essay on homelessness in california

Homelessness in California: Causes and Policy Considerations

Key takeaways.

California’s homeless crisis is associated with high housing costs, inadequate shelter spaces, deinstitutionalization, and changes in the criminal justice system.

To improve housing affordability, California needs to streamline and accelerate housing production and reexamine the regulations that have hindered new housing development.

To reduce the unsheltered homeless population, more shelter capacity and increased investment in cost-effective housing are needed.

A large share of the chronically homeless suffers from drug addiction and mental health problems. More treatment facilities and lower barriers for treatment are needed.

For decades, California has had one of the country’s largest populations of unhoused people. In recent years, however, the challenges have severely worsened for the Golden State. The homelessness counts in California rose by 42 percent between 2014 and 2020, while the rest of the country had a 9 percent decrease. On any given night, the state has more than 160,000 homeless persons.

Figure 1: State Homelessness Point-in-Time Counts

About 70 percent of California’s homeless live outside a shelter system, sleeping in tents, public open spaces, or vehicles. That’s a stark contrast with New York, where only 5 percent of the homeless population are unsheltered. Opinions diverge on how to reduce the unsheltered homeless population. Disputes center around whether to focus on building permanent housing versus shelters and interim housing and the legality of public encampments.

Another challenge lies in the interactions between mental illness, drug addiction, and homelessness.  In 2020, about 25 percent of all homeless adults in Los Angeles County had severe mental illnesses such as a psychotic disorder and schizophrenia and 27 percent had a long-term substance use disorder. Moreover, a higher percentage of so-called chronically homeless 1 have drug addiction, a severe mental illness, or both.

Meanwhile, state and local governments have spent billions of dollars to combat homelessness. Between 2018 and 2020, California spent $13 billion on homelessness, across nine state agencies through 41 programs (Har 2021). Governor Gavin Newsom signed a $12 billion funding package of bills in 2021 to tackle the homelessness crisis. 

With so much money being spent to combat homelessness, what are the prospects for reducing the numbers once and for all? This policy brief provides an overview of the major contributing factors to the rising homelessness in California and highlights the impact of policies, legislation, and regulations on several of those factors: housing, mental health, illicit drug use, and crime.

Housing affordability and availability

California has one of the most expensive and fastest-growing housing markets. Between 2000 and 2021, home values more than tripled in most metro areas in the Golden State. As of March 31, 2021, the typical home value in California was $775,000, double the levels in New York and Florida and triple the level in Texas ( Zillow ).

The median rent for a two-bedroom apartment is well over $3,000 in the Bay Area, more than twice as much as the national average of $1,200. In more than two-thirds of California’s ZIP codes, families are "rent-burdened" as they spend more than 30 percent of their income on rent (ABC 2021).

High housing costs and a low stock of affordable housing create a precarious situation, especially for lower-income families and individuals who are at higher risk of becoming homeless.

Figure 2: Median Rent for a Two-Bedroom Apartment, California, 2022

High housing costs are rooted in both demand- and supply-side factors. On the demand side, California boasts robust jobs and household income growth. Between 1990 and 2017, high-paying industries embraced the most vigorous job growth, including information technology (up 127 percent), education and health services (up 107 percent), and professional and business services (up 84 percent) (CA Government 2019). In 2021, the state accounted for 44 percent of the nation’s new jobs that year.

While the housing demand has surged, the supply has fallen short of the national average since 1991, as demonstrated in Figure 3. The supply shortage is exceptionally sharp in coastal cities. For example, San Francisco added 38,000 new jobs from 2016 to 2018 but built only 4,500 new housing units (McQuillan 2020). California ranks 49th among all U.S. states for housing units per capita (McKinsey Global Institute 2016).

Figure 3: Residential Building Permits, Per 1K Population

One key factor exacerbating the housing supply shortage is the single-family zoning and local opposition to housing, often embodied by the “not in my backyard,” or NIMBY, sentiment. Each additional growth control policy a community added was associated with a 3-5 percent increase in home prices (Taylor 2015; Rothwell 2019). 

Another factor is the high costs and uncertainties in housing development related to lengthy entitlement processes, which include zoning changes, permit applications, standards variances, site plan reviews, design reviews, and environmental impact reviews (EIR) required by the California Environmental Quality Act (CEQA).

For projects that required an EIR, the average timelines for approvals were 43 months in Los Angeles and 77 months in Santa Monica (O’Neill, Gualco-Nelson, and Biber 2018). In recent years, some CEQA lawsuits tried to block infill housing (i.e., new housing on vacant, underused lots in an older neighborhood) and housing projects near transit lines. CEQA lawsuits can be filed anonymously and by parties attempting to advance an economic rather than environmental agenda, such as business competitors (Hernandez 2018; Hernandez et al. 2019).

Legislative efforts have been made in recent years to accelerate housing production, subdivide lots, and relax certain zoning restrictions to allow for more home building. Senate Bill 35 was signed into law in 2017, aiming to streamline the approval processes for multifamily housing development. Senate Bill 9 was ratified four years later, allowing many homeowners to build additional units on their property or subdivide their land into two lots. While this could help create more than 700,000 new homes that would otherwise not be market feasible, owner-occupancy requirements may mean that only a share of that potential will likely be developed (Metcalf et al. 2021). Despite the recent policy achievements, the housing supply shortage will persist in the near future.

A dearth of shelters

About 70 percent of the homeless in California are unsheltered, more than in any other state. A primary reason for the sizable unsheltered population is the low stock of emergency shelters and transitional housing. Between 2007 and 2020, while the total homeless population increased in California, the shelter capacity remained flat for a decade before rising again after 2017, and the bed counts at transitional housing facilities had a continuous decline. 

Figure 4: Year-round beds in emergency shelters, transitional housing, and permanent supportive housing, California, 2007-2020

While the development of shelters has stagnated, there’s been a push for “Housing First” among many advocates and policymakers who believe permanent housing plus supportive services is the most important step to solving chronic homelessness.

Housing First is both an ideology and a practice developed in the 1990s that broke from the model of requiring homeless people to transition from emergency shelters to more permanent subsidized housing only when they met certain criteria around sobriety or treatment for mental illness.

The Housing First approach immediately provides homeless clients with an apartment and supportive services for drug addiction and/or mental illness (Tsemberis 2004). The supportive services are provided but participation is not required of the homeless clients.

Some benefits were attributed to Housing First, including higher housing stability, fewer emergency room visits, and improved medication adherence (Tsemberis, Gulcur, and Nakae 2004; Padgett, Henwood, and Tsemberis 2015; Aubry et al. 2016; Buchanan et al. 2009).

Meanwhile, Housing First showed no effects in reducing drug use, alcohol consumption, psychiatric symptoms, or enhancing the quality of life (Rosenheck et al. 2003; Mares, Greenberg, and Rosenheck 2007; Stergiopoulos et al. 2010).

Throughout the 2000s, Housing First received ample attention from academics, news media, and policymakers. But the policy carried unintended consequences when resources were diverted from shelters and other interim housing to building permanent housing projects.

For example, then-San Francisco Mayor Gavin Newsom presented a 10-year plan in 2004 that promised 3,000 new permanent supportive housing units in the following decade.

At the end of the decade, the city had been on track in creating permanent supportive housing. But city planners didn't anticipate an influx of homeless people, for whom the original plan was unable to accommodate.

The shelter capacity was weakened as the plan “directed the City to move its focus away from traditional emergency shelters and toward shelters with 24-hour crisis clinics and sobering centers.” As a result, the city reduced 440 year-round emergency shelter beds between 2005 and 2014 while adding only 26 beds with some crisis or sobering management (City and County of San Francisco 2014).

Figure 5: San Francisco Built No New Shelters during the 10-Year-Plan Period

With a rising homeless population and a shrinking shelter capacity, San Francisco’s unsheltered homeless population doubled from about 2,655 to 5,180 between 2005 and 2019. After the 10-year plan ended in 2014, city planners began building shelters again, but it was too little too late.

Building permanent supportive housing was embraced with similar enthusiasm in Southern California. In 2016, Los Angeles voters approved Prop. HHH, which authorized city officials to issue up to $1.2 billion in bonds to reduce homelessness by developing and remodeling permanent supportive housing. According to a report by the L.A. Controller Ron Galperin, five years after the passing of the proposition, only 14 percent of promised projects had been completed, a total of 1,142 units. Development costs were high and continued to rise. In 2021, the average per-unit cost was almost $600,000. Some units are extremely expensive. Fourteen percent of the units exceeded $700,000, and at least one project is estimated to cost nearly $837,000 per unit.

