Imelda Padilla-Frausto

D. Imelda Padilla-Frausto is a Center research scientist and co-author of a fact sheet on rent burden shouldered by low-income seniors in California. In this brief interview, Padilla-Frausto discusses the concept of rent burden and poverty, regional rent and senior budgets, and the image of “worry-free” retirement living.

Q: Your study says that more than three-quarters of low-income senior renters are rent burdened (pay 30 percent or more of their income on rent). How did this happen?

​Many low-income older Californians live on a fixed income year after year. But rental housing costs in California rise dramatically every year, creating an ever-growing gap between older adults’ income and rental housing costs. As this gap widens, more adults become rent burdened. Housing tends to be the biggest expense in older adults’ budget as documented by the California Elder Economic Security ™ Index (Elder Index), and low-income, older Californian renters are the most vulnerable.

In fact, California ranks third in the nation for having one of the largest gaps between renters’ wages and the cost of rental housing. This large gap is for wage earners so we can assume it is much worse for those on fixed-incomes like older adults.

Q: How can the rent burden for seniors be higher in Sacramento than in San Francisco? And what can be done about it?

​This difference is most likely due to rent-control policies that exist in San Francisco but not in Sacramento. For this data, rent burden is calculated using current spending on rent. So, while the cost to a new renter for a one-bedroom apartment in San Francisco is more than twice that for a comparable unit in Sacramento, the long tenure of older renters in San Francisco’s rent-controlled units likely reduces the actual rents paid by most seniors.

There are a few things that can be done to decrease the number of rent-burdened older adults, such as adopting more local rent-control policies for older adults in particular and building more affordable housing for seniors. Another unique approach would be to subsidize low-income older renters like the pilot project in Santa Monica called Preserve Our Diversity. This program provides rental assistance to their long-term residents over the age of 65 who would otherwise be displaced from the city due to their inability to pay their rent. The Santa Monica Housing Council used the Elder Index for Los Angeles City to identify the income an older adult needs to pay for basic living expenses.

Q: There's a general image that older adults retire and live comfortably in senior communities. What is the reality?

​For some fortunate older adults, this may be true, but for many older adults, the happily-ever-after ending of the “golden years” is complete fiction. Recent data from the Elder Index shows over one-quarter of older adults do not have enough income to cover basic living expenses, and there are particular groups of older adults who are disproportionally impacted.

For instance, older renters fare the worst compared to those who own their homes, regardless if they have a mortgage or not. Older Latinos, blacks and Asians are more likely to be economically insecure than their white counterparts. Older women are more likely to have less income to meet their basic living expenses than older men, but there is still one-quarter of older men who are economically insecure. Similarly, older Californians age 75 and over tend to be more vulnerable to economic insecurity than those age 65 through 74, but still one-quarter of the younger age group face economic challenges.

According to the 2018 California Health Interview Survey, over 3.2 million adults in California reported that they had serious psychological distress in the past year. Mental health issues have also had a tremendous impact on work, with about 72% of respondents experiencing mental health problems stating that they had to take time off of work, and 1 in 5 reported that they were unable to work for more than three months.

D. Imelda Padilla-Frausto, a research scientist at the UCLA Center for Health Policy Research, has focused her research on social and environmental factors related to mental health, access to mental health services, and economic insecurity. In this brief interview, she discusses the continued need for mental health research, the link between the COVID-19 pandemic and mental health distress, and policy implications discussed in an upcoming policy brief she is authoring, which calls for some added support for individuals experiencing moderate psychological distress.

Q: How did you get into mental health research? What is the current landscape of this type of research and in what ways can it be improved?

My research into mental health began when I was a teenager trying to understand and help a loved one when they were diagnosed with a serious mental illness. From the challenging times of getting them the proper services and care to the celebratory times of recovery and watching them graduate with their bachelor’s degree, it was these experiences that led me to dedicate my career to mental health research.

The landscape of mental health research is expanding in exciting ways. We are learning so much more about the brain, biological markers, and treatments have been improving over the years. At the same time, we also know that there are many psychosocial factors that contribute to poor mental health and mental disorders, and we are learning more about the combination of psychosocial and biological markers from various studies. I am beginning to see more efforts to take a public health approach to mental disorder which include strategies for preventing mental disorders and intervening early to mitigate the severe and disabling effect of serious mental illnesses.

The National Institute of Mental Health (NIMH), the lead federal agency on mental health research, recently published their strategic plan for research, which I’m happy to see incorporates each of these aspects. I think to ensure NIMH efforts are achieving positive results, it will be crucial to develop and establish mental health surveillance systems at the national, state, and local levels to collect population-level data on mental health and service use outcomes. These efforts would also need to include more frequent psychiatric epidemiological surveys. The last Collaborative Psychiatric Epidemiological Surveys were conducted nearly two decades ago (2001-2003) even though the landscape of psychosocial factors contributing to poor mental health and improvements in treatment has changed during that time.

One aspect of mental health research that I believe is not given enough attention is in the area of mental health services and policies. I believe more needs to be investigated in this area to better understand the complexities of accessing timely and appropriate care that is culturally relevant and linguistically appropriate. There is a crucial need for collecting current mental health data and conducting more mental health service research, as about 1 in 5 U.S. adults experience mental illness and 1 in 25 experience serious mental illness, according to the National Alliance on Mental Illness, but only about one-half receives the services they need.

