COVID-19 Emergency Rental Assistance Improved Mental Health Care And Psychotherapy Use Among Low-Income Renters

Area of Science:

• Public Health
• Health Services Research
• Mental Health Services

Background:

• Housing insecurity is a significant social determinant of mental health.
• The COVID-19 pandemic exacerbated housing insecurity in the US, particularly among low-income renters.
• The federal Emergency Rental Assistance (ERA) program was implemented to mitigate pandemic-related housing instability.

Purpose of the Study:

• To evaluate the impact of the ERA program on mental health outcomes, specifically anxiety and depression symptoms.
• To assess the effect of ERA on the utilization of mental health care services.
• To investigate the mechanisms through which ERA influences mental health and care use, distinguishing between indirect (housing alleviation) and direct (resource availability) effects.

Main Methods:

• Utilized quasi-experimental design with 2021-23 Household Pulse Survey data.
• Employed causal mediation analyses to examine indirect and direct pathways of ERA's effects.
• Focused on low-income renters experiencing housing insecurity.

Main Results:

• ERA significantly decreased symptoms of anxiety and depression.
• These reductions were achieved through both indirect effects (alleviating housing insecurity) and direct effects (providing financial resources).
• ERA increased psychotherapy use among renters with anxiety or depression symptoms, primarily through direct effects.

Conclusions:

• The ERA program demonstrated a dual benefit, improving mental health by addressing housing insecurity and by directly enabling access to care.
• Future rental assistance initiatives should integrate features that streamline application processes and expedite benefit delivery.
• Optimizing delivery mechanisms can enhance the capacity of assistance programs to address urgent mental health needs concurrently with housing stability.