Using permanent housing to solve homelessness met with the reality of California housing development: slow and expensive.

It takes about four years to complete an affordable housing project in the Bay Area, costing about $400,000 to $700,000 per unit, typically a studio, one-bed, or two-bed apartment (Bay Area Council Economic Institute 2021).

Cheaper, faster alternatives exist. For example, a bed costs about $43,000 in a shelter and $73,000 in a “tiny home” — compact housing units that can be quickly built (Bay Area Council Economic Institute 2021). While these options have disadvantages such as crowding and restrictive rules (e.g., no pets) and are less permanent or aesthetically appealing than long-term houses, policymakers need to weigh those shortcomings against the suffering of people sleeping on the street.

In states with sufficient housing stock and a small number of homeless people, Housing First can solve the "houseless" problem. Still, intensive care is needed if the root cause of an individual’s homelessness is mental illnesses, drug addiction, or alcohol abuse (Pearson 2007).

In contrast, in places with a housing shortage, such as coastal California, there is a long wait before permanent housing becomes available, which defies the original vision of Housing First to immediately provide an apartment (Tsemberis, Gulcur, and Nakae 2004). As cautioned in a JAMA paper, the high capital costs to develop permanent supportive housing in some localities can prohibit Housing First as a viable option (Kertesz and Weiner 2009).

In 2020, only one-third of California’s homeless moved into permanent housing, 47 percent were awaiting housing and still accessing services, and 16 percent were no longer engaging in services (San Jose Mayor's Office 2021). While waiting for permanent housing, it’s imperative for homeless people to have a safe place to sleep. The longer people stay unsheltered, the more their mental and physical health deteriorates, making it harder for them to go back to the labor force, find housing, and regain financial stability. 

Mental illness, drug addiction, and crime

Drug addiction and mental illness are consistent risk factors for homelessness (Tsai and Rosenheck 2015; Thompson et al. 2013; Yamamoto et al. 2019). Substance use can be both a cause and a result of homelessness (Johnson and Chamberlain 2008).

There are also differences in terminologies. In 2019, the Los Angeles Homeless Services Authority released a report showing 25 percent of the unsheltered homeless had a severe mental illness and 14 percent had a substance use disorder. Using the same survey data, the Los Angeles Times showed a much higher prevalence level: about 51 percent with mental illness and 46 percent with substance use disorder. The critical difference lies in the definition of mental health and drug addiction. The government's estimates are lower because they only counted people with a permanent or long-term severe condition (LAHSA 2020).

Appendix Table A.1. contains estimates for the prevalence of mental illness and drug addiction among the homeless. The prevalence is particularly high among the chronically homeless, over 75 percent of whom have substance abuse or a severe mental illness (Kuhn and Culhane 1998; Poulin et al. 2010; Ellen Lockard Edens, Mares, and Rosenheck 2011). Powerful drugs such as P2P methamphetamine induce psychosis, the symptoms of which are sometimes confused with schizophrenia.

Several structural changes are related to the mental illness and drug addiction crisis seen among the unsheltered homeless population in California today.

Deinstitutionalization

The 1950s brought two key developments that affected homelessness. First, through books such as The Shame of the States by Albert Deutsch, the public gained insights into practices at many of those institutions, which were criticized as cruel and inhumane. In 1954, chlorpromazine (also known as "Thorazine") was approved by the U.S. Food and Drug Administration as a new antipsychotic drug, which gave many people hope that mental health patients could live in the community with the help of medication.

In 1963, President Kennedy signed the Community Mental Health Act into law to provide federal funding for community-based mental health care, aiming at replacing institutional care with community care. At the same time, federal law generally prohibited states from using Medicaid funds to pay for non-elderly adults (i.e., age 21-64) in “institutions for mental disease” (IMDs). 2 As state mental hospitals were considered IMDs and ineligible for Medicaid funds, states responded by closing down state mental hospitals (Geller 2000).

As a result of the nationwide deinstitutionalization, the number of mentally ill patients in public psychiatric hospitals plummeted from 558,239 in 1955 to 37,209 in 2016. As shown in Figure 6, the number of patients per 100,000 Americans decreased from 337 in 1955 to 11 in 2016 (Torrey et al. 2012; Treatment Advocacy Center 2016a; SAMHSA 2016).

However, the vision of providing care in the community didn’t materialize as was planned. The increase of beds in the community didn’t nearly make up for the loss of beds in public mental hospitals. Even if we add all other beds, including ones in private hospitals, general hospitals with psychiatric units, VA Medical Centers, and 24-hour residential treatment centers, the total beds throughout the country were about 170,000 in 2014, compared with over 550,000 in 1955 (SAMHSA 2016).

With the closing of state psychiatric hospitals and inadequate community-based care, streets, jails, and prisons have become the new asylum for many of the mentally ill.

Figure 6: Number of Inpatients in Public Mental Hospitals per 100K Americans

California was no exception amid the nationwide deinstitutionalization and has had a shortage of adult psychiatric beds. According to a RAND study (McBain et al. 2022), California is estimated to have a shortfall of 4,767 acute and sub-acute inpatient beds and 2,963 community residential beds. The magnitude of the state’s need for adult psychiatric beds is expected to grow over time.

Short of psychiatric inpatient beds, emergency room doctors often have little choice but to release mentally ill patients within a few days. Some patients may be referred to a county or private agency for help. But the time and effort it takes to access those services can be a barrier for many.

In recent years, there have been policy efforts to allow managed care organizations (MCOs) to receive Medicaid reimbursement for acute psychiatric care. But that care extends to only 15 days per month (Treatment Advocacy Center 2016b).

Realignment and Proposition 47

In the past decade, California began enacting laws to reform the criminal justice system and reduce populations in the state’s overcrowded prisons. But some advocates and policymakers now recognize that legislation may be having unintended consequences for some homeless people.

With the state’s prison population swollen to nearly 174,000 inmates — 200 percent of capacity — the California Public Safety Realignment Act (AB 109) was passed in 2011. The law meant low-level offenders would now receive sentences in county jail or non-custodial mandatory supervision rather than being sentenced to state prison.

Three years later, voters passed Proposition 47, which recategorized some nonviolent offenses from felonies to misdemeanors. This included burglary and theft under $950 and possession of controlled substances including cocaine, heroin, and methamphetamine ( Proposition 47 FAQ ). In 2021, S.B. 73 was signed into law, which further ended mandatory minimum sentences by giving judges discretion to grant probation instead of jail time for nonviolent drug crimes.

AB 109 and Proposition 47 reduced prison overcrowding, arrests, felony conviction, and long incarcerations (Bird et al. 2016; Petersilia et al. 2014; Mooney et al. 2019). But the laws also reduced the number of people going through drug courts — and being able to access services to help stabilize sobriety.

Overseen by a judge, a drug court seeks to harness the coercive power of the criminal justice system to persuade drug offenders to receive treatment (U.S. Department of Health and Human Services HHS 2016). If they pass the drug treatment program, their charges are dismissed. Studies have shown the effectiveness of drug courts on increasing treatment completion, reducing recidivism, incarceration, and subsequent drug use (Gottfredson, Najaka, and Kearley 2003; Wilson, Mitchell, and MacKenzie 2006; Sevigny, Fuleihan, and Ferdik 2013; Belenko, Patapis, and French 2005).

After the passing of Proposition 47, many of those already in the drug court system began dropping out of mental health and substance use disorder treatment. Moreover, the number of individuals referred to treatment by the criminal justice system also decreased (Hunter et al. 2017).

Homeless persons addicted to drugs face high barriers to access treatment in the community. Such barriers include long waiting lists for treatment programs that accept Medi-Cal, logistic constraints like the lack of a phone (to call in order to enroll), transportation, and documentation, and no help in accessing treatment (Brubaker et al. 2013). The new laws may have taken away an effective channel through which some homeless would have been able to access and complete drug treatment.

Policy Considerations

Homelessness in California is complex, and the diverse causes and trajectories of homelessness suggest the solutions are also diverse. Policymakers should consider a combination of strategies that address the housing shortage and costs issues and those that tackle the mental health and drug addiction crisis.

Housing development

• Streamline and expedite the approval process for new housing projects.
• Simplify funding applications for affordable housing projects.
• Expand permissible residential development on commercial property (Metcalf et al. 2021).
• Expand the use of CEQA exemptions.
• Amend CEQA to eliminate the automatic right of appeal for meritless cases and to prevent ambushes in which claimants raise issues too late (Kolkey 2019).

