By Katie Derrick, LMSW, Jesse Tree Community Health Worker
Word on the Street Issue 41, March 2024
. . .
Editor’s Note: A version of this article was previously published by the Idaho Capital Sun
One of the most underrepresented impacts on our health is our housing. Typically, when people think about how housing impacts their health, they think of issues such as air quality, mold, infestations, the safety of the home and the surrounding environment. While these are certainly important to consider, what about the stress of housing insecurity?
At Jesse Tree, a homelessness prevention agency serving households in Ada and Canyon Counties, health issues are one of the most common reasons that our clients fall behind on their rent. An unexpected medical procedure, a work injury, a sick child, or complex health issues are all circumstances that we frequently see. Recognizing the interconnected nature of housing and health, our Community Health Program implemented a brief screener in July of 2023 to examine the health issues and barriers that our clients are facing and identify ways we can best support them. Through our process, case managers complete the screener with their clients by asking questions about their physical and emotional health, including resource insecurity. By compiling this data, we can better understand larger trends and gaps in health care in our community.
A few trends from our health screener are cause for concern. Based upon data collected between October and December 2023, 42.37% of our clients reported that they visited the Emergency Department (ED) in the last 3 months, and 22.03% stated they visited the ED more than once in that timeframe. Frequent ED visits are often associated with a lack of accessibility to adequate health care, whether this be transportation barriers, lack of funds, or the absence of an established relationship with a primary care provider. Across the nation, approximately 42% of people use the ER in a year (CDC, 2023). However, our screener indicates the same percentage of Jesse Tree clients in our community have been admitted to the ER in just the last 3 months, a much shorter time frame.
Additionally, 46.02% of our clients reported that they always or often struggled with mental health symptoms such as isolation/loneliness, fatigue, and nervousness. Whether someone recently received a 3-day notice to pay or vacate or they are attending eviction court, involvement in any step of the legal eviction process is typically daunting and anxiety-producing. Someone already experiencing mental symptoms may find this process especially challenging. In a study of individuals appearing in eviction court, numerous mental health impacts were found: 39% of participants screened positive for generalized anxiety disorder, 37% for posttraumatic stress disorder, 33% for major depressive disorder, and 17% reported suicidal ideation. Despite this significant reporting of mental health concerns, less than 25% of participants received any mental health services during the 9-month follow-up period (Tsai et al., 2021). Furthermore, adults who have been evicted have higher rates of mental health hospitalization and suicide mortality (Himmelstein & Desmond, 2021). Here in Ada County, we experienced a 57% increase in eviction court filings in 2023 from 2022; in 2022, there were 805 filings, while in 2023, there were 1,399. The correlation between health and housing insecurity is vital to examine, especially considering the amount of individuals in our community who are impacted by the eviction process.
When affordable housing is sparse and tenants are having to spend such a high percentage of their income solely on rent, what happens to their other basic needs? Quality food, transportation, hygiene products, and clothing are often sacrificed. Even further, visits with a primary care provider or a mental health professional become much less accessible, as out-of-pocket costs and the loss of wages to attend appointments become unbearably expensive. In 2023, Idaho experienced a massive Medicaid disenrollment. The reality we are seeing is that our clients are often uninsured or cannot afford basic medical care. This data indicates that our neighbors, and their mental and physical health, are struggling. It is time that we as a community and state pay attention to the negative health impacts of housing insecurity and invest in addressing it.
Sources:
CDC. (2023). Emergency department visits. https://www.cdc.gov/nchs/fastats/emergency-department.htm
Himmelstein, G. & Desmond, M. (2021). Eviction and health: A vicious cycle exacerbated by a pandemic. Health Affairs Health Policy Brief. DOI: 10.1377/Hpb20210315.747908
Tsai, J., Jones, N., Szymkowiak, D., & Rosenheck, R. A. (2021). Longitudinal study of the housing and mental health outcomes of tenants appearing in eviction court. Social Psychiatry & Psychiatric Epidemiology, 56(9), 1679–1686. https://doi.org/10.1007/s00127-020-01953-2