Mental health and wellbeing – key issues

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The evidence for the mental health and wellbeing impacts of housing, especially poor housing conditions, is less developed than that supporting physical health impacts. There is often a clear pathway between a housing hazard and a physical health impact. The evidence for physical health outcomes are often medium or large scale and quantitative, whilst much of the evidence found relating to mental health is based on a smaller scale and is often qualitative studies. The result is that in relation to physical health, it is easier to make statements about the relationship between housing hazards and health due to the consistent and robust quantitative studies. In respect of mental health, the nature of the research base makes it more difficult to reach general conclusions. However there is some evidence of pathways that might link poor housing conditions to mental health outcomes. For example, living in poor housing conditions has been shown to increase stress, and reduce empowerment and control, each of which have clear links with mental health outcomes.

notting hill houses in portobello road market

Housing hazards, as defined and assessed through the Housing Health and safety Rating System (HHSRS), are not the only housing issues which impact on an individual’s mental health and wellbeing. Homelessness, lack of security of tenure and the fear of retaliatory eviction by landlords contribute to an individual’s mental health and wellbeing.

The physical and mental health effects of poor housing disproportionately affect vulnerable people; however the mental health effects are made worse for older people living isolated lives, the young, those without a support network and adults with disabilities.

For many individuals with mental health problems, there is a strong link to insecure, poor quality and overcrowded homes. These environments compound the mental health issues, such as increased noise and the chaotic way of living, especially if overcrowded.  They may also find themselves isolated and without support mechanisms. Substandard housing has also been found to impact on socio-emotional development, psychological distress, behavioural problems, and educational outcomes of children and young people. There is a growing base of evidence to indicate that very young children under school age are very susceptible to long term mental health issues, such as anxiety and depression, if they are in substandard housing. Some evidence also suggests that there is also a greater impact on women, at home alone, especially if a single parent; and older people who due to disability, lack of simple interventions such as handrails or other support mechanisms find themselves housebound and socially isolated.

Interventions that improve housing conditions have been shown to result in improvements on mental health measures, including reduced anxiety or depression, psychological distress, and improved patient reported health score. Providing a warm home has been clearly shown to benefit both young and old in relation to their feeling of wellbeing as well as reducing the physical risks that can arise from cold homes.

Health Impacts

Children are most likely to live in overcrowded housing compared with working age adults and pensioners. There is building evidence that living in a crowded home can have a negative impact on a child’s development and educational attainment. Overcrowding may have both direct and indirect effects. The latter are of course less easily measured. For example, children’s education may be affected by overcrowding directly, through a lack of space for homework, as well as indirectly because of school absences caused by illness, which may be related to overcrowding.

Qualitative research, with small numbers of families, has revealed a link between overcrowding and: stress, tension, and sometimes family break-up; anxiety and depression; a lack of privacy, particularly for adolescents and disrupted sleep patterns., which for the young can lead to problems with cognitive development, reading skills and sometimes even the ability to speak with clarity which ultimately will impact on their education and health  The chaotic sleeping arrangements were an underlying cause of many mental health effects.

Excess cold also has an impact with clear evidence linking home temperatures and mental health. The evaluation of the UK Warm Front Scheme, found that increasing the warmth of homes had a clear impact on mental health – those with bedroom temperatures of 21degreesC were 50% less likely to experience depression and anxiety than those whose bedrooms were only 15degreesC

Other housing hazards such as condensation, damp and mould; noise; pests; living in flats; draughts and the age of homes have also been shown to have some connection to mental health.

The cost to the NHS and society of poor housing conditions is discussed in physical health – key issues; however current cost estimates often do not include impacts on mental health. This means that it is possible that cost savings would in fact increase due to the reduction in mental illness – which costs England at least £105bn each year. In addition, the social and economic costs associated with mental ill health – in terms of personal suffering and family and community impacts as well as costs to employment and benefits payments – would likely decrease.

The inequalities in the prevalence of poor housing, combined with the mental health impacts, mean that there is a clear case for action: housing is an important social determinant of health, and there is a need to improve housing conditions in order to help to reduce health inequalities.

Listed below are issues which are associated with the Housing Health and Safety Rating Scheme, there are wider issue such as housing tenure, the existing health and wellbeing of the individual, including the use of drugs and alcohol.  Although these are issues that can contribute to physical health issues as well.

Hazards and their mental health and wellbeing effects

Hazard Mental health and wellbeing effect Vulnerable Groups*
General Substandard Housing Mental health – anxiety, depression
Socio-emotional development
Disruption to education and impact on academic achievement
25 years or less
Damp and Mould Growth Depression Anxiety
Feeling of Shame
14 years or less
Excess Cold Depression and anxiety
Slower physical growth and cognitive development in children
65 years plus
Lead Continual exposure at low levels has been shown to cause impaired cognitive development and behavioural problems in children. Under 3 years
Crowding and Space Psychological distress and mental disorders;Reduction of tolerance;
A reduction of the ability to concentrate;
Disruption to education and impact on academic achievement.
Stress tension and sometimes family break-up
Lack of privacy
Entry by Intruders Fear of crime;Stress and anguish.
Lighting Depression and psychological effects caused by a lack of natural light or the lack of a window with a view.
Noise Stress responses;Sleep disorders;
Lack of concentration;
Anxiety and irritability
Domestic Hygiene, pests and refuse Emotional distress
Personal Hygiene, sanitation and Drainage Feeling of shame   

* The definition of vulnerable groups in the HHSRS guidance is,  ‘Vulnerability to particular hazards is restricted to age groups. It does not extend to vulnerability for other reasons’.   This definition may be limited in relation to mental health, especially as the evidence is beginning to show that it is not just age that that makes an individual at risk of mental health outcomes from the housing hazards presented.