Mental health and the housing crisis

It’s true, Dorothy — there’s no place like home.

In 2014 my husband and I started the search for our first home in the idyllic and pastoral town of Silverton. Like many millennials, we had embraced nomadism, hopping from one college town to the next, finishing our degrees, working when we could, and doing our best to scrape up enough savings to make homeownership a reality.

When we arrived in Silverton in the summer of 2014, we were pampered by a weekend-long real-estate tour, complete with luncheons and leisurely tours from home to home as we halfway pretended to know how to scrutinize and discern our options. Historic craftsman or new build? Farmhouse or neighborly cul-de-sac? One story or two stories? At the end of the weekend, our realtor told us to sleep on it and take our time. We made a decision and with relative ease, we effectively moved away from the yellow brick road, tapped our ruby-red slippers, and found our home.

This all seems like a bit of a dream compared to current realities. Dorothy’s ruby red slippers are far more elusive. Leisurely tours and long luncheons are out as the housing shortage and historically low inventory has pushed supply and demand to its brink. The task of finding a decent home is now too often laced with competition, angst, and for some, desperation.

In Oregon, historically low inventory across the state has meant potential buyers are pressured to act fast, facing sometimes daunting bidding wars, multiple rejected offers, and the reality of having to make concessions in order that their offer stands above the rest. As wildfires ripped through our state in 2020 and displaced thousands, an already-meager housing market was crunched even more. Baby boomers looking to downsize have limited options, putting a pause to Generation X looking to “buy up,” limiting millennials seeking to make their first home purchase, which ultimately keeps many in limbo leaning on an already-sparse and inflated rental market.

Of course, for many, the notion of homeownership is farfetched anyhow. In an economic landscape where housing costs have far outpaced wages and nearly 40 percent of Americans would struggle to cover a $400 bill, saving for a down payment or building credit can seem beyond reach. Throughout Oregon, estimates of cost-burdened renters or homeowners (individuals or families paying upwards of 30 percent of household incomes) hover between 40 and 60 percent, depending on the region. With affordable housing still woefully inadequate when matched with demand, it is not surprising that Oregon and many other states are also seeing rising rates of housing insecurity and homelessness.

2020 has been (and 2021 will likely be) a time for reevaluating. COVID, widespread financial shifts, political and social upheaval, and injustice has caused many of us to take pause and reevaluate our beliefs, relationships, work, social supports, and yes, where we call home. Some of this reevaluating has been by choice and some by sheer necessity. No longer being tied to the city office, suburbia and small-town life becomes appealing. Others are being forced to move secondary to financial hardship while breakups, divorce, death, and natural disaster have also played unique roles in the relocation boom of 2020-21.

These moves and shifts all have a story and come up daily in my office. Relief and hope for some, desperation and worry for others. Our health and well-being are inextricably tied to where we call home.

From a purely mental-health perspective, housing location and affordability has been demonstrated to have clear implications with behavior, self-esteem, substance abuse, exposure to crime, and access to self-care activities. Stretched to pay rent or a monthly mortgage, families may have to sacrifice quality mental healthcare or prescription costs. Multiple moves amid rising rents increase stress and lead to poorer health and education outcomes. Overcrowding in living spaces increases the risk for emotional instability and illness. Substandard housing increases exposure to environmental hazards such as mold, pests, lead-based paint, and structural deficits.

Ultimately, a safe and affordable home provides welcome respite for individuals and families accustomed to living in perpetual survival mode. This allows for an overall reduction in mental-health symptoms, less emergency visits, improved adherence to treatment recommendations, and a lower susceptibility to trauma and violence.

The economic case for affordable housing is also noteworthy as financial stability is pertinent to individual and collective mental health. When housing is more affordable, families have more money for discretionary spending, supporting local businesses. Evictions, which spark a cascade of instability are fewer. Health expenditures are reduced as health outcomes improve. Childhood poverty, limiting academic performance and opportunity, is reduced, allowing youth to pursue education and career goals that enhance the economic output of entire communities for generations to come.

Practical interventions for increasing affordable housing are feasible. The passing of Oregon HB 2001 in 2019 paves the way for duplexes and townhouses to be constructed in lands previously zoned for single-family dwellings. Subsidies and incentives for developers ought to be expanded and the red tape of infrastructure costs, building-code headaches, and design standards relaxed. Employer-assisted housing programs ought to be cultivated with rental assistance or forgivable downpayment loans. Safe parking areas can provide reassurances to homeless individuals living out of their cars.

Low-income rental assistance and landlord mitigation funds can help minimize evictions. Regional housing counsels can help forge multi-disciplinary partnerships intimate with the needs of a particular community.

Quality mental health is far bigger than the number of therapy rooms or savvy medication prescribers. Where we call home will always be one of the most significant determinants of our individual and collective wellness. It’s going to take hard work, commitment, and creativity, but when we prioritize the health and safety of our neighbors, we make ourselves a bit safer and healthier, too.