It’s Not Just About the Buildings: How Community Development Organizations are Promoting Residents’ Mental Health
Around the country, housing and community development groups are increasingly stepping up to partner with residents to improve community well-being by proactively strengthening residents’ emotional and mental health.
By Amanda Abrams
If there were any upsides to the Covid-19 pandemic, one would have to be the increased public awareness of mental health issues that it brought. With so many people simultaneously facing isolation, anxiety, grief and other overwhelming emotions, it became impossible to sweep them under the rug.
It has been recognized that those with means are often able to obtain the care they need to address their emotional struggles. But lower income communities, particularly those that have been historically marginalized, have fewer resources to support their mental health needs. They have less free time and money, reduced access to natural settings, and organizations that assist them have traditionally focused on meeting more tangible needs like food and housing. To further complicate the situation, for some BIPOC communities, acknowledgement of mental health struggles has often been taboo. And importantly, many of those communities are already bearing a disproportionate burden of generational trauma that stems from historic and systemic inequities directed by race and ethnicity.
The leaders of Codman Square Neighborhood Development Corporation, in Dorchester, Massachusetts, are intimately familiar with those challenges. “There have always been mental health issues in our community, but the pandemic certainly exacerbated them,” said Gail Latimore, Codman Square’s executive director. “It’s become more acceptable to acknowledge them, but there are stigma issues that still remain.”
During Covid, the organization partnered with the University of Massachusetts, Boston to offer a regular Zoom meeting focused on mental health and relaxation techniques. The initiative was surprisingly successful, with around 50 people participating, mostly from the surrounding neighborhood.
When the meetings ended in 2022, Latimore and her colleagues realized they needed to find a way to continue to meet residents’ emotional needs. The neighborhood was experiencing increased gun violence that the staff attribute in part to anger and pent-up frustration. The result is the creation of what they’re calling their Anti-Racism Equity Army. The program is composed of two parts: residents learn about the history and context of racism in the U.S., while they are simultaneously provided with strategies and advocacy opportunities to address it.
Cultivating a sense of agency and empowerment can offset some of the harmful impacts of racism, said Marilyn Forman, director of community organizing and resident engagement at Codman Square. “We want them to understand their power and how to use it.”
Environmental factors can deeply impact mental health, too
Around the country, community development groups like Codman Square have been dipping their toes into programs that address residents’ mental health. Some began that work prior to 2020, already noticing an increased need among the populations they worked with. “Before the pandemic, mental health challenges in low-income communities were becoming a recurrent theme,” said Laura Choi, senior vice president of public engagement at the Federal Reserve Bank of San Francisco.
Part of that was a by-product of the increased focus that arose a decade ago among professionals and practitioners on the impact that housing, food, transportation and other needs can have on a person’s health. Those necessities were originally deemed “social determinants of health,” but the list of key needs has since expanded. The Vital Conditions for Well-Being and Justice include not only concrete needs like food and shelter, but also less tangible requirements like meaningful work and a sense of belonging. The widely accepted statistic that 80 percent of a person’s health comes from these non-clinical, environmental factors has led community development professionals to think much more broadly about health and how to improve it.
Mental health is similarly impacted by environmental factors, if not more so. Studies have repeatedly demonstrated a clear causal link in both adults and children between housing affordability struggles, food insecurity, other indicators of poverty, and mental health. A lack of those vital conditions often leads to stress, which can manifest in physical symptoms but also causes problems in itself.
In addition, mental health professionals emphasize that racism itself is a mental health issue. “There are things that many Black people have to contend with that can contribute to mental health conditions or exacerbate them,” said Nicole Cammack, a licensed clinical psychologist and the CEO of the organization Black Mental Wellness. From daily microaggressions to large-scale historic trauma like segregation, as well as ongoing systemic racism, Black communities may experience heightened mental health challenges simply by existing.
Even watching the news can be traumatic, Cammack emphasized. “Witnessing the murders of Black people on television — that can be triggering, leading to nightmares and hypervigilance. If you’re already having a hard time, that can contribute.”
For many working in the housing and community development field, Covid-19 and the racial justice protests following George Floyd’s murder in 2020 made the issues difficult to ignore. Many more groups have incorporated approaches to mental health work in some way. “There’s a lot of interest in how to do this well,” said Choi, who regularly communicates with the communities her institution works with.
