Health care is essential to ending homelessness

April 1, 2022

Originally published in CalMatters – April 1, 2022


During a recent effort to clear a homeless encampment, outreach workers convinced Shalise Garcia to move into a motel near LAX. It was far from the community she knew in West Los Angeles, but at least she and her partner would be out of the elements.

Before the transfer, no one asked Garcia or her partner about their health care needs. No one made sure they knew how to get in touch with their clinician at Venice Family Clinic who prescribed the medication that helped them manage their opioid addiction.

By the time Garcia reached our clinician by phone, she and her partner had run out of their medication. We ordered a rideshare service to bring them to the clinic, where the couple got the medication they needed. They retained their sobriety and housing.

But the delay was worrisome and unnecessary. If Garcia and her partner had fallen back into addiction, they likely would have wound up back on the streets. Their story illustrates how important it is that health care be an integral part of any plan to house people experiencing homelessness.

With California voters placing homelessness as one of the main issues facing the state, creating new housing is at the top of practically every candidate’s agenda, as it should be. Homelessness is an emergency, and we must treat it as such.

But health care – and that includes substance use treatment and mental health services – cannot be an afterthought if we expect our housing programs to succeed.

People living on the streets are among our most vulnerable: They die, on average, 30 years earlier than people who have homes. They have higher rates of mental illness and substance use disorder than people who are housed. Trauma and adverse childhood experiences are also a significant factor in this population.

Yet our political response is more about addressing the numbers than the needs. We count how many people are homeless, but we make assumptions about their needs. Simple changes, like listing an individual’s health care providers on counties’ homeless digital record-keeping systems and including clinicians who work with homeless populations in planning, could make a difference.

Gov. Gavin Newsom’s recent proposal to establish CARE Courts to help individuals with mental health and substance use issues would create another tool for pairing health care with housing. Success will depend on the state and local governments fully funding the courts, including meaningful health care and creating more supportive housing.

Individualized approaches will still be needed, as illustrated by Collette Carlson, a woman who was living near a market in Venice. She had lost a leg after an untreated infection led to an amputation, and her mental illness caused her to lash out at people who tried to help.

Dr. Coley King leads our street medicine program, which has nine teams of clinicians, case managers and social workers who go into the community to provide care to people experiencing homelessness.

He visited Carlson often, eventually earning her trust. She agreed to accept medication for her mental illness. With her thoughts more organized, Carlson agreed to move into a shelter. In more secure surroundings, she could be fitted for a prosthetic leg and begin the process for more permanent housing. King continues to see her, which helps her stay on her medication.

This kind of follow-through and personalized attention is necessary for many people experiencing homelessness to succeed in housing. Engaging in thoughtful planning from the start ensures patients stay connected to their providers.

With the elections bringing a much-needed focus to homelessness, we call on our political leaders to prioritize health care in their plans to end homelessness. Housing is a powerful form of health care. But housing without quality health care will not yield the long-term success we all want for our state.