People’s health and well-being are improved through experiences of stability and safety. Affordable, healthy housing offers both, studies show, while living in substandard housing or being homeless increases stress and is associated with mental and behavioral risks.

A Tuesday APHA 2024 session, “Housing as a Social Determinant of Mental Health,” examined how being unhoused contributes to problems with mental and behavioral health.

A study presented by Lu Zhang, an assistant professor in the College of Behavioral, Social and Health Services at Clemson University, found that residential segregation — the separation of people into racial, ethnic or income categories — is a structural risk factor for mental and behavioral health. Meanwhile, the social determinants of low income, lack of health care, living in environmentally polluted areas and unhealthy behaviors increase risk.

“Unhealthy behaviors, particularly smoking and inadequate sleep — often used as coping strategies for stress — accounted for 86% of the association,” Zhang said of the study.

People being evicted from their home due to nonpayment of rent is especially harmful and many times leads to homelessness, said Ihsan Kahveci, a doctoral student in sociology at the University of Washington. 

Eviction from a home is a seismic experience in which a person must vacate a premises within days. Landlords often call police to remove people unable to leave by an appointed time. 

In a study of over 1,100 people evicted in King County, Washington, more than half reported poor or very poor health and 38% reported mental health disorders.

“Eviction is a precursor to homelessness,” Kahveci said. “And sociodemographics determine eviction risk and health.”

But simply keeping people housed is not always sufficient to lowering risk of mental health complications.

A study by Jose Scott, a PhD candidate at the University of Southern California, followed over 350 residents at a low-income run-down housing project in Los Angeles. The residents were moved to a mixed-use environment of new apartment complexes, a grocery store, retail plaza and green spaces. 

Nearly 60% of residents reported improved mental health, showing the power of living in a well-maintained home and environment. Still, some residents felt the move disrupted their social networks, increased a feeling of not belonging and created stress due to uncertainty of keeping their home. 

Scott said the lesson learned was that moving people into well-maintained affordable housing is only part of the answer. People also need to retain or create new social connections, perhaps through community centers and projects.

Most people with severe mental health challenges who cannot work have difficulty finding affordable housing. People on supplemental security income generally cannot afford to pay rent and living expenses in U.S. cities.

North Carolina tiny homes project

Amy Blank Wilson, associate professor in the School of Social Work at the University of North Carolina at Chapel Hill, is co-director of the university’s Tiny Homes Village project, a demonstration project focused on expanding affordable housing options for people with severe mental illness.

Fifteen tiny homes were built in Chapel Hill through a partnership of the university, local organizations and construction companies. In Chapel Hill, the average home costs over $600,000. The tiny homes were built for $50,000 each.

Each tiny home has a front porch, living room, modern kitchen, a separate bedroom and a separate bathroom with large shower. Each home is furnished and bathed in sunlight from several large windows. Moving people in will begin shortly.

The Tiny Homes project provides a starting point and blueprint for developing more affordable housing options for people with mental illness, while offering them a place of their own to feel safe in, Wilson said.

“Home is where our story begins,” she said. “Where we live creates a social context that supports our health.” 

Photo by AS Photograpy, courtesy Pexels.