Diagnosing the youth mental health crisis? Don’t forget housing and extreme heat

THE CITY OF BOSTON recently announced a new $21 million initiative to address the urgent need for more mental health services and programs for youth and families. This announcement follows a report from the Boston Public Health Commission detailing how widespread persistent sadness and anxiety has become amongst youth and adults. And the problem is growing. Between 2015 and 2021, youth in Boston experiencing persistent sadness steadily increased from 26.7 percent to 43.9 percent.

Leveraging federal funds and grants, including through the American Rescue Plan Act (ARPA), the City of Boston is committing to building a larger, more diverse mental health workforce to address this crisis. In the next five years, the program is expected to reach 50,000 youth in 21 Boston Public Schools. This is a transformative investment in the future of Boston.

In addition to meeting the current moment with mental health interventions, it’s critical we understand the underlying factors leading to this growing crisis among our youth. That way, the city can work toward preventing mental health issues before they start.

Effective prevention requires accurate diagnoses; diagnosing the current crisis is complicated. While the usual culprits – like the pandemic, school closures, and social media – are often mentioned, more is at play. Research points to two additional and significant issues: housing and extreme heat.

Stable and affordable housing is vitally important to supporting mental health throughout life. Research tracking health outcomes of children in New York City found that those living in gentrifying communities – particularly those living in market rate housing – had higher rates of anxiety and depression than youth whose neighborhoods did not gentrify.

Unstable housing in any form causes intense stress, especially in its more severe forms, like homelessness and eviction. Research shows the ripple effects of eviction on mental distress of not just those directly affected, but also their neighbors. In less severe forms it can create tradeoff situations that also impact the health of young children, forcing choices between paying for rent or food.

Given skyrocketing regional housing prices and insufficient supply of affordable homes, creative, forward-thinking policies to help families stabilize and stay in Boston will also reap dividends for mental health — from our youngest children and youth, all the way to our oldest residents. A stable, affordable home provides the roots that every young person needs to thrive.

Mitigating the increasing impacts of extreme heat, both independently and in conjunction with housing, is also critical to curbing this rising mental health crisis amongst youth. From 2010 to 2020 Boston had more hot days than anytime in the prior 50 years. Extreme heat has been linked to increased emergency department visits for mental distress, including among youth.

Many buildings in the Northeast are not adapted for keeping cool in summer but rather staying warm in winter, given the historical climate. Even when air conditioning is available, the cost to run it may be prohibitively expensive for lower income families. This is one of several conditions known as energy insecurity, which is itself associated with worse mental health. Low-income tenants are particularly vulnerable to energy insecurity during heat waves, and unhoused people bear the brunt of heat waves.

Cities are on the frontlines of a growing national mental health crisis. A 2023 survey by the US Conference of Mayors found that 97 percent of mayors reported an increase in demand for mental health services in the previous two years. Ten years of data from the Menino Survey of Mayors identified similar trends of mayors feeling increasingly responsible for responding to this crisis.

The Boston University Initiative on Cities is responding to the need for better understanding the challenges facing cities, and proposing solutions, by embarking on a five-year “Urban H” research and practice agenda. This agenda will examine the interlocking state of housing, heat, and health – particularly mental health – in cities locally, nationally, and internationally.

We applaud the City of Boston for its critical investments in the well-being of our city’s youth mental health. With an expanded view of prevention that includes housing stability and heat mitigation, these efforts can carry forward for generations and help stem the tide of the worsening mental health crisis harming our young people.