Shelters, interim housing, and alternative housing options

• Expand shelter capacity, including congregate and non-congregate shelters.
• Improve the quality and safety of congregate shelters and eliminate unnecessary rules such as restrictions on pets.
• When there are shelter spaces, the “right-to-shelter” should be enforced. Other rules such as no public defecation and public urination should be enforced to address the quality-of-life issues.
• Increase the development of innovative, cost-effective housing, such as tiny homes and modular homes.
• Promote shared-housing and consider reducing the implicit tax on housing sharing  (He, O’Flaherty, and Rosenheck 2010; Ellen and O’Flaherty 2007).

Permanent supportive housing

• Conduct in-depth research on the long-term outcomes of permanent supportive housing (PSH), to understand the effects of PSH on labor force participation, drug use, and psychiatric symptoms.
• County governments conduct site inspections on whether the PSHs have a sufficient staff-to-client ratio and whether homeless clients living in PSHs can receive timely, adequate treatments for their mental illness and drug addiction.

Mental health treatment

• Increase psychiatric beds at the acute, sub-acute, and community residential levels (to prevent mental health patients being released prematurely).
• Lower the barriers for the homeless with a mental illness to seek treatment (e.g., shorten the wait time for intakes to accommodate the needs of mental health patients).
• CARE (Community Assistance, Recovery & Empowerment) Court, a new framework that’s still unfolding, has the potential to provide useful tools to help those with severe mental health and substance abuse problems.
• For individuals lacking insight into their illness or unable to access community treatment voluntarily, Laura’s Law should be invoked to compel them to receive treatment detailed in the assisted outpatient treatment (AOT) order.
• Use Lanterman-Petris-Short (LPS) conservatorships for adults with serious mental health illness and gravely disabled (i.e., cannot take care of basic, personal needs for food, clothing, or shelter).

Drug addiction

• Build the infrastructure for addiction treatment inside hospitals to broaden the access to addiction treatment.
• Lower the barriers for homeless drug addicts to seek treatments (e.g., not requiring phone calls to be the first step of enrollment since many homeless have no easy access to phones).
• Increase the number of treatment facilities that accept Medi-Cal, which covers most homeless persons.
• Increase the number of treatment facilities with detox beds and residential care to reduce wait time and achieve “treatment on demand.”
• Make appropriate use of drug courts to incentivize people into receiving and completing addiction treatments.
• Improve accountability by enforcing the law on petty crimes, which are used by some homeless persons to sustain drug use habits.

Jialu Streeter a Research Scholar and the Director of Partnerships at the SIEPR. Her research primarily focuses on the economics of aging, retirement security, and financial security and mental wellbeing of older adults.

Table A.1.: The prevalence of mental illness and substance use among the homeless population.

Note: Substance abuse can include the abuse of drugs and alcohol. The estimates based on Point-in-Time data tend to be lower because (i) the data focus on serious conditions that last long term or permanently and (ii) the point-in-time data sample includes all homeless, sheltered and unsheltered, individuals with and without children

[ 1 ] Chronically homeless is defined as a person who is homeless for at least 1 year or 4+ separate occasions in the last 3 years and has a substance use disorder, serious mental illness, developmental disability, PTSD, cognitive impairments from brain injury, or chronic physical illness or disability (HUD 2009). In California, chronically homeless account for one-third of all homeless.

[ 2 ] The definition of IMDs has been modified many times. Between 1966 and 1988, a facility was deemed an IMD if it was licensed as a psychiatric facility, accredited as a psychiatric facility, or under the jurisdiction of the state's mental health authority. After 1988, a facility would be classified as an IMD if it had more than 16 psychiatric treatment beds.

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Wilson, David B., Ojmarrh Mitchell, and Doris L. MacKenzie. 2006. “ A Systematic Review of Drug Court Effects on Recidivism. ” Journal of Experimental Criminology 2 (4): 459–87.

Yamamoto, Ayae, Jack Needleman, Lillian Gelberg, Gerald Kominski, Steven Shoptaw, and Yusuke Tsugawa. 2019. “ Association between Homelessness and Opioid Overdose and Opioid-Related Hospital Admissions/Emergency Department Visits. ” Social Science & Medicine 242 (December): 112585.

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How California Homelessness Became A Crisis

Greg Rosalsky

For a city as opulent as San Francisco, it's long been jarring to see the extreme poverty of those experiencing homelessness on its streets. If you walk around downtown, tents, makeshift cardboard beds and human excrement can be seen littering the sidewalks. Impoverished people lie on the ground as a blur of highly paid professionals whiz by.

In 2018, a U.N. official visited San Francisco on a world tour examining housing conditions. She was shocked by what she saw. Her official report concluded that the city's treatment of unhoused people "constitutes cruel and inhuman treatment and is a violation of multiple human rights, including rights to life, housing, health, water, and sanitation." The number of homeless San Franciscans has only grown since then to more than 8,000 people, most of whom sleep on the streets, not in shelters.

San Francisco is pretty typical of major American cities these days, especially on the West Coast. Tent cities filled with poverty-stricken people have sprouted up from San Diego to Seattle. As of January 2020, California alone had about 151,000 inhabitants experiencing homelessness.

There are many contributors to the problem. The horrors of childhood trauma and poverty, mental illness and chronic drug abuse surely add to the likelihood that someone lives on the streets. But Nan Roman, president of the National Alliance to End Homelessness, says the primary cause of the crisis is simple: Housing has gotten way too scarce and expensive.

"It's sort of a game of musical chairs"

A few years ago, a team of economists at Zillow found that once cities cross a threshold where the typical resident must spend more than a third of their income on housing, homelessness begins to spike rapidly. When incomes don't keep pace with the cost of rent, a cascade effect ripples through the housing market: High-income folks start renting places that middle-income folks used to rent, middle-income people start renting places that low-income folks used to rent, and low-income folks are left scrambling.

"It's sort of a game of musical chairs," Roman says. "And people who have a strike against them — because they have mental illness or a substance abuse disorder or a disability — are the least likely to get the chair."

[Editor's note: This is an excerpt of Planet Money 's newsletter. You can sign up here ]

Homelessness wasn't always this bad. "In the 1970s, there was an adequate supply of affordable units for every low-income household that needed one — and we really didn't have homelessness," Roman says.

By the 1980s, homelessness emerged as a chronic issue. There were many factors, including the federal government deciding to slash the budget for affordable housing. By then the California state government had significantly cut taxes and gutted social programs , including for state-funded mental institutions, resulting in thousands of people with mental illnesses and other difficulties struggling to make it on their own.

Yet the core reason for the crisis boils down to supply and demand for housing. As regions like the San Francisco Bay Area became magnets for highly paid professionals in the computer-driven economy, they failed to build enough new units to keep up with demand.

A 2016 study by McKinsey Global Institute estimated that California needs 3.5 million new housing units by 2025 to deal with its chronic housing shortage. Yet new housing construction has only slowed since then, despite Gov. Gavin Newsom's campaign promise to lead an effort to produce those 3.5 million units. Even before the pandemic wrought havoc on the construction business, California was constructing only about 100,000 new homes per year, way below the minimum 180,000 per year that analysts say the state desperately needs.

As Conor Dougherty documents in his illuminating new book, Golden Gates , the politics of building new housing in California is a mess. Homeowners fear new high-rises will blight neighborhoods and damage their home values . Existing renters fear development will cause more gentrification and displace them. Zoning and various regulations make it hard to build new housing.

Many advocates say California needs some kind of new rent control program, but the city of San Francisco passed a rent control law back in 1994, which helped keep existing renters from getting displaced — but only exacerbated the deeper problem of rental scarcity. The 1994 law, which expanded rent control to small, multifamily dwellings, convinced a large number of San Francisco landlords to take their rentals off the market by doing things such as selling their units as condos or bulldozing them and building new ones because the law didn't apply to new construction. Research finds that, of those properties that fell under the new rent control law, there was a 15% decline in overall rental supply and a 25% decline of rent-controlled supply in the years that followed.

The result of all this is obscenely high rents and property prices. Combined with stagnating wages for huge swaths of low-income jobs and a lack of political will for spending substantially more on subsidized housing, it's easy to see why a large population of people has been doubling up, living with their parents, moving to the city's increasingly expensive outskirts, and being pushed out onto the streets.

What's different than, say, New York?

Booming cities in other states have arguably done a better job than San Francisco and Los Angeles by at least providing a bandage for the gushing wound. New York City, for example, has a "right to shelter" and a sprawling shelter system that helps people sleep indoors every night. New York City has a rate of homelessness similar to San Francisco and LA, but it has a different character.

