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What a landmark new study on homelessness tells us

How homeless people in California lost their homes, and how they cope.

A young woman sits outside a makeshift tent created out of a blue plastic tarp and cardboard boxes, among other homeless people camped near an overpass in San Diego, on March 24, 2023.
About 30 percent of the US’s homeless population lives in California. A recent large study describes their lives.
Melina Mara/The Washington Post via Getty Images
Rachel M. Cohen is a senior reporter for Vox covering social policy. She focuses on housing, schools, homelessness, child care, and abortion rights, and has been reporting on these issues for more than a decade.

While unsheltered homelessness in the US has grown conspicuously worse over the last decade, understanding the experiences of those living without housing remains logistically difficult. So much of what researchers know about the daily lives of the non-homeless population is through household research, like the Census Household Pulse or the American Community Survey. A lack of clear data on those without housing makes it harder to understand how they lost their shelter, how they survive — or don’t survive — and easier for half-baked theories and myths to spread about homeless individuals themselves.

That’s what makes an ambitious new study out of California — where 30 percent of the nation’s homeless population lives — so significant. Led by the Benioff Homelessness and Housing Initiative (BHHI) at the University of California San Francisco, researchers sought to reflect the experiences of all people ages 18 and older experiencing homelessness in the state.

Their final report, the California Statewide Study of People Experiencing Homelessness, or CASPEH, includes nearly 3,200 administered questionnaires and 365 in-depth interviews collected between October 2021 and November 2022, including from urban, rural, and suburban areas.

“It’s incredibly difficult to do representative studies of people experiencing homelessness, so the fact that this study was able to obtain a large and representative sample of adults experiencing homelessness in California is impressive,” Elizabeth Bowen, an associate professor at the University of Buffalo who studies unhoused people, told Vox. The last large representative study of homelessness in the US was conducted nearly 30 years ago.

The CASPEH research provides firmer evidence for some things long associated with homeless individuals — namely, that lacking housing serves as a meaningful barrier to health care and income benefits, and is a key driver of discrimination in one’s daily life.

A quarter of participants reported an inability to access prescription medications for physical health conditions, and almost half reported their overall health as poor or fair. Nearly two-thirds had at least one chronic health condition.

The study also provided clarity on other experiences for those living without housing. Almost half reported symptoms of depression or anxiety, and 12 percent reported experiencing hallucinations. Participants cited frequent interactions with the police, with one-third of respondents spending at least one night in jail during their current episode of homelessness. Over a third reported losing belongings to confiscations in the prior six months, including important personal documents and medication.

One of the most staggering findings, even to experts on homelessness, was just how little notice most people said they had before they lost their housing, and precisely how low their incomes were at that point. In the six months prior to their homelessness, the median monthly household income of respondents was just $960. Leaseholders — meaning those who had a rental lease or a mortgage — reported a median of just 10 days notice that they were going to lose their housing. Non-leaseholders — referring to those living with family or friends — reported a median notice of just one day.

Most CASPEH respondents said they believed a monthly rental subsidy of $300 to $500 would have prevented their homelessness for a sustained period, or a one-time payment of $5,000 to $10,000. Nine in 10 respondents believed a housing voucher would also have staved off their slide into homelessness.

“I was really surprised by how little people thought it would have taken to prevent their homelessness,” Margot Kushel, the principal investigator of the study, told Vox. “Do we know if people are overly optimistic? Sure, they might be. But I sort of believe people are experts in their own lives and people really felt that, had they interrupted that cycle, they could have hung on, but once they became homeless everything else fell apart. Once they lost their housing, then their job opportunities declined and they got to a hole they couldn’t pull out of.”

What researchers learned about the demographics of homelessness in California

CASPEH interviewed people between the ages of 18 and 89, with a median age of 47. Researchers found an aging homeless population in California: 44 percent of those surveyed were 50 and older, which is consistent with separate state data that found between 2017 and 2021, the number of people 55 and older who sought homelessness services increased significantly — more than any other age group.

Compared to the overall California population, researchers found non-white groups overrepresented among the homeless, with 26 percent of participants identifying as Black and 12 percent identifying as Native American or Indigenous. Thirty-five percent identified Latino/x as their sole racial identity or one of their racial identities.

