Mental Health Care Needs in Subsidized Housing: What It Takes to Build a Mental Health Supporting Community

Background and Purpose: Housing and the well-being of people are closely related. Subsidized housing particularly serves individuals and families with lower incomes and/or disabilities who are vulnerable to psychological distress. Understanding mental health issues in housing is critical in promoting mental health and emotional well-being of this underrepresented population. Previous quantitative studies report a high prevalence of mental illness and low mental health service utilization among public housing residents, which suggests mental health care needs in subsidized housing. Yet, a dearth of studies includes housing residents or employees who work with residents with mental illness or mental health concerns and examines their perspectives on mental health care needs. This study focused housing employees who directly work with residents and explored their perspectives on mental health care needs in subsidized housing.      

Methods: Five semi-structured focus groups (6 to 8 participants per group) were conducted. A total of 32 participants who have direct contact with residents recruited from a local housing authority in a Southwestern state. Twenty-four participants were females, and eight were males. Participants’ working experiences at a housing authority ranged from less than a year to over ten years. A focus group interview guide included questions about 1) their encounters with residents with mental health concerns; 2) challenges experienced when assisting residents with mental health concerns; and 3) their perceived need for mental health education or training. Focus groups ran between an hour and an hour and a half. Focus group interviews were transcribed verbatim. Thematic analysis was conducted using NVivo.

Results: Thematic analysis revealed five key themes: prevalence of mental health issues; unexpected role as housing employees; safety; multiple layers of barriers to mental health care; comprehensive mental health care needs. The majority of the participants (97%) reported various incidents related to mental health issues with residents, such as suicide and threats related to mental illness symptoms. Untreated mental illness jeopardized the safety of residents, neighbors, and housing employees. Although none of the participants were required to help residents with mental health concerns, their formal role in managing resident properties and providing customer services placed them in informal and unexpected roles to deal with residents’ mental health needs. Multiple layers of barriers were reported to meet mental health care needs in subsidized housing including lack of resources and mental health literacy, and uncertainty about policies of staff’s involvement in residents’ mental health care. Participants suggested needs for comprehensive mental health care including mental health education for employees and residents, availability of mental health resources on-site, and clarification on policies in working with residents with mental health concerns.

Conclusions and Implications: Findings suggest that, despite urgent mental health care needs of the residents, housing employees struggle to accommodate their needs. Integrated and comprehensive mental health services and policies that promote mental health care of residents are recommended. Building subsidized housing entities with built-in mental health support system may be a way of supporting housing residents who suffer from socioeconomic injustice.