How Does Housing Stability Affect Mental Health?
Stable housing is critical for all Americans. Yet, each year millions of Americans living with mental health challenges face additional barriers to accessing and maintaining stable housing.
Mental health includes emotional, psychological, and social well-being. Mental health illnesses are among the most common health conditions in the US. About one-quarter of all Americans live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression, that may affect their ability to successfully cope with life’s ordinary demands and routines. Many more will experience less-severe mental health challenges. Mental health can vary over one’s lifetime, and more than 50 percent.
Though there’s no single cause for these challenges, stable and affordable housing is one evidence-based way to support people’s mental health—regardless of the severity of their mental health challenges or illness—throughout the life course.
The cyclical nature of housing instability and less-severe mental health challenges
For people with less-severe mental health challenges, lack of stable housing can exacerbate symptoms. A study analyzing the impact of long-term housing affordability stress—meaning high housing cost burden—found that both persistent and intermittent exposure to housing affordability stress negatively affected self-reported mental health related to social, emotional, and mental functioning, even when accounting for initial mental health status. This is true for renters as well as homeowners; a study on mortgage strain found homeowners with missing mortgage payments or those having trouble paying a mortgage experienced depression, feelings of shame, social isolation, and anxiety.
Access to more stable housing can help alleviate some less-severe mental health challenges. One study on housing assistance in New Haven, Connecticut, found that people who received rental assistance reported significantly less psychological distress than those on waiting lists, suggesting rental assistance can help support mental health among people earning lower incomes. Another study looking at a small sample of children ages 2 to 17 found that children living in public housing had better mental health outcomes than those on a waiting list. A recent study found housing assistance helped reduce anxiety and helped improve variables that influence mental health, specifically anxiety and stress.
More-severe mental illness and disability may make obtaining stable housing more difficult
For those with more-severe and persistent mental health disabilities, there are often high barriers to accessing housing. A testing study focused on how housing providers treated people experiencing mental illness or a developmental disability, finding housing providers were less responsive to housing applications, were given negative responses for reasonable accommodation, and were encouraged to look for other units. The number of Fair Housing complaints related to mental illness and disability has increased in recent years, suggesting that Fair Housing law may not be applied equally.
Beyond discrimination, during the 20th century, many state-run hospitals closed. Today, inexact funding formulas and lack of community resources have led many with mental health challenges to struggle with finding needed supports. This is particularly true for Black and Latino populations, who face a larger treatment gap and higher barriers to high-quality health care because of numerous factors, including income inequality, inequal access to employer-provided health care coverage, and discrimination and bias in the health care system.
All of this is exacerbated by the acute affordability crisis, which further limits the units available and affordable for the nearly 90 percent of people with severe mental health illnesses who do not live with family. Many of these individuals rely on Social Security Insurance and Social Security Disability Insurance payments, which put most housing out of reach; nationally the average rent for a modest studio apartment required more than 100 percent of their monthly SSI payment.
Housing as a cost-effective support for severe and persistent mental health illness for people who also experience homelessness
Though housing isn’t the only intervention needed to support those with more-severe and persistent mental health illness, it is one critical component for helping individuals. Housing First and supportive housing are not only effective at encouraging housing and health stability but are also cost-effective for people who experience severe mental health disorders and who experience homelessness. People with severe and persistent mental illness make up roughly 30 percent of the population experiencing homelessness.
Housing First is an intervention that makes housing and mental health services immediately available to people experiencing homelessness and severe mental health disorders. Research shows that a Housing First approach can support people with severe and persistent mental health disorders who also experience homelessness:
A randomized control study in four French cities focused on individuals with severe mental health challenges and housing instability found that those who were randomly assigned to supportive housing with a care support team demonstrated higher housing stability and higher scores for psychological well-being. The cost of housing helped save overall health care and residential costs by reducing emergency room visits. A study of homeless youth with mental illnesses in Canada found that young people who received Housing First experienced higher rates of quality of life and housing stability, though the study didn’t find statistical differences in other measures, such as psychological distress.
A systematic review of 26 studies found that Housing First programs increase housing stability and quality of life and that the economic benefits are substantial: every $1 invested in Housing First programs results in $1.44 of cost savings.
Another study found that Housing First and high-quality supportive housing in California helped clients access more frequent, more consistent mental health outpatient services.
A strong evidence base points to housing as a critical component of supporting people experiencing mental health challenges, particularly those with severe and persistent mental health concerns. However, ensuring those who need access to stable housing will require an increase in awareness and action from policymakers.
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