As of January 2020, 72% of homeless Californians were unsheltered. Compare that to New York state, where only 5% are unsheltered. The result is a city where homelessness, while still troubling, is also less in-your-face. Warmer weather on the West Coast, which may alter thinking about the cruelty of allowing people to sleep outdoors, could play a role in the difference, but New York has a "right to shelter" because of a 1979 court decision that interpreted the state constitution to give New Yorkers this right.

Instead of building a big system of shelters, California's cities have taken a more lackadaisical approach that the UC San Diego sociologist Neil Gong calls "tolerant containment" — basically shoeing the unhoused to certain neighborhoods of squalor such as San Francisco's Tenderloin or Los Angeles' Skid Row, and then selectively prosecuting them for living on the streets. Gong calls this approach "a Frankenstein's monster created by mating civil libertarianism with austerity."

Along came the pandemic

Tristia Bauman, a senior attorney at the National Homelessness Law Center, says California cities have historically been just as vigorous as other cities in forcibly removing encampments and penalizing people for homelessness. In 2018, however, the 9th Circuit Court of Appeals held that the Eighth Amendment's cruel and unusual punishment clause prohibited cities from penalizing people for sleeping outside when they lack access to indoor shelter or long-term housing. Following that ruling, and in line with CDC guidance advising increased permissiveness during the pandemic, some say West Coast cities, lacking adequate shelters, have increasingly allowed homeless encampments.

Last year, Californians of all political stripes ranked homelessness as the biggest single issue they wanted the state to tackle. With a political groundswell, legal interventions, and the Biden administration providing billions of federal dollars for the cause, California politicians are finally trying to do something big to help people who are unhoused and housing insecure.

Gov. Newsom recently announced a $12 billion plan promising to "provide 65,000 people with housing placements, more than 300,000 people with housing stability and create 46,000 new housing units." The initiative builds on programs implemented during the pandemic that converted hotels and other buildings into housing for the unhoused. San Francisco Mayor London Breed, following up on a city ballot initiative that authorized taxing big companies and using the funds to help the homeless, wants the city to spend more than a billion dollars on the problem over the next two years.

These programs will hopefully go a long way toward addressing the problem. But as long as California fails to address the root cause — a chronic shortage of affordable housing and an ongoing failure to significantly ramp up new construction — the state seems doomed to grapple with obscene levels of homelessness.

Did you enjoy this newsletter segment? Well, it looks even better in your inbox! You can sign up here .

Correction June 11, 2021

A previous version of this article incorrectly stated the 1994 rent control law in San Francisco "resulted in a 25% decline in the supply of rentals in the city." Before 1994, large apartment buildings in the city already had rent control. The 1994 law expanded rent control to small, multifamily buildings. The researchers found that, of those properties that fell under the new rent control law, there was a 15% decline in rental supply and a 25% decline in rent-controlled supply in the years that followed.

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State of homelessness in california fact sheet.

Homelessness Policy Research Institute

This brief summarizes what we know about homelessness in California, who is experiencing homelessness in California, how we got here, and several emerging issues.

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← The 2019 Annual Homeless Assessment Report (AHAR) to Congress Part 1: Point-in-Time Estimates of Homelessness

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Report Identifies Causes and Consequences of Homelessness in California

The Toward a New Understanding: California Statewide Study of People Experiencing Homelessness (CASPEH), released by the University of California San Francisco Benioff Homelessness and Housing Initiative (BHHI), finds unhoused people experience significant barriers to obtaining housing, such as high costs, discrimination, and logistical barriers. Unhoused people in California reported significant sources of trauma in their lives that predated homelessness, including physical and sexual violence, incarceration, substance abuse, and mental health challenges. Most participants said that financial assistance such as monthly subsidies, one large payment, or rental assistance would have prevented the loss of their housing.

CASPEH included data collected between October 2021 and November 2022 from a representative sample of adults experiencing homelessness across California. Data were collected from 3,200 questionnaires and 365 in-depth interviews conducted in English, Spanish, or other languages with a translator. Questions focused on characteristics of people experiencing homelessness, how they became homeless, what happened to them while homeless, and what barriers prevented them from accessing housing. The study was also informed by a lived experience advisory board, local leaders, and partners including government representatives, service providers, and advocacy groups.

Contrary to the myth that homeless people migrate to California, the study found that 90% of people experiencing homelessness in California were most recently housed in-state. The vast majority of those experiencing homelessness were single homeless adults, 48% of whom were over the age of 50. Black and Indigenous people were disproportionately impacted by homelessness. Traumatic experiences were common, with 72% of the participants experiencing physical violence and 24% experiencing sexual violence at some point in their lives. Seventy-nine percent reported a previous incarceration. Substance abuse and mental health conditions were also common, with 1 in 5 reporting a history of an overdose and 1 in 3 reporting a suicide attempt at some point in their lives.

The study revealed different factors contributing to homelessness. Overall, 47% of participants reported economic reasons for leaving their last housing, 32% reported health reasons, and 63% reported social reasons such as conflict with roommates, overcrowding, or not wanting to impose on others. Extremely limited incomes played a significant role—median monthly household income prior to becoming homeless was $960. Thirty-six percent of participants reported seeking any type of support prior to experiencing homelessness, such as advice from family and friends, information about housing resources, or transportation support. The most common type of support sought was from family and friends. Many participants stated they were unaware of government and nonprofit services that could help.

Participants experienced many adverse impacts on their health and wellbeing while homeless. Seventy-eight percent of the participants said they spent most of their time unsheltered during the last six months. Forty-one percent said there was a time they wanted to be sheltered but could not access it. Participants were asked whether several interventions would have prevented their homelessness for at least two years. Seventy percent said a shallow monthly subsidy of $300-$500 would have prevented their homelessness; 82% said one lump-sum payment of $5,000-$10,000 would have kept them housed; and 90% said an ongoing subsidy that capped their housing costs at 30% of their income would have prevented their homelessness.

Based on the CASPEH’s findings, BHHI presents six policy recommendations:

• Increase access to housing affordable to households making less than 30% of the Area Median Income by increasing the amount of affordable housing, expanding rental subsidies, and making it easier to access subsidies;
• Expand targeted homelessness prevention by strengthening eviction protections and providing financial and legal supports at locations where people access other services and upon release from institutions such as jails, prisons, and drug treatment centers;
• Increase behavioral health supports to meet demand by expanding low-barrier treatment for mental health, substance abuse, and harm reduction services. Staff permanent supportive housing and intensive case management services;
• Provide training, job search assistance, and transportation to reduce barriers to employment and increase household incomes;
• Increase services for the unsheltered homeless;
• Center homelessness services around racial equity.

The report is available at https://bit.ly/42WktJs

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Study traces ‘causes and consequences’ of California homelessness — and challenges myths

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Good morning, and welcome to the Essential California newsletter . It’s Wednesday, June 21.

The lives of California’s unhoused population are as complex and nuanced as those of anyone else. That doesn’t sound like a radical statement, but in conversations about homelessness, it can be.

A newly released study from UC San Francisco’s Benioff Homelessness and Housing Initiative aims to explore that truth with a comprehensive account of “the causes and consequences of homelessness in California,” according to its authors.

Researchers surveyed nearly 3,200 people experiencing homelessness across eight counties in the state, using their answers to create representative statewide estimates. They also conducted in-depth interviews with 365 of those participants.

The study found that nearly half (47%) of all unhoused adults in the state are 50 or older, with Black and Native American residents “dramatically overrepresented.” Notably, 41% of that share became homeless for the first time at 50 or older.

For Times columnist Anita Chabria, the report demonstrates that California’s income inequality has reached a point where “if you are older and unable to work, homelessness is a real threat throughout the Golden State.”

“As much as we want to see the average homeless person as a drug tourist dropping into too-progressive cities for the good fentanyl and lax laws ... or someone whose mental illness makes it impossible for them to live unaided, the truth is simpler — and much more devastating,” she wrote this week . “As Californians age, they are being priced out of housing.”

The study breaks down the many factors that people pointed to as contributing to their homelessness. The top reason cited was a loss or reduction of income. Researchers also broke down the primary reasons cited by both leaseholders and non-leaseholders — participants who didn’t have their name on a lease or mortgage before their most recent episode of homelessness. Non-leaseholders were more likely to report social reasons — such as conflicts with other residents or discrimination — while leaseholders pointed to economic reasons. Fleeing domestic violence was one common reason for both groups.

The authors also pointed to a few misconceptions about homelessness, including “myths of homeless migration.”

According to researchers, “90% of participants lost their last housing in California and 75% of participants live in the same county as where they were last housed.”

