Is homelessness a mental health and addiction crisis, or is it driven by an affordable housing crisis? That question underpins the debate among policymakers and politicians struggling to move people off the streets faster than they become homeless. 

Researchers say housing is the most important intervention to end homelessness, and now a report from the University of California-San Francisco sheds deeper insight: While California’s high housing costs and low incomes drive people into homelessness, those with behavioral health conditions face added risk of becoming homeless. And once people lose housing, homelessness makes them more likely to use drugs or experience a mental health problem. 

The report found that nearly half of homeless adults in California have a serious mental health condition or use drugs or alcohol, and 42% of people who regularly use drugs began doing so after becoming homeless. 

“Complex behavioral health needs, including substance and mental health problems, increase the risk of becoming homeless, and homelessness exacerbates these problems,” said Margot Kushel, director of the Benioff Homelessness and Housing Initiative at UCSF. 

Kushel and others argue that housing and supportive services are critical. Instead, President Donald Trump is pushing a treatment-first approach. 

During his campaign, Trump called for relocating homeless people to large camps and forcing treatment, a punitive approach that he says will come with jail time if people refuse. 

Now in office, Trump has launched a broad assault on “Housing First.” 

The nationwide anti-homelessness policy, aimed at getting people into permanent housing, was created under President George W. Bush and for decades has steered federal funding into housing and social service programs. 

Already, city and county officials are being told that the federal Department of Housing and Urban Development “will not enforce” homelessness contracts if they follow the Housing First model. And as Trump officials seek major funding cuts, the president this month issued an order shrinking the U.S. Interagency Council on Homelessness, which was established under President Ronald Reagan to coordinate homelessness initiatives around the nation. 

The focus has been on offering housing and voluntary treatment, even if those promises elude too many people. Now, those programs will be eroded. 

Democratic U.S. Rep. Maxine Waters of Los Angeles warns: “Make no mistake that Trump’s reckless attacks across the federal government will supercharge the housing and homelessness crisis in communities across the country.” 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.USE OUR CONTENTThis story can be republished for free (details).

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