It is exciting to see that most of the new approaches use upstream interventions that aim to reduce mental health challenges before they become unmanageable. And many are collaborating with a range of partners — including, importantly, residents themselves.
Romi Hall, director of Healthy Homes and Communities at NeighborWorks America, agreed. Her organization recently surveyed a wide range of housing and community development groups to hear about their post-Covid status. “Mental health is really big on the frontier,” Hall found. But simultaneously, many community development practitioners are wondering, “Where do we go next with this?”
So far, the new approaches fall into a few categories. Some organizations are creating physical spaces or programs that allow people to feel a sense of belonging and safety, two important domains on the Vital Conditions for Well-Being and Justice framework. Others are boosting residents’ services in order to proactively provide more support and contact. And some are overhauling their entire approach to ensure that a focus on mental health pervades everything they do.
Aerika Loyd, a professor of psychology at the University of California at Riverside who focuses on health and development among young people of color, said that community-based approaches like these have some significant strengths. “I think they’re particularly relevant for groups with collectivistic cultures. They can be very powerful.” She pointed out that community groups often have an intimate understanding of residents’ culture, needs, and viewpoints that can complement or even supplant outside interventions. “And people may be more open to it.”
While there are groups that provide clinical options such as counseling, it is exciting to see that most of the new approaches use upstream interventions that aim to reduce mental health challenges before they become unmanageable. And many are collaborating with a range of partners — including, importantly, residents themselves. After all, one thing that has become clear over the past few years is that the best way to meet the needs of people in a community, particularly less tangible needs, is to work directly with them to find solutions.
Creating safe gathering spaces for cultural connection
San Diego’s City Heights neighborhood is home to one of the country’s largest communities of East African refugees. Residents arrived fleeing war, famine and other catastrophes, but many struggled in their new country. In addition to the significant trauma they brought with them, they now lived in an individualistic culture where economic survival was a real challenge.
The community organization United Women of East Africa Support Team (UWEAST) came together specifically to assist fellow residents in navigating services that could meet their health, economic, and educational needs.
Over time, the group’s leaders noticed that young men in the community were hurting. A spate of suicides — rare in their home countries — had occurred, and substance abuse and justice system involvement had become more common. “We were seeing young men in their early 20s using drugs, not going to college, ending up in prison,” Jama Mohamed, a Somalian refugee and UWEAST program coordinator, has said. “We kept having this conversation: what do we need to do?”
In response, UWEAST joined with several other organizations, including Prevention Institute, a national group focused on finding upstream solutions to health-related problems. Prevention Institute’s typical approach to community-level issues is to probe deeply into potential causes. In this case, said Ruben Cantu, an associate program director at the institute, “We coached them through the process of doing a community assessment. We asked, ‘What are the biggest needs? Where is this coming from? What’s driving these needs?’”
The answers revealed that gentrification-related displacement was one of the issues causing real turmoil in the East African community. Spaces that had once served as sanctuaries — mosques, churches, culturally-specific stores and restaurants — were disappearing. Young men in particular had lost their sense of belonging, as well as the physical places where they could connect.
In response, UWEAST, with support from Prevention Institute and other partners, created a local community center. “It’s a place where they can come together to hang out,” said Cantu. There, they can be themselves, learn about behavioral health services, and receive job and leadership training.
“Our long term evaluation is still going on, but in the short term, they’ve been able to build an internal resilience to weather the changes in the community,” said Cantu.
Across the country, another group has come to a similar conclusion about its community’s needs. Virginia Community Voice (VCV), a participant in Build Healthy Places Network’s Community Innovations for Racial Equity Initiative, is an organization focused on Richmond’s traditionally Black neighborhood of Southside. During Covid, VCV was able to provide some funding for families struggling financially, and its leaders gained a glimpse into the deeper trauma many residents were experiencing.
“We really saw how much people were feeling pain,” said Lea Whitehurst-Gibson, VCV’s Executive Director. “It was already there, but it was exacerbated by the pandemic.”
In listening to residents, responding to their needs, and advocating for them, the organization has always inherently promoted community healing. But in the wake of Covid, Whitehurst-Gibson and her staff realized it was time to more explicitly focus on those underlying issues. Through surveys and interviews, Virginia Community Voice staff learned that residents, and particularly seniors, wanted a safe space where they could engage with neighbors.