The research highlights the complex trajectories that lead to homelessness, but also presents compelling evidence of something advocates for the unhoused have long been saying: Poverty is in many cases the original sin. Traumatic experiences can intensify a person’s mental health and substance use — which affect an array of people regardless of their housing status. But add the stress and trauma of living on the edge of financial ruin and a vicious spiral begins to take shape.

The authors also highlighted several solutions in the form of government policy, namely confronting the lack of affordable housing for Californians living in extreme poverty.

“In 2023, California had only 24 units of housing available and affordable for every 100 extremely low-income households,” the study states.

Recommendations include:

• Mitigating the often-sudden housing loss people experience by investing in more rent subsidies and mediation to avoid evictions
• Responding more swiftly when people lose housing to connect them with vital services and lessen their time on the streets
• Increasing access to substance use treatments and harm reduction service outreach

You can explore the full report here .

And now, here’s what’s happening across California:

Note: Some of the sites we link to may limit the number of stories you can access without subscribing.

L.A. STORIES

The pandemic-sparked remote work revolution has had a dramatic effect on downtown L.A.’s once-bustling financial district. “While the neighborhood shows signs of recovery,” my colleague Roger Vincent writes, “few expect it to return to being the bustling hive of suits and ties that it was.” Los Angeles Times

After months of mostly gloomy skies, the sunshine is back in L.A. to mark the start of summer. Today marks the summer solstice, a.k.a. the longest day of the year. If you’re looking to get out and kick off the new season, here are 11 spots across the county for a picnic. Los Angeles Times

POLITICS AND GOVERNMENT

California’s insurance woes are reaching our cars. That’s according to insurance agents who report difficulty securing quotes for clients who they say would have easily been covered last year. San Francisco Chronicle

Florida Gov. Ron DeSantis, fond of lobbing insults at California and its governor, visited Gavin Newsom’s home turf this week. DeSantis was in Sacramento to make his pitch to California Republicans and raise some money for his 2024 presidential election bid. The New York Times

CRIME, COURTS AND POLICING

A man accused of killing two women in Ventura County was convicted of involuntary manslaughter and received the maximum prison sentence for the crimes on Tuesday — and was released from custody the very same day. That’s because a state law gave Shawn Shirck, now 29, an added day of credit for time served as he sat in jail for nearly four years while the case experienced pandemic delays. Los Angeles Times

California Atty. Gen. Rob Bonta announced a new plan to crack down on organized retail crime in the state. His office is partnering with the Justice Department and more than a dozen retailers and online marketplaces to increase information sharing in a bid to strengthen evidence for prosecutions. Los Angeles Times

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HEALTH AND THE ENVIRONMENT

A bloom of toxic algae has sickened or killed more than 1,000 marine mammals along Southern California’s coast this month , including hundreds of sea lions and dozens of dolphins. High concentrations of a neurotoxin produced by the algae have been reported in waters off Ventura and Santa Barbara counties. Los Angeles Times

Construction kicked off Tuesday on a Wyoming wind farm that’s set to be the largest in the U.S. — and to provide a direct line of wind energy to Southern California . The Equality State actually exports the majority of the electricity it produces (wind or otherwise), and its growing supply of wind power is a boon for California and other Western states that have mandated switches to clean energy. Associated Press

CALIFORNIA CULTURE

Some UCs and other elite universities may have name-brand draw, but a new analysis of federal data shows graduates of community colleges and CSU schools sometimes draw considerably larger salaries than their counterparts . The findings, writes Times education reporter Teresa Watanabe, highlight a “growing scrutiny over the value of college degrees — and whether higher education is worth the rising costs.” Los Angeles Times

What would you do if the dog you adopted to provide a better life attacked someone? Writer Michelle Madden chronicles the journey she and her rescue dog Buddy took to find healing and stability after a harrowing experience. Los Angeles Times

Free online games

Get our free daily crossword puzzle, sudoku, word search and arcade games in our new game center at latimes.com/games .

AND FINALLY

Today’s California landmark is from Terry Ogden of Visalia: Ocean Beach in San Diego.

Terry writes:

The scene reminded me of many trips to California beaches from north to south: pier, surfer, fisherman — all in one frame.

What are California’s essential landmarks? Fill out this form to send us your photos of a special spot in California — natural or human-made. Tell us why it’s interesting and what makes it a symbol of life in the Golden State. Please be sure to include only photos taken directly by you. Your submission could be featured in a future edition of the newsletter.

Please let us know what we can do to make this newsletter more useful to you. Send comments to [email protected] .

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Ryan Fonseca writes the Los Angeles Times’ Essential California newsletter. A lifelong SoCal native, he has worked in a diverse mix of newsrooms across L.A. County, including radio, documentary, print and television outlets. Most recently, he was an associate editor for LAist.com and KPCC-FM (89.3) public radio, covering transportation and mobility. He returns to The Times after previously working as an assistant web editor for Times Community News, where he helped manage the websites and social media presence of the Burbank Leader, Glendale News-Press and La Cañada Valley Sun. Fonseca studied journalism at Cal State Northridge, where he now teaches the next generation of journalists to develop their voice and digital skills.

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California Health Care Foundation

The california statewide study of people experiencing homelessness.

The number of people experiencing homelessness is at crisis levels in California, and there is clear public demand for policymakers to address it. Yet there are many conflicting ideas about how to do that. To design effective programs and policies to help people, we need to understand who is experiencing homelessness, how they became homeless, what their experiences are, and what is preventing them from exiting homelessness.

To answer these questions, the UCSF Benioff Homelessness and Housing Initiative conducted the California Statewide Study of People Experiencing Homelessness , the largest study of homelessness since the mid-1990s. Researchers recruited a representative sample of 3,200 people experiencing homelessness who completed a survey, and 365 participated in in-depth interviews.

The study demonstrated that most people become homeless primarily because the cost of housing has become unsustainable.

Researchers drew a direct connection between health and homelessness, noting that unsheltered homelessness is “devastating” to people’s health. Many study participants said that experiencing homelessness worsened their health, including their mental health. Of those who reported substance use, many said they used drugs or alcohol to cope with the circumstances of homelessness.

Key health findings from the study include these:

• 45% report poor or fair health
• 60% have a chronic illness
• About half have symptoms of serious depression and/or anxiety

The report provides policy recommendations, including several related to homelessness prevention, behavioral health, delivery of care outside of traditional health care settings, and health equity.

To guide their work, the researchers convened three advisory boards, one composed of people with lived experience of homelessness, another with leaders from each of the representative regions, and the final with people who work on local, state, and national homelessness programs and policies. The research was conducted between October 2021 and November 2022.

Both CHCF and the Blue Shield of California Foundation provided additional funding for the study.

A related project, Unhoused , a photographic and audio essay, invites you to meet some of the Californians coping with the state’s homelessness crisis and hear from them in their own words. It was produced with CHCF support.

Special Reports

Since publication of the initial study in July 2023, UCSF researchers have combed its data and are periodically rolling out special reports focused on specific populations.

Pregnancy and Homelessness , published July 2024, examines who experiences pregnancy during homelessness, how they lost their housing, their experiences during homelessness, and barriers to regaining housing.

Toward Dignity: Understanding Older Adult Homelessness , published May 2024, reviews who experiences homelessness in late life, how they lost their housing, their experiences during homelessness, and the barriers they face to regaining housing. Watch an accompanying webinar .

Toward Equity: Understanding Black Californians’ Experiences of Homelessness, published February 2024, reviews who experiences homelessness in the Black community, what may have precipitated their homelessness, experiences during their episode of homelessness, and what impacts their return to permanent housing. An accompanying webinar explores the report’s findings.

About the Authors

Margot Kushel, MD, is professor of medicine at UCSF, division chief of the Center for Vulnerable Populations, and director of the Benioff Homelessness and Housing Initiative at Zuckerberg San Francisco General Hospital and Trauma Center. Tiana Moore, PhD, MS, MA, is policy director at the Benioff Homelessness and Housing Initiative.

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UCSF study unpacks root causes of California’s homelessness crisis

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The timing could not have been better.

A massive UC San Francisco study of California’s worst-in-the-nation homelessness crisis was released Tuesday as Gov. Gavin Newsom and legislative leaders were negotiating details of a new state budget, with homelessness spending as one of the knottiest issues.

The study bolsters previous research which concluded that California’s chronic shortage of housing, which imposes crushing costs on low-income families, lies at the heart of the crisis.

