make it tough to keep working. And if they lose their jobs and can’t contribute any money, the tension ratchets even higher. Of the people living with relatives the researchers interviewed, 43% of them were paying no rent at all.
Kushel says there are off ramps on this loop that should be more widely used, pointing to “really exciting models of homelessness prevention, where in low income communities, they’ll have subway and bus posters saying, Are you at risk of becoming homeless? Call us.” These programs might offer anything from infusions of cash and mediation services to a bunk bed and negotiations over cleaning. “What was really striking to us, was how little money people thought it would have taken,” says Kushel. Most participants suggested less than $500 a month or a one time payment of $10,000, would have kept them housed.
Where Did They Turn For Help Before Being Evicted?
The report found that two thirds of all the people interviewed did not seek help from anyone before they became homeless. And almost a quarter of those who turned to someone else for support, turned to families. In a perverse way, this might be good news, because it could mean that existing homelessness prevention services are working and people who seek help are able to stay housed. But it also suggests that the message that some help is available is not percolating to where it needs to go.
“What we know is that for prevention programs to work, there needs to be enough money and the right services,” Kushel says. “And also, they need to be targeted at the right people.” The CASPEH report recommends raising awareness about programs in places like local medical clinics, unemployment offices, public schools, churches, and bus stops in low income neighborhoods. It also advocates for educating those leaving institutional settings on their options for support. There aren’t currently enough services to meet the needs in California, says the report, and it calls for more. “But we also need to do a better job of getting the word out,” says Kushel. “We kind of know where people are at risk, and we need to meet them there.”
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