VCV heard them and is now developing a “healing hub”: a renovated school where residents of all ages can come together and be supported by wellness practitioners. “Our vision is for this to be a community center on steroids,” said Whitehurst-Gibson. She and her staff are envisioning a wide range of therapeutic services provided by partners, including the city’s health department, as well as broader offerings like a community farm.
“Healing-centered transformation means equipping neighbors in historically marginalized communities with the tools to realize their vision for themselves, their children, families and communities.”
The organization is explicitly designing the hub to prioritize racial healing for community residents. “We need a shift from trauma-informed care to healing-centered transformation. This is especially critical in communities of color that need space to heal — not just from the stress of the Covid-19 pandemic, but from centuries of unhealed trauma resulting from racism and oppression,” VCV has written about the project. “Healing-centered transformation means equipping neighbors in historically marginalized communities with the tools to realize their vision for themselves, their children, families and communities.”
Above all, this innovative approach to community health will be a place where residents can connect with one another. “We don’t always want to think about [mental health], but it’s easier if someone’s validating it with you,” said Whitehurst-Gibson.
Residents’ services can meet people where they are
Some community development organizations are taking a more individualized approach to boosting residents’ mental health.
In southwest Ohio, St. Mary Development Corporation is a nonprofit providing affordable housing and services to people over age 55. While the organization has for years prioritized and invested in the Vital Conditions for Well-Being and Justice, even just a decade ago its leaders considered it primarily just an affordable housing developer.
But gradually, in parallel with increased awareness in the broader society, mental health has become an important topic for residents. Today, Executive Director Tim Bete says that 20–25 percent of residents report having mental health or substance abuse issues. In response, St. Mary has increased and refocused the services it provides.
“When residents feel stable and healthy, they’re happier and more successful.” Covid bore that out: despite the major stressors during the pandemic, she said, tenants in buildings with strong residents’ services tended to have better outcomes.
For instance, realizing that isolation was a real danger for many residents, St. Mary’s leaders installed free Wi-Fi throughout most of their communities and taught residents to use hands-free Amazon Echo devices. For those who had formerly been intimidated by computers, the training was revolutionary, particularly during Covid. Residents began asking Alexa to remind them to take their medication at a certain hour, to play their favorite music, to tell them a joke. “They got a big kick out of it,” said Bete. And because they were all learning something new at the same time, he added, “we found that it built personal relationships between residents.”
In 2021, the organization hired a full-time employee to run a wellness program for older adults. The focus is on both physical and mental health, with the understanding that the two deeply affect each other. For example, assistance with their physical mobility allows residents to do more of the activities they enjoy, which directly impacts their mental health. The initiative also offers educational services on stress management, substance abuse, depression, and grief.
And St. Mary provides service coordination to assist residents with general issues that arise, from figuring out how to buy groceries or get to appointments to adapting treasured possessions so that they remain usable. “The service coordinator plays a role that families are used to. It keeps people independent,” said Bete. “It all impacts mental health in one way or another. Otherwise, residents give up.”
While directly quantifying the mental health benefits of service coordination for seniors can be difficult, programs like St. Mary’s have been found to significantly reduce general healthcare costs — in part because of the activities, outings, and overall social support they make possible.
St. Mary is one of 53 affordable housing groups around the country that’s certified by CORES, a rating system indicating the effectiveness of resident services programs that’s administered by the coalition Stewards of Affordable Housing for the Future (SAHF).
Alexandra Nassau-Brownstone, vice president of resident outcomes at SAHF, is in charge of the CORES program. She says she’s seen a growing interest in service coordination among affordable housing providers, both for- and non-profit, as well as in mental health issues more broadly. “I’m hearing about a lot more organizations thinking about how to better support housing stability, and a big piece of that is resident wellness,” she said.
It’s not all altruistic; for-profit housing providers have realized that better services lead to fewer evictions, which ultimately results in cost savings. Regardless of the motive, recipients benefit.
“The pressures of not being able to pay rent, the impact on people’s well-being: that is mental health,” Nassau-Brownstone explained. “When residents feel stable and healthy, they’re happier and more successful.” Covid bore that out: despite the major stressors during the pandemic, she said, tenants in buildings with strong residents’ services tended to have better outcomes.