About a third of California’s 40 million people live in poverty or near-poverty, United Ways of California recently reported . Sudden illness, an accident, a layoff or an unexpected car repair bill can easily lead to unpaid rent, eviction and a lack of shelter.

Homelessness, the UCSF study found, often leads to – or exacerbates – alcohol or drug dependence, mental health problems and violence, indicating that its victims need more than just roofs over their heads.

“Something goes wrong, and then everything else falls apart,” the study’s lead researcher, Dr. Margot Kushel, the director of the Benioff Homelessness and Housing Initiative at UCSF, told the New York Times. “Everything in their life gets worse when they lose their housing: their health, their mental health, their substance use.

“This is a problem of this toxic combination of deep poverty and high housing costs,” Kushel added. “We’re a state, like every state in this country, that has a lot of very poor people, and we just don’t have the housing for them.”

The study recommends a wide array of services and projects to help those experiencing chronic homelessness to get off the streets and protect others from the same fate.

It would seem to bolster the demands of city and county officials not only for additional billions of dollars to help homeless Californians escape their plight, but for a multi-year state commitment to provide continuity.

While Newsom has been willing to provide local governments with some funds, he’s been highly critical of their homelessness efforts and so far unwilling to make long-term commitments.

That conflict was evident when the state seemingly had oodles of money, and has become even sharper now that Newsom and legislators must contend with deficits that could continue for the remainder of Newsom’s governorship .

Interestingly, the Benioff study was requested by Dr. Mark Ghaly, Newsom’s secretary of health and human services, who said, in a statement, “this study reinforces the importance of comprehensive and integrated supports,” which is what local officials advocate in their demands for additional state aid.

The state plays only a tangential role in providing housing and social, medical, addiction and mental health services to those in squalid encampments that have become unwanted California symbols and fodder for political and media critics .

City governments are the main overseers of housing construction and joust with the state incessantly over zoning, building permits and other hurdles for projects to house low-income families and individuals – the ones most in peril of becoming homeless.

Meanwhile, county officials provide welfare, medical and mental health services with local, state and federal funds and often squabble with their city counterparts over how those programs are sited and administered in urban centers.

The Benioff study tells us that contrary to popular belief, those lacking shelter are overwhelmingly Californians, not migrants from other states, who largely remained in their communities after falling on hard times.

California’s crisis will not be resolved without the “comprehensive and integrated” approach Ghaly advocates and that means state, county and municipal officialdom must set aside fingerpointing and blame-shifting to work cooperatively. Otherwise, we’ll just waste billions of more dollars and the crisis will continue to worsen.

Dan Walters Opinion Columnist

Dan Walters is one of most decorated and widely syndicated columnists in California history, authoring a column four times a week that offers his view and analysis of the state’s political, economic,... More by Dan Walters

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Homelessness and Mental Health Interventions in California

When homelessness emerged in American cities during the eighties at rates similar to those seen in the Great Depression, people were shocked, and nowadays this issue is far from obsolete (Gowan 44). The relationship between mental health issues and homelessness has always been at the forefront of the concern over housing insecurity and societal perceptions of the homeless that dictate the policy that governs them. Studies have shown that about half of homeless people have traumatic brain injuries — far above the amount recorded for the general population. This, combined with the emotional trauma associated with living on the streets, is conducive to significant mental health problems that can be observed in the homeless population (Padgett). Especially in California, homelessness has become a crisis. There are about 113,000 people in California at any time who are homeless, of which 25% are considered chronically homeless (Vogel). About 70% of the homeless in California live outside a shelter compared to 5% in New York. In addition, about 25% of the homeless adults studied in Los Angeles County suffer from a severe mental illness, suggesting a strong correlation between homelessness and mental illness. 

As housing prices increase and homelessness becomes more prevalent in California, addressing the mental health ailments of this population becomes increasingly important in improving their quality of life and addressing the issue of homelessness as a whole. While most welfare efforts are targeted at keeping people off of the streets, there are not enough efforts focused on eliminating the root of the problem (Streeter et. al). This study focuses on the concerns that are associated with the access of mental health resources for the homeless, the existing social welfare programs that are targeted towards mental health in the homeless population, the issues with these programs, and what can be done to solve these discrepancies. By volunteering with a program aimed at helping the homeless, I got a better understanding of the field to help evaluate what should be done to address the epidemic of mental illness in the Californian homeless population. I observed both the triumphs and shortcomings of the shelter and ultimately realized that despite its helpful philanthropic efforts, facilities like the Day House cannot be a long-term solution to the homelessness crisis in California.

To learn about resources available to the unhoused, I volunteered at the Dorothy Day House, a homeless shelter in Berkeley, California, that hosts about 30-50 residents and provides hundreds of meals every day to food-insecure people living at other shelters or on the street. While working at this facility, I was able to experience the attitudes that fellow volunteers had towards the homeless who came there for their meals and generally understand the systems that are in place to assist the unhoused who may or may not suffer from mental illness. I was also able to observe the effects of mental illness on some of the people whom the shelter served. Overall, this experience provided deep insight — in the forms of conversations with shelter volunteers and residents as well as observation of the operations in the establishment — into the inner workings of organizations and welfare programs targeted at helping the homeless.

When I initially arrived at the shelter, it was a Saturday for the dinner shift. My job was to help prep meals as a kitchen assistant. The volunteer coordinator, Eve, was an elderly lady who was warm and kind to all the volunteers, and any time a shelter resident asked her for peanut butter, or a splash of milk, she joyfully obliged. She explained to me that she has been volunteering at the shelter for months, and that she loves it: the shelter residents are amazing, and she enjoys her work. She mentioned that some of them are experiencing tough situations and are a bit harsh on the volunteers, but for the most part they are very grateful to the staff. Understanding that she was knowledgeable on homelessness issues, I asked her what resources are available to the residents who seek mental health aid. She told me that she was not completely sure how accessible it was, but that she knew that a licensed therapist would come in and do volunteer work with some of the residents every once in a while. While I was happy to hear that professional volunteers were benefiting the residents, studies have shown that public psychotherapists are burdened with a high case load which affects the quality of care (Padgett). Further, the long-term benefits of this work cannot be seen without repeated care and access to housing, which can be difficult when people move in and out of the shelter (Caton 72-87). I wondered how effective this method of volunteer-driven mental health care was in addressing the needs that shelter residents had in accessing reliable mental health care.

In order to better understand this issue from a professional’s perspective, I spoke to clinical social worker and psychotherapist Kristen Clayton who has experience working with homeless clients in emergency care departments and in other facilities. She was able to provide deep insight into the reasoning behind the homelessness crisis and the issues that exist with programs that are targeted towards improving homeless mental health. I asked her what programs she has encountered that are available to the homeless who wanted to seek out mental health care.

“So there are […] family health centers and different subsidized clinics that are meant to provide that mental health treatment to anybody that wants to access it. The problem is that they are very impacted, and you know mental health treatment is voluntary unless you are a danger to self, others or incredibly disabled, but even then, you know it is incredibly difficult to force out-patient treatment. You can force inpatient treatment, but we expect people to follow up.” (Clayton)

She explains that when choosing between factors of immediate survival like food and water, or visiting a mental health clinic, the latter would fall to the lower priority. Since there are rarely checkups from the facilities themselves to the homeless, it is difficult for them to consistently maintain their mental health care. Outreach alone has proven to have limited success in solving long-term mental health issues with the homeless, unless combined with a housing solution (Caton 1-20). Having reliable follow-up care is essential to the longevity of the benefits of mental health treatment and ultimately to the goal of keeping housing-insecure people housed. 

There are a few models of mental health case management that have been used to improve the long-term efficacy of social welfare programs targeted at the mentally ill homeless. One of these is the standard or “broker” case management technique. It has the overall goal of connecting patients with the resources they need and coordinating its implementation. Broker-style case managers typically have a case load of about 35 clients, and their services are time-limited. The results of this case management technique included better housing stability compared to standard community treatment. 

Another method is intensive case management, which involves a more comprehensive approach where the case manager, who must have a clinical degree, collaborates with the patient’s physicians, educates their family on their mental ailment, implements crisis intervention if needed, and monitors their progress. Case managers usually have about 15 clients and are less constricted by time. When combined with housing solutions, the results of this method were better overall life satisfaction. 

