Researchers who have mapped neighborhoods across Colorado where housing and health crises overlap hope an online tool they developed will help policy makers and advocates decide how best to use limited resources to support struggling communities.
"The purpose of this study is really to be a conversation starter," said Elysia Clemens, deputy director of the Colorado Evaluation and Action Lab at the University of Denver, which funded the study.
According to the study released late last year, 71 census tracts -- 6 percent of all census tracts in Colorado -- have significantly higher rates than the state average of both households spending more than they can comfortably afford on rent and of people experiencing mental health issues. Most of those 71 neighborhoods were in metro areas such as Denver along the Front Range.
Researchers Jieun Lee, an assistant professor in the University of Northern Colorado's Department of Geography, and Ivan Ramirez, a visiting assistant professor in the University of Colorado Denver's Department of Health and Behavioral Sciences, said the results of the study they conducted bolstered national research by others that has shown a link between housing and health.
"Ultimately, lack of access to affordable housing is stressful, both physically and emotionally, especially when it may lead to eviction and homelessness," Lee and Ramirez wrote in a study that added a geographic dimension to that social and economic reality.
They said their work could highlight "the exact locations" to target resources and programs.
Phillip Chung, senior director of evaluation and learning at Mile High United Way, said too often data is collected and studied in isolation, which can make it hard to see the multiple factors that burden communities. Mile High United Way's work includes granting millions of dollars to support organizations working in such areas as education, health and economic stability.
The Lee and Ramirez research is "an important step toward looking ... holistically," Chung said.
Chung was not involved in the study, for which Lee and Ramirez looked at households spending 30 percent or more of their income on rent, leaving little cushion for low- and moderate-income families who also have to pay for food, transportation, health care and other necessities. Lee and Ramirez also looked at data on three mental health factors: people who described themselves as having poor mental health in response to a survey conducted every other year by the Colorado Health Institute, suicide rates, and death rates linked to drug use.
The researchers identified census tracts where the percentage of households spending at least 30 percent of income on rent was higher than the state average, which was a startling 50 percent in 2018, according to the Colorado Housing and Finance Authority. Lee and Ramirez also identified census tracts where mental health issues were higher than the state average. Statewide, about 15 percent of Coloradans said they had poor mental health, according to the 2019 Colorado Health Access Survey. Colorado saw just over 20 suicides for every 100,000 people in 2017, and just under 20 drug-related deaths for every 100,000 people in 2017, according to the state health department.
The publicly available mapping tool released alongside the Lee-Ramirez study allows a viewer to, at the click of a mouse, see data across the state or drill down to a census tract.
Lee and Ramirez also provided maps that make access to mental health care visual. Those maps are not part of the mapping tool. Digging down to pages 25 to 28 of their report is required to see that the neighborhoods with higher than average rates of rent-burdened households and of people experiencing mental health issues aren't necessarily under-served when it comes to being within a 30-minute drive of a mental health care treatment facility, substance abuse treatment facility or community behavioral health centers.
Use this slider to compare the study's "mental health distress" and "rent-burdened" layers for the Denver area. Darker colors represent higher concentrations. See the whole map here.
Lee and Ramirez explored further and found that in general, neighborhoods that were under-served by treatment and behavioral health facilities did have higher rates of suicide and rent-burdened households. Yet neighborhoods that were better served had higher rates of drug-related deaths, suggesting, the researchers said, that even more access is needed "or there are other barriers to access that play a role, such as social stigma or cost."
It was one area of further possible study highlighted by the data.
Brittany Katalenas, a social worker with training in the descriptive and analytical mapping techniques Lee and Ramirez used, saw another potential line of inquiry after reading the study, with which she was not involved.
Katalenas, who founded an organization to connect low-income families to housing, said she would like to see a map showing where renters who use federal vouchers are able to find housing. In her experience, she said, it's often in neighborhoods with little access to mental health and other support services struggling families need.
"If you really want to get at the root causes of poverty and mental health, we have to look at the concentration of poverty," she said.
"Our vouchers are concentrating poverty," Katalenas said.
"I thought the study was good-ish," she said of the work of Lee and Ramirez. "But we need to see more."
Clemens, whose Colorado Evaluation and Action Lab funded the study, said that the goal of this first step was not to determine the why behind the data.
"This was really kind of an exploratory study," said Clemens, who was one of the editors of the study.
Clemens's lab connects academics to state and local governments. In the case of the Lee and Ramirez project, researchers had proposed a study of any relationship between asthma and low-income housing. Clemens reached out to state housing officials, who said they wanted to know more about mental health issues.
"That's what generated the focus," Clemens said. "We try to be a bridge and a translator."
Cathy Phelps, executive director of Denver's Center for Trauma & Resilience, said staff at organizations such as hers who provide counseling and other services to under-served communities have seen how unstable housing can lead to mental stress, which can in turn make it harder to secure housing.
If vulnerable people "had additional emotional, social support, we could steady them," Phelps said.
Phelps questioned, though, whether highlighting struggling neighborhoods as the Lee and Ramirez study does could result in stigmatizing those areas.
Clemens said how data is used determines whether information is stigmatizing or strengthening.
"Researchers, journalists, and community leaders have the power to frame and use these findings as an opportunity to strengthen communities," Clemens said. "We have the responsibility to use the information as a conversation starter about how and where to making smart, culturally responsive investments and policies. We also need to acknowledge that this is map is one piece of information, not the full story for any community."
Christine Benero, president and CEO of Mile High United Way, said data such as the information gathered by Lee and Ramirez was a starting point, a guide to determining which neighborhoods needed attention. The next step, she said, was to look at the strengths of those communities.
United Way also compiles research to inform decision-making. A United Way database of behavioral health centers and other community resources helped Denver's Department of Public Safety develop the Community Asset and Resource Mapping Application, or CARMA, an app police officers have been piloting to guide people in crisis to services.
The Lee and Ramirez study was striking for Jules Kelty, executive director Focus Points Family Resource Center.
"What it tells me is that, no matter what, I need to make sure that mental health is something I should always provide," Kelty said.
Thanks to a partnership with the Mental Health Center of Denver, a full-time mental health professional who is fluent in English and Spanish offers counseling in an office at the Focus Points headquarters in Elyria-Swansea. Some neighbors, Kelty said, are spending 50 percent or more of their income on housing. Many of the people the nonprofit serves are new to the United States, sometimes having fled violence or instability in other parts of the world.
Referrals to the on-site therapist are made by staff of such Focus Points projects as job-skill training, a food pantry, English classes or a program that offers assistance with mortgage payments or rent.
"You cannot break the cycle of poverty until you address mental health," Kelty said.