The vast majority of those homeless in California (nine out of 10) had been living in the state before losing their homes — bucking the idea that maybe people are flocking to the sunny West Coast to live outside in the nicer weather. Seventy-five percent of those homeless adults, in fact, live in the same California county as their last stint in housing.

Many of those experiencing homelessness had been homeless before. Only 39 percent said this was their first episode, and the median length of all respondents’ current bout of homelessness was 22 months. More than a third met the federal criteria for being chronically homeless.

In terms of gender and sexuality, most respondents (69 percent) identified as cisgender men, and 30 percent identified as cisgender women. One percent identified as nonbinary, transgender, or gender nonconforming, though that rate was higher (6 percent) for participants ages 18-24.

Researchers also learned that prior experiences of violence and substance use were common among the homeless: Nearly three-quarters reported past experiences of physical violence, and 24 percent said they had experienced sexual violence. Sixty-five percent reported having had a period in their life in which they regularly used illicit drugs, and 62 percent reported having had a period in their life with heavy drinking.

What it’s like to be homeless in California today

Among those experiencing homelessness, 78 percent said they spent the majority of the previous six months unsheltered — meaning living on the streets, in cars, in abandoned buildings, or anywhere not meant for humans to live. Ninety percent said they had spent at least one night in the past six months unsheltered. Forty-one percent said there had been a time when they wanted a homeless shelter but couldn’t access it.

One of the more astounding findings was how many women of reproductive age — 26 percent — reported experiencing pregnancy during their current bout of homelessness, including 8 percent at the time they were interviewed. “I have to admit to you that when those numbers came in I was so shocked,” Kushel told Vox.

To cope with homelessness, many respondents used drugs, and particularly methamphetamine (31 percent). While 6 percent of participants reported receiving any current drug or alcohol treatment, 20 percent said they wanted treatment but were unable to receive it.

“People talked to us really plainly about how they couldn’t possibly stop using drugs until they were housed,” Kushel said. “Many were using drugs to stay awake, because they were scared of violence if they fell asleep, or their stuff being taken away again. And if you can’t fall asleep and you’re hungry, then yeah, meth can help you.”

Few people experiencing homelessness were working, though many were looking for work. Just 18 percent reported income from jobs, and 70 percent reported it had been at least two years since they had worked 20 hours or more weekly. Nearly all participants expressed interest in obtaining formal housing, though fewer than half had received any formal assistance to do so. Just 26 percent received assistance monthly or more frequently in the six months before they were interviewed.

What BHHI researchers recommend as a policy response

While the research was requested by Democratic Gov. Gavin Newsom’s secretary of health and human services, the study was not funded by the state, giving BHHI, as Kushel put it, “the autonomy to say what we wanted.”

Based on their findings, the researchers say California should increase access to housing for those with extremely low incomes by boosting production, expanding rental subsidies, bolstering housing navigation services, and enforcing anti-discrimination laws.

Researchers also encourage more federal and state investment, not only in assistance to those experiencing homelessness, but also in homelessness prevention — such as financial and legal aid targeting social service agencies, domestic violence clinics, community organizations, and health care settings, where vulnerable people are most likely to go. Given how little notice people report having before they lost their housing, finding ways to provide aid faster should be a priority.

To support those dealing with mental health and substance use issues, the researchers recommend expanding low-barrier treatment options for those experiencing homelessness, and for those who transition into permanent supportive housing.

Dr. Mark Ghaly, the secretary of California’s Health and Human Services Agency, said in a statement that “this study reinforces the importance of comprehensive and integrated supports,” though as CalMatters reported, Newsom has criticized local governments’ efforts to address homelessness as lacking urgency, and has yet to make long-term funding commitments to them.

Kushel told Vox that ultimately, there needs to be more housing in California to address the acute statewide shortage and bring down the high prices. But even if California does build more housing generally, Kushel says that, to address the state’s homelessness crisis, there needs to be more subsidized housing specifically provided for people with extremely low incomes. “I do not believe the market is going to solve for this given how incredibly poor everyone was,” she said.

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