Finally, there is assertive community treatment, which is the best for patients with severe mental illness, and when studied has the highest overall efficacy. As the most service-enriched treatment mechanism, it combines a team of professionals, including a psychiatrist, a nurse, one or more case managers, and sometimes a social worker, forensic specialist, or housing specialist. The team shares 10-15 clients, and the results show that this method produced the highest overall life satisfaction, lower psychiatric symptomatology, and lower rates of homelessness. When studied, the most effective strategy in increasing housing stability resulted from an intervention that began with housing and support and ended with assertive community treatment. In addition, the net cost of implementing assertive community treatment was found to be lower because of the higher success rates and thus lower need for expensive inpatient mental care (Caton 72-87). Even with this proven, highly effective solution available, the public must support funding homeless interventions in order for policymakers to enact it. 

In my experience in the field, I found that volunteers and staff treated the homeless with compassion and hospitality. The homeless who came to the shelter for food or accommodation were generally kind and grateful, happy to accept help. However, one experience I had while volunteering was a bit off-putting. At the end of my breakfast shift, a homeless guest who was visiting the shelter to receive a meal began asking me questions about where I was from. I answered a few casually, and he continued to ask more questions about my ethnicity and then invasive questions I was unwilling to answer. I excused myself and told him my shift had ended, and it was time for me to leave. He seemed upset and raised his voice at another volunteer who had agreed that I needed to go home. I quickly exited and walked about a block down the road before noticing that he was following me on his bicycle while yelling absurd statements that clearly reflected his mental instability. This experience led me to wonder how a homeless person like this could receive suitable mental health care. He would most likely not take the initiative to follow up with a mental health professional, and he may even be labeled as hostile or uncooperative and be turned away from care. How can medical professionals address a case like his, and how can policymakers create programs for a group of people like him? I feared that the general population would see someone like him in public, and it would fuel the anti-homeless sentiment that has developed since the advent of modern-day homelessness in the 1980s (Gowan 44). It may even result in support for increased policing of the homeless rather than implementing affordable mental health care programs (Gowan 54). Without considering the societal and systemic factors that led him to act in this manner, it is difficult for people to address his situation with empathy. 

Societal perceptions of the homeless are of great importance when it comes to allocating funding for social services and programs aimed at helping this population (Reutter). One of the regular volunteers at the shelter told me that we needed to be very patient and thoughtful with the people we serve. He explained that we were the only people in their lives who abide by their requests and that anyone else they encounter will treat them with disrespect and as if they are unwelcome. From my observations in the field, I found that compassionate treatment of the homeless resulted in a friendly environment that was conducive to their prosperous mental health and development of a better quality of life. This is how all programs regarding the homeless should be treated. The homeless are simply victims of a flaw in our society that marginalizes them and considers them insignificant. When given the opportunity to get back on their feet, they can, and there are programs that have been proven to be very effective in doing this. 

The focus on incarceration in homelessness intervention programs is not only ineffective in addressing the issue of housing insecurity and intrinsically fostering systemic violence, but it is also economically inadvisable. In 2015, it was reported that about half of the $100 million budget in Los Angeles County allocated towards homelessness was used for policing. In fact, often police officers were inappropriately sent to calls requiring mental health professionals (Holland). Also, in 2017-2018, California cities spent more than three times as much on policing than on housing and community initiatives (Graves and Hoene). In a model solution, Eugene, Oregon began its CAHOOTS (Crisis Assistance Helping Out on the Streets) project in 1989 which was pioneering in crisis intervention without law enforcement. This program partners a medic and a crisis worker to respond to non-emergency 911 calls. The results were stark as the city had a $2 million budget and saved $14 million in ambulance costs and an estimated $8.5 million in public health. Also, the need for law enforcement lessened. Other cities like Denver and Olympia have also tried similar programs and noticed benefits (Dholakia and Gilbert). 

While an affable environment, the Dorothy Day House cannot be a long-term solution to homelessness. The residents are burdened by an increasing cost of living, while their mental health barriers only worsen. With homelessness levels at an all-time high in California, having increased by 7% between 2019 and 2022, the issue of housing insecurity clearly stems from flaws in a system that does not prioritize the health and security of marginalized peoples (Tobias). As an authority over institutions that foster systemic violence against impoverished people, it is the responsibility of the government to address this injustice. Mental health issues are extremely prevalent among the unhoused and perpetuate the problems that they face. Thus, policymakers and medical professionals must work together to develop solutions to make reliable, high-quality mental health care services accessible to the homeless. The ability to do this relies on high structural competency (Padgett) and approval from the public which is made difficult by the social exclusion of the homeless (Pattison and McCarthy). Using data that shows what interventions are most effective and economically feasible, the problem of homelessness and mental health can be addressed.

Sakeena Baxamusa’s “Homelessness and Mental Health Interventions in California” shows how combining direct, individual ethnographic study with deep and careful research can produce a powerful intervention. The essay was written for Prof. Seth Holmes’s Fall 2022 Art of Writing class, “Inequality and the Body: Health, Medicine, Society and Environment.”

Fall 2022 Award Winner

Works Cited

Caton, Carol L. M. The Open Door: Homelessness and Severe Mental Illness in the Era of Community Treatment . New York, NY: Oxford University Press, 2017. 

Clayton, Kristen. Personal Interview. 

Dholakia, Nazish, and Daniela Gilbert. “What Happens When We Send Mental Health Providers Instead of Police.” Vera Institute of Justice , 2021,  https://www.vera.org/news/what-happens-when-we-send-mental-health-providers-instead-of-police . 

Gowan, Teresa. Hobos, Hustlers, and Backsliders Homeless in San Francisco . Minneapolis: University of Minnesota Press, 2010. Print. 

Graves, Scott, and Chris Hoene. “California Spending on Law Enforcement, the Legal System & Incarceration.” California Budget and Policy Center , 18 Jan. 2022, 

https://calbudgetcenter.org/resources/california-spending-on-law-enforcement-the-legal-system-incarceration/ . 

Holland, Gale. “L.A. Spends $100 Million a Year on Homelessness, City Report Finds.” Los Angeles Times , Los Angeles Times, 17 Apr. 2015,  https://www.latimes.com/local/lanow/la-me-ln-homeless-cao-report-20150416-story.html

Padgett, Deborah K. “Homelessness, housing instability and mental health: making the connections.” BJPsych bulletin vol. 44,5 (2020): 197-201. doi:10.1192/bjb.2020.49 Pattison, Ben, and Lindsey McCarthy. “The Role of Mental Health in Multiple Exclusion

Homelessness.” Social Policy and Society, vol. 21, no. 3, 2022, pp. 405–421., doi:10.1017/S147474642000069X. 

Reutter, L. et al. “Public perceptions of the relationship between poverty and health.” Canadian journal of public health = Revue canadienne de sante publique vol. 90,1 (1999): 13-8. doi:10.1007/BF03404091 

Streeter, Jialu. “Homelessness in California: Causes and Policy Considerations.” Stanford Institute for Economic Policy Research (SIEPR) , May 2022, 

https://siepr.stanford.edu/publications/policy-brief/homelessness-california-causes-and-policy-considerations . 

Vogel, Nancy. Housing the Mentally Ill and Chronically Homeless : an Effective Solution, but Counties Need Greater Flexibility . Sacramento, CA: Senate Publications & Flags, 2011.

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California’s Homelessness Is a Failure of Will

Removing the state’s encampments won’t fix the problem.

By Matthew Desmond

Produced by Jillian Weinberger

Gov. Gavin Newsom of California has ordered state officials to remove homeless encampments and makeshift shelters, affecting thousands of unhoused people. In this audio essay, the sociologist Matthew Desmond calls out Californians who, “despite their self-declared progressivism, have been unwilling to do what was necessary to address the housing crisis.”

Below is a lightly edited transcript of the audio piece. To listen to this piece, click the play button below.

California Progressives Are Making Homelessness Worse

Matthew Desmond: I’m Matthew Desmond, a writer and sociologist focused on poverty and homelessness in America.

Audio clip of news segment: Now in: Drastic action by Gov. Gavin Newsom. He signs an executive order allowing cities to remove homeless encampments.

Clip of news segment: The order will direct state agencies on how to remove the thousands of tents and makeshift shelters that line freeways.

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Five Recent Trends in Homelessness in California

Published On October 3, 2023

The number of people experiencing homelessness in California has grown steadily in recent years. On a given night in 2022, more than 171,000 people across the state slept in shelters, vehicles, tents, and other places not meant for habitation (Figure 1). Five Recent Trends in Homelessness in California , the first research brief in a new collaborative series, takes a closer look at homelessness across the state in recent years, highlighting key trends:

• The scale of California’s homelessness crisis is larger than any other state and worsened during the Covid-19 pandemic.
• Stark racial and ethnic disparities in California’s homelessness rates have continued to grow.
• Unsheltered homelessness remains more common in California than any other state, and unsheltered chronic homelessness has grown more rapidly than homelessness overall.
• Some of the largest increases in recent years have been in places that did not previously have high levels of homelessness, including suburban and rural areas of the state.
• The range and scale of efforts to address homelessness have grown over time, including large expansions in shelter and housing capacity.

