By now, many of you know that I’m a bit of a policy wonk, which means I don’t let myself get too surprised by the latest research too often (though research findings themselves do sometimes surprise me!). Like I wrote last week, it’s not often that a truly newsworthy story is brought to light. But I’ve done some digging on another issue this past week, and it’s a pretty jaw-dropping, can’t-miss, sound-the-alarm kind of stat: Fully one quarter of all Americans can’t pay for housing.
Even this past week when listening to my local NPR station, I heard a story of families waiting on rent relief funds that still had not been disbursed – funds that are the difference between a person having a roof over their heads and being unhoused.
Now, in most of my posts, I like to write about developments in the world of mental health policy, challenges with how care is delivered in the United States, and what we can do to more effectively navigate our own experiences with mental health issues.
But what can get overlooked in the middle of those reflections are the preconditions of mental health challenges – the community factors that we sometimes forget about that are foundational for our health. It’s not just that we need to think about how we can better attend to the mental health needs of our fellow citizens in the present and future; we also need to think about why people are struggling in the first place – to look beyond the individual pieces and embrace more of the whole. That’s what I want to write a little bit about today.
Housing insecurity is a huge issue in American public life. Whether for renters or even for homeowners, paying the landlord or getting the mortgage check in on time is becoming increasingly difficult. And the science is clear that stress caused by housing insecurity is detrimental to our mental health.
Researchers have found that prolonged or short-term exposure to housing insecurity are both associated with lower mental health, and that this is especially true for those with poor job security and in low-to-moderate income tiers.
We could probably just call this the science of common sense. After all, it doesn’t take much to imagine that not knowing if you’ll have a place to sleep at the end of the month is an enormous stressor in your day-to-day life. And when findings as clear as these intersect with the harsh reality of current housing insecurity in the United States, it’s easy to see how this can spiral into a significant cause of mental health challenges.
In other words, housing insecurity like so many other community conditions serves as a precursor to mental health problems. Have you ever been in a situation where you didn’t have stable housing? It’s a distressing feeling. In fact, having been in the trenches and talked to a lot of folks who were unhoused, the lack of security really messes with your head, as well as with your ability to manage even basic tasks. If you haven’t spent time at a shelter or taken a moment to talk to someone who is unhoused, you should.
What can policymakers do?
First of all, they should take care to incorporate housing needs into their efforts to tackle mental health care in America. In fact, it’s an explicit finding that mental health policy may be less effective if it doesn’t consider housing quality. So, to our leaders: don’t forget about housing! There’s a bidirectional relationship there that needs to be called out.
Second, there are a couple of paths that policymakers could explore to address the issue of housing insecurity across the country. One such path is the greater provision of affordable housing. This has always been a tricky topic because for developers, high-end, more limited housing options result in greater profitability—but they come at the expense of the cost of living for many families who need affordable places to live. (Washington, DC, for example, is just one of many cities that have had such challenges.) Finding ways to make housing more affordable will be essential to slowing the rapid increase in rent prices we are currently facing. When my family sold our Denver home, I jokingly told my wife that we were never going to be able to afford to go back – and this is actually true in many neighborhoods as the cost to get into a home can be prohibitive for many to even consider!
Those in charge of housing policy could also play a helpful role by investing in what is known as supportive housing—a combination of affordable housing and coordinated services that "helps people struggling with chronic physical and mental health issues maintain stable housing and receive appropriate health care.” As with most policy issues, nothing is isolated: housing, job security, and health care are all inextricably linked. For leaders, then, there is an opportunity to take a more wholistic approach to mental health and housing by coordinating resources that serve our most vulnerable populations.
Housing policy may be complex, but the science here is simple: when people face uncertainty about whether they’ll have a place to live, mental health is degraded. That means we need a renewed focus not just on mental health care, but on housing insecurity and issues like it that serve as central determinants of health.
Only by taking that kind of wholistic approach can we begin to arrive at the mental health solutions that so many of our fellow citizens need—and deserve.
One of the most fulfilling things I ever did in my life was the six years I spent on the Board of a Virginia supportive housing agency, which built supportive housing and provided services in the Richmond area when I joined the BoD, and by the time I rolled off had fully deployed Housing First principles state-wide in its housing development work. The org took over existing buildings - a brewery, a bottling factory, a motel that had become Crack/Prostitution Central, other commercial building footprints/exterior walls - and repurposed them into studio apts with supportive services for tenants. I learned so much from that time, really baked in my already established thinking that stable housing was the prime solution for most problems that wind up as "mental health" or "SUD" diagnoses.
I don't know how I found your blog, but well done! One aspect of this that I think about is that the cost of housing, even above the affordable housing level, can be a source of mental stress, as well. The homes that cost so much that both heads of household (or more than just two people in the house) need to work means that they don't have the freedom to perhaps take a pay cut or stop working altogether when life gets busy, a family member gets ill, etc. And with the possible recession coming/ here, the loss of a job can create all sorts of mental health challenges as well. Can you imagine the worry if one or both of the payors of a mortgage/ rent are at risk of losing a job? Because like you note in your post, even if they decide to sell their house, for example, will they even be able to find something more affordable/ less expensive? The provision of affordable housing is not just a mental health concern for those at or below the poverty line... the availability of attainable housing at all levels creates mental health concerns that impact everyone.