Q: How is the current pandemic affecting the mental health of Americans and individuals across the globe? Will there be an assessment of the impact of COVID-19 on mental health?

The COVID-19 pandemic has undoubtedly affected mental health across the U.S. and beyond ─ from grieving the loss of loved ones to having uncertainty about the future. The public health crisis has removed us from our normal routines: children are out of school, unemployment rates have risen drastically, those who have jobs are working from home if they are able to, and there are restrictions on leaving the house to help “flatten the curve.” I’d assume many people are finding it difficult to adjust to this “new normal”, which unfortunately has put many children’s and families’ mental health at-risk if they are in living situations with difficult family dynamics or where domestic violence exists. Due to massive economic losses, individuals are experiencing issues accessing essential resources such as food and not being able to pay for housing, rent, and other necessities, also contributing to a great deal of mental and psychological distress. There’s also added mental and physical stress on individuals who are at a higher risk for being infected, such as those with chronic, underlying conditions and older adults.

Yes, there is definitely going to be analyses of how COVID-19 has impacted (or will continue to impact) the mental health of individuals across the country. NIMH has rolled out the Mental Health Impact of COVID-19 Pandemic Study, which aims to assess the impact of the current public health emergency. Also, with COVID-19 questions included in the California Health Interview Survey (CHIS) since March 2020, researchers will be able to assess the mental health impact of this pandemic.

The United Nations published a policy brief COVID-19 and the Need for Action on Mental Health that discusses the mental health impact from the 2008 economic crisis which included a rise in “deaths of despair” among working age Americans. Suicide and substance-use accounted for most of these deaths and were linked to the loss of hope due to the lack of employment and rising inequality. As the economic burden from COVID-19 increases, the short and long-term mental health impacts on individuals, families, and society as a whole must not be overlooked, there needs to be ongoing assessments. I imagine other researchers and public health advocates will want to look at the mental health services and supports needed across diverse groups.

Q: Can you give us a preview of the upcoming policy brief and suggested steps to bridge the gaps in mental health services for individuals experiencing mental distress?

The suggestions in the upcoming brief talk about the passage of the California Mental Health Services Act (also known as Proposition 63) and efforts to expand mental health services in the state, in particular, prevention and early intervention services. While there have been efforts to identify service needs for individuals with serious psychological distress, this policy brief is the first to identify service needs for individuals with moderate psychological distress who may benefit from prevention and early intervention services. Our findings highlight that funding and resources need to be dedicated to expanding services to almost 2 million Californians who have serious or moderate psychological distress but who have not accessed professional help in the past year. In March 2020, the Kaiser Family Foundation conducted a poll that found that almost 50% of adults reported that the pandemic has affected their mental health and 19% said that there was a major impact on their mental health. As such, we also suggest legislation may be needed to devote funding to address the likelihood of having a heightened demand for mental health services. Our policy brief will be published in mid-July and in the upcoming year we will be increasing our mental health research portfolio with a series of policy briefs on the increase in serious psychological distress over the past two years, the mental health of Latino and Asian ethnic groups and their use of services, women’s mental health, and a fact sheet on teen mental health. We hope to engage stakeholders to move progress forward in the field.

A study published today by the UCLA Center for Health Policy Research shows that the economic effects of COVID-19 increased the risk for poor mental health among California adults.

The research, which draws data from the 2020 California Health Interview Survey, revealed that because the pandemic disrupted many California adults’ ability to pay for housing, basic necessities and child care, it increased the risk of psychological distress, which in turn severely impaired their daily functioning.

During the first year of the pandemic, 12% of the respondents reported that they had experienced serious psychological distress, and 11% reported moderate psychological distress. Those who had difficulties with finances or child care due to the pandemic were up to twice as likely to have serious or moderate psychological distress.

“In order to reduce the additional risk of psychological distress and severe impairment related to COVID-related economic hardships, policymakers need to give all Californians access to the financial and social resources that will help bridge the gap in economic insecurity,” said Imelda Padilla-Frausto, PhD, a research scientist at UCLA CHPR. “Recovery from the pandemic begins with addressing many longstanding inequities across the state.”

The research revealed that marginalized racial and ethnic groups were disproportionately affected:

• 15% of Latino adults lost their jobs and 26% had their work hours reduced; for white adults, those figures were lower — 11% and 22%. ;
• 16% of Black and African American adults said they had difficulty paying their rent or mortgage, versus 11% of Latinos, 9% of people of Asian descent and 5% of white residents.
• 15% of Black and African American adults said they had difficulty paying for other basic necessities due to the pandemic, compared with 12% of Latinos, 8% of people of Asian descent and 6% of white residents.

While the pandemic seemed to shine a light on those issues, UCLA researchers said these racial and ethnic inequities existed prior to COVID-19.

Additionally, COVID-related financial and child care struggles increased the risk of severe functional impairment — meaning difficulties carrying out day-to-day tasks such as household chores, work or school responsibilities, and issues surrounding their social life and personal relationships — for adults with serious or moderate psychological distress.

The risk for severe functional impairment among adults with serious or moderate psychological distress was significantly higher for people who had financial or child care struggles due to the pandemic.

For example, 55% of those who had serious or moderate psychological distress and who also had difficulties with child care said their personal relationships were severely impaired — and 55% of that group also said their ability to carry out household chores was severely impaired. The struggles also took a toll on people’s social lives: 53% of those who had serious or moderate psychological distress and challenges with child care said their ability to manage their social life was severely impaired.​