Source: Point-in-Time Counts of homelessness from the U.S. Department of Housing and Urban Development * 2021 counts were disrupted by the COVID-19 pandemic

These patterns underscore the need for sustained resources to address homelessness, equitable service provision, and expansions of deeply affordable housing. To understand efforts to meet these needs, the Terner Center, Abt Associates , and UCSF’s Benioff Homelessness and Housing Initiative (BHHI) collaborated on a statewide assessment, presented in a new series of research briefs. In the coming months, our teams will publish findings from interviews with hundreds of people with lived experience of homelessness, local government administrators and staff, nonprofit service providers, and other stakeholders from local homelessness and housing organizations throughout California. We also analyzed quantitative data from local homelessness service, shelter, and housing programs.

The briefs in this series will point to where progress has been made and where gaps remain. The briefs will also lift up innovations in policy and practice, and recommend additional ways to make homelessness rare, brief, and non-recurring for all people in California.

Click here read the full brief, Five Recent Trends in Homelessness in California.

Click here to see the landing page for the full research series.

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How California’s Homeless Problem Became Intractable

California governor Gavin Newsom sharply criticized a judge’s recent injunction that prevents San Francisco from clearing homeless encampments within the city, calling the injunction “preposterous” and “inhumane.”

California governor Gavin Newsom sharply criticized a judge’s recent injunction that prevents San Francisco from clearing homeless encampments within the city, calling the injunction “preposterous” and “inhumane.” San Francisco’s efforts to clear these encampments is a significant change from the city’s long-standing policy of permitting the homeless to live on city streets, which has overwhelmed some city neighborhoods with 24/7 drug trade and public health dangers that some consider to be much worse than in the slums of developing countries .

There are now over 172,000 homeless individuals in California , reflecting California’s flawed, long-standing approach to homelessness, one that has burned through billions of dollars, exacerbated crime, damaged cities, and facilitated substance abuse. Newsom, and those within the state’s Democratic party who share his views, are far too late in accepting that the state’s approach to homelessness has failed.  

The problem of homelessness has become intractable under status quo policies. California has spent $20 billion on homelessness in the last five years , and during this period the number of unhoused persons has increased by nearly 40,000. It is tempting to conclude from these statistics that the more California spends, the worse homelessness becomes. There is more than a hint of truth to this.

An important reason why state and local government homeless policies have failed is because they have been based the “Housing First” approach, which provides permanent housing for homeless individuals without requiring them to be treated for substance abuse or mental health issues. Beginning in 2016, California law has required that all state and local homeless policies follow Housing First principles. However, since Housing First became law, chronic homelessness in California has increased, rising from 32,000 in 2016 to about 61,000 this year. Before the new law took effect, chronic homelessness fell from 65,000 in 2005 to 32,000 in 2015.

The idea behind Housing First was that providing homeless individuals with permanent housing would lead them to get their lives together, based on the assumption that substance abuse and emotional health challenges were a consequence of homelessness, not a cause. However, a study by the US Department of Health and Human Services found that Housing First policies had no effect on helping the unhoused deal with substance abuse or mental health issues. This fact is inconsistent with the common narrative among Housing First supporters that providing permanent housing will be transformative for the homeless dealing with substance abuse or mental health problems . The evidence that Housing First policies do not work as intended is critically important, because 63 percent of unhoused Californians have substance abuse, mental health issues, or both.

Housing First policies also drive up costs enormously, because building permanent housing for the homeless population has become inordinately expensive. Building a single unit of housing—some of which are either studio or one-bedroom apartments—in San Francisco costs up to $1.2 million . This amount can purchase nearly four median-priced single-family homes in the rest of the country. San Francisco has advised the state that it will build 33,000 units of housing for homeless and low-income households over the next eight years, which pencils out to nearly $40 billion at current costs.

I don’t know of anyone who can account for why building costs are so high. Some of it is due to large permitting delays and reviews. Some is due to the large number of lenders that are typically involved in such projects, which means more attorneys, accountants, auditors, and administrative staff. Some is due to prevailing wage requirements, which drive up labor costs significantly. But I doubt that those factors together add up to $1.2 million per apartment unit.

An audit of “affordable” housing construction costs is in order. More broadly, an audit of spending on California homelessness is in order. Historically, the political leadership within the state has been unwilling to perform such an audit , despite calls for an audit from Republican lawmakers since at least 2020. Republicans were able to put together bipartisan support for an audit earlier this year , with Democratic senator David Cortese and assemblyman Evan Low joining Republican senators Roger Niello and Rosilicie Ochoa Bogh and assemblyman Josh Hoover in requesting the audit. Senator Niello remarked : “Homelessness is the most urgent issue facing California. Given the crisis has only worsened, we need to know what the money has accomplished and what programs have been effective in moving people to permanent housing.”

The homelessness spending audit will inform policymakers about where spending is working and where it isn’t. But even if California reformed its homelessness policies to tie providing shelter with substance abuse and mental health treatment and if it reduced building costs substantially, homelessness would remain a problem for the state. This is because far too many Californians cannot realistically afford to live in the state, given that California’s political leadership has implemented a mare’s nest of policies—tax, regulatory, energy, and housing—that have substantially raised the cost of living.

The median California home price is about $832,000, and the median condominium price is about $645,000. California gasoline costs are the highest in the country. Electricity costs are the nation’s third highest. Rents are the third highest.

About 13 million Californians live in or near poverty, defined as a household income for a family of three of only about $41,000 per year. If these people were a state, they would be the fifth largest state in the country, smaller than New York but larger than Pennsylvania. And many of these individuals and families are just one piece of bad luck—job loss, car repair, health expenditure ­—from becoming homeless.  

California’s Democratic Party lawmakers have chosen to make living in California extremely expensive. Now, they must confront the overwhelming problem of dealing not only with the state’s current homeless population of 172,000 but also the many more thousands who will become homeless in the future because of their policies. California’s status quo policies have given rise to what has become a perpetual problem. And those who created those policies show no willingness to change.

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Officials clear homeless encampment at California state beach

California homeless encampments.

LOS ANGELES (AP) — Officials cleared a homeless encampment at a California state beach Thursday, a month after Gov. Gavin Newsom directed cities and state agencies to take urgent action against people sleeping in public spaces.

Bright yellow trash trucks rolled onto the sands of Dockweiler State Beach, located behind the Los Angeles International Airport, accompanied by county workers and local law enforcement for the cleanup operation.

The operation was organized by LA City Councilmember Traci Park along with the Los Angeles Homeless Services Authority. The beach is part of California’s state park system, but the county provides its maintenance and lifeguard services while the city handles policing.

Park's office did not immediately respond to requests for comment Thursday.

Earlier this summer, Gov. Newsom issued an executive order for state agencies to start removing homeless encampments on public land in his boldest action yet following a Supreme Court ruling allowing cities to enforce bans on people sleeping outside. He urged cities and counties to do the same, but they are not legally mandated to do so.

In August, he threatened to take away state funding from cities and counties that are not doing enough to clear encampments as he appeared to work alongside California Department of Transportation workers to throw away trash.

Under Newsom’s leadership, the state has spent roughly $24 billion to clean up streets and house people, including at least $3.2 billion in grants given to Los Angeles county and city to build shelters, clear encampments and connect homeless people to services, Newsom said.

Los Angeles Mayor Karen Bass and LA County officials have pushed back against the governor's approach, saying that criminalizing homelessness or simply clearing encampments without offering services or shelter does not work. While more than 75,000 people were homeless on any given night across Los Angeles County, according to a tally at the start of the year, there are only about 23,000 emergency shelter beds in the county.

James Kingston, 63, was forced out of the encampment Thursday. He said he lived at the beach because of how many cans and bottles he can collect on the weekends for money.

Like many others, he was unfazed by the clean up crew, since he's experienced this several times while being homeless over the past six years. Some people left as soon as police showed up, while others watched as officials cordoned off their tents. Shortly before the cleanup, they had received a notice that it would be happening.

“You just grab your important stuff and everything else has got to go,” Kingston said. “You just got to let it go because that's how it is.”

This story has been updated to correct that Newsom was working alongside California Department of Transportation workers. The story should have also made clear that $3.2 billion in grants to build shelters, clear encampments and connect homeless people to services have been given to the county and city of Los Angeles.