Resident services are expensive, and organizations often struggle to afford them. Implicitly acknowledging that constraint, Fannie Mae announced its new Healthy Housing Rewards program in 2018. The initiative offers a loan rate discount to developers who incorporate CORES-certified resident services and engagement, or physical amenities deemed health promoting.
While the certification processes can be complicated, participation in the program has grown quickly, demonstrating community development groups’ strong commitment to doing more for residents.
Overhauling the entire approach to put people first
“We had to make a shift. We were losing staff,” said Katsi Miranda-Lozada, director of community engagement at New Kensington Community Development Corporation (NKCDC). She was explaining why the Philadelphia organization decided to make a wholesale change and reorganize itself around a trauma-informed approach.
The phrase “trauma informed” has become popular of late in the community development field. Practitioners say it’s largely because the concept has already been used in healthcare and education for several years and has accrued a body of evidence. Some groups use it and descriptors like “person-centered design” or “resiliency” interchangeably; ultimately, they are all about an outlook that puts people and their experiences first.
Kensington, where NKCDC is based, is a low-income community experiencing very high rates of drug use and violent crime. Several years ago, the group’s leaders realized they needed to do more to acknowledge both the trauma that residents were experiencing, as well as the mental health struggles affecting staff as a result of their work in the neighborhood.
Today, that awareness pervades everything the organization does. “It’s how we deliver services and talk to people about it,” said Miranda-Lozada. When the group works with partners, it often trains them first in its trauma-informed approach. Community health workers take it into account in their interactions with residents. And the organization’s leaders have revamped their hiring policies to give greater weight to people with relevant lived experience.
NKCDC began its shift in 2017, but gradually other organizations have followed suit. Preservation of Affordable Housing (POAH) is a national nonprofit working in 12 states. Over the past few years, the group’s leaders became increasingly interested in identifying obstacles to residents’ success — particularly those caused by the housing group itself.
“We were also learning a lot about trauma-informed care,” explained Julianna Stuart, POAH’s vice president of community impact. “We began to think about how this applied to our organization as a whole: to how we manage, to rules and policies, to building design. What would it mean to reimagine affordable housing through that lens?”
How we feel about ourselves and our future is reflected in our physical health and our ability to build a satisfying life for ourselves and our family.
In 2020, the organization won a $2.5 million award through the Housing Affordability Breakthrough Challenge competition, sponsored by Enterprise Community Partners, to do just that.
Over the course of two years, POAH created a deliberate, collaborative process to examine its operations and how they could be more people-centered. Four teams of residents and staff, each located in areas where the organization has housing developments, met regularly, together with professional facilitators and architects. Team members interviewed those living and working in POAH’s communities, then presented the results for the groups to unpack. Eventually, they devised solutions that could greatly reduce the stress experienced by residents.
For example, why did moving into many of POAH’s properties come with a dense set of requirements implicitly accompanied by the threat of eviction, which invariably increased residents’ anxiety? In response, group members created an orientation video and a process that introduced new residents in a much more welcoming manner.
Or lease violations: “It’s an overutilized tool to manage behavior or respond to challenges at a property,” said Stuart. In the past, residents had been given 10 days to respond to a potential violation. “We said, let’s change it to at least 30 days, and also make it so we don’t give those out so easily.”
The teams took on similar challenges in the physical environment. They identified and upgraded dark corridors, and management offices with walls so thin that no conversation could remain confidential. “How can we improve and promote a sense of safety in those spaces?” Stuart asked rhetorically.
Now POAH is incorporating those results in its properties around the country. The organization recently made all its findings available on its website so that other community development groups can make their properties — and the experience of living in them — safer, healthier, and more equitable. Above all, the group’s goal is to ensure that it isn’t adding more stress to residents who may already be struggling with a significant mental load.
In the end, residents and property owners aren’t the only ones who benefit. It’s a healthcare issue as well. Researchers have known for years that people with unaddressed trauma are at a higher risk for cancer, heart disease, asthma and diabetes. Similarly, having a sense of control over one’s life, and changes in one’s community, is directly correlated with better health outcomes.
In the end, of course, it’s all connected. How we feel about ourselves and our future is reflected in our physical health and our ability to build a satisfying life for ourselves and our family. When we’re left to languish, the costs are borne by a range of actors, including landlords, healthcare institutions, and taxpayers. Organizations’ ability to partner with communities and collaboratively design programs that can address issues before they have snowballed can make a world of difference.
