Social Determinants Of Health: Housing

Where We Stand

NAMI believes that all people with mental health conditions deserve access to supports that promote wellness. NAMI supports public policies and laws that help address social determinants of health, including ensuring stable, safe, affordable, and supportive housing options for people with mental health conditions.

Why We Care

Access to affordable housing is a critical social determinant of health, and a person’s access to housing can affect — and is affected by — mental health. Experiencing housing instability may contribute to stress, anxiety or other mental health symptoms. The symptoms of a serious mental health condition can also lead to housing instability. Moreover, it’s well-documented that people with mental illness experience housing discrimination throughout the rental process.

People with mental illness are overrepresented in the unhoused population, as about 1 in 5 people experiencing homelessness in the U.S. have a serious mental health condition. Homelessness has a profoundly negative impact on mental health, and children are especially susceptible to the psychological effects of homelessness and housing instability.

The leading cause of homelessness is a lack of affordable housing. Many people with a serious mental illness rely on Supplemental Security Income (SSI) for their incomes. Yet, research shows that there are zero U.S. housing markets in which a person living solely on SSI can afford a safe, decent apartment without rental assistance. This is why rental assistance is so critical. Available forms of rental assistance include project-based vouchers – assistance attached to a specific housing unit – and tenant-based vouchers – assistance that families can use to rent any private apartment that meets program guidelines. Yet only 1 in 4 eligible low-income renter households receive the help they need.

Stable, safe and affordable housing supports recovery, and helps prevent hospitalizations and involvement in the criminal justice system. Various housing programs have proven benefits for people with mental illness. Housing First programs provide permanent housing and support services to people experiencing homelessness without preconditions, thereby eliminating access barriers. The U.S. Department of Housing and Urban Development (HUD) Housing Choice Voucher Program (Section 8) provides vital housing assistance to families, the elderly and disabled individuals with low incomes. The Supportive Housing for People with Disabilities Program (Section 811) is dedicated to developing and subsidizing rental housing for very or extremely low income adults with disabilities, including severe mental illness. These federal programs, as well as other state and local initiatives, provide critical housing supports for people with mental illness. Yet they are often underfunded, and only have the resources to serve a fraction of individuals with mental illness in need.

When we invest in programs that work, we are also investing in success and recovery. NAMI supports public policies and laws that adequately fund and implement effective housing programs to provide housing stability for people with mental health needs.

How We Talk About It

• Social determinants of health are factors in a person’s life, like the conditions in the places where a person lives, learns, works and plays, that impact their health risks and outcomes, including their mental health.
• A person’s ability to access housing can impact their mental health and wellness. At the same time, having a serious mental illness may also impact a person’s ability to get or maintain housing, especially when faced with discrimination.
• Poverty, unemployment, and a severe lack of affordable housing are commonly recognized causes of homelessness. These risk factors can be exacerbated by mental illness and substance use disorders, as well as justice-system involvement, which is a common experience for many people with mental illness.
• When a person does not have their most basic human needs – like housing – met, they have a more difficult time maintaining their overall health, including their mental health.
• Housing assistance programs help people with mental health conditions find and maintain affordable housing while connecting them with critical health care and community services.
• Efforts to provide stable housing  for people experiencing homelessness can reduce health care costs and improve health outcomes for people with mental illness. Unfortunately, these housing programs currently serve just a fraction of individuals with mental illness who need it.
• NAMI believes that policymakers must address housing needs and related social determinants of health to allow people with mental health conditions to focus on getting and staying well.

What We’ve Done

• NAMI resource “Finding Stable Housing”
• NAMI blog “New Report Shows Challenges Facing People with Serious Mental Illness Living on SSI”
• NAMI article on people with serious mental illness being priced out of housing
• NAMI article on supporting recovery for people with mental illness
• NAMI endorsement of the “Keep Your Home and Prevent Homelessness Act”
• NAMI letter to President Biden and HUD Secretary Fudge urging the Administration to prioritize robust investments in housing vouchers, public housing, and the national Housing Trust Fund

NAMI letter to the Biden Administration urging additional legislation, regulation, and guidance to ensure that those with criminal records are not effectively blacklisted from finding suitable housing