from Health Affairs: Right to Counsel in Eviction Cases – A Public Health Imperative

By Aashna Lal

Approximately 7.6 million Americans face the threat of eviction each year, with evictions increasing in most major cities. Threat of eviction is associated with a number of adverse health outcomes, including high blood pressure, anxiety, despair, and physical illness. Actually, experiencing an eviction is associated with even worse health and socioeconomic outcomes, as well as higher rates of homelessness.

What is more, these health risks are not evenly distributed. Due to decades of discriminatory housing policies, racial segregation, and income and wealth inequality, people of color, specifically women and those with young children, are disproportionately represented in eviction cases. While a growing body of literature recognizes this as a public health issue, few have examined the health benefits of specific interventions aimed at reducing the incidence of eviction.

One promising intervention is implementing a right to counsel in housing court. Policy makers who establish such a right commit to ensuring that eligible individuals facing threat of eviction are represented by a lawyer; when those individuals cannot afford to hire a lawyer, one is provided at low or no cost. Unfortunately, right now, this right is uncommon. Most states do not guarantee legal representation in housing court, meaning that if you want a lawyer by your side, you have to hire one out of pocket. As a result, a large proportion of tenants are left to appear in complex bureaucratic eviction hearings entirely on their own. This lack of legal aid in eviction cases contributes to high rates of housing instability and homelessness, which are significant predictors of health. Given the numerous adverse outcomes associated with eviction, implementing a right to counsel for people facing the threat of eviction should be considered a public health imperative.

Evictions And Health Outcomes in the United States

Since the start of the COVID-19 pandemic, there has been a spike in the number of studies on the relationship between eviction and health. A scoping review of studies from 2009 to 2022 found “strong and consistent evidence that eviction was significantly and positively associated with poor mental health, injection drug use, violence, exposure to infectious diseases, and mortality.” Eviction has been linked to a four-times higher likelihood of committing suicide and higher rates of depression compared to those who have not experienced eviction. For women with newborns, there is a strong and consistent association with premature births and low birthweight. Eviction during early childhood is also associated with a number of adverse health and developmental outcomes. Some studies have found that these impacts persist for years; for example, in the two years following an eviction in New York City, people visited the emergency department or required hospitalization for a mental health condition at higher rates than those who did not experience eviction. In many studies, the association between eviction and adverse health outcomes is amplified for Black renters, women, parents, and those residing in low-income neighborhoods.

Eviction is also associated with adverse socioeconomic outcomes. The 2.9 million children who face the threat of eviction each year encounter disruptions to their schooling, often leading to lower attendance and higher rates of dropping out. Having an eviction or even just a filing on record usually results in “blacklisting,” as many landlords will deny applicants with a prior eviction filing. Eviction also has strong ties to homelessness. In New York City, an eviction increased the likelihood that a household would apply for a homeless shelter by 14 percent, and 25 percent of families eligible for shelter cited eviction as the reason for their homelessness. In Massachusetts, the number of homeless or at-risk households citing eviction as the primary cause was 45 percent in 2011.

Importantly, this is a racialized issue. Black and Hispanic Americans face disproportionately high rates of evictions. For example, Black Americans make up 51.1 percent of eviction filings and 43.4 percent of evictions, despite accounting for only 18.6 percent of all renters, translating to approximately one in five Black Americans in rental units facing the threat of eviction each year and one in 10 actually being evicted. This issue is exacerbated for women of color, especially those with young children, meaning that women and children of color are at much higher risk of facing the adverse health and socioeconomic outcomes associated with eviction.

Right To Counsel in Housing Court

As of 2021, approximately 90 percent of landlords were represented by legal counsel in eviction cases, compared to less than 10 percent of tenants, an arrangement that “systematically sets up tenants to fail.” The rental housing landscape in the US is notoriously complex, leaving the vast majority of tenants without the knowledge and experience to defend their case. Right to counsel is an increasingly popular intervention to address this inequity. Seventeen cities, four states, and one county have implemented a right to counsel for low-income tenants facing eviction, with varying eligibility thresholds. In these jurisdictions, the outcomes are extremely positive. In Kansas City, Missouri, 91.5 percent of tenants have avoided eviction, compared to the 99 percent of tenants who were evicted before a right to counsel was established. In New York City, 84 percent of represented tenants remained in their homes, and default judgments dropped by 34 percent. In Cleveland, Ohio, 93 percent of represented clients avoided an eviction ruling or an involuntary move.

The benefits also extend beyond lowering the number of evictions. In a Quincy, Massachusetts, study, represented tenants “received almost five times the financial benefit (for example, damages, cancellation of past due rent) as those without full representation.” In Cleveland, of the 21 percent of clients who were originally unaware of rental assistance, approximately 98 percent wanted rental assistance, and lawyers helped 81 percent of them obtain it. In California, fully represented tenants with an eviction ruling were given twice as long to move as unrepresented tenants. Some cities with a right to counsel have also seen a drop in the number of evictions filed, suggesting that landlords may be less likely to file unlawful evictions when they know tenants will be represented.

Pilot studies also show a direct association between access to counsel and reductions in homelessness. As a result, cities with a right to counsel are estimated to save millions of dollars each year from homelessness costs. A San Francisco, California, report projected more than $1 million in savings from emergency shelter costs alone, and the Boston Bar Association estimates that implementing a statewide right to counsel for eviction cases would save Massachusetts about $37 million in emergency shelter, health care, and foster care costs.

Persistent Obstacles

Undoubtedly, paying for legal fees for all low-income individuals who face the threat of eviction is expensive. It may even be more affordable for state or federal government to provide rental assistance to tenants or landlords instead of guaranteed legal assistance. However, it is well-documented that a number of landlords engage in predatory, often illegal, eviction practices, justifying the need for a right to counsel. A sizable body of reports during the COVID-19 pandemic illustrates this tendency, revealing tens of thousands of eviction notices that were issued despite a federal eviction moratorium and federal rental assistance. A July 2022 report by the US House Select Subcommittee on the Coronavirus Crisis found that four large corporate landlords did not comply with the federal eviction moratorium and rental assistance programs, filing almost 15,000 evictions and using numerous strategies to mislead, harass, or deceive their tenants.

Furthermore, there is not substantial evidence that increasing affordable housing alone will decrease eviction rates. A study of neighborhood characteristics and eviction rates in Kansas City found that eviction rates are higher in neighborhoods with more federally subsidized units. Additionally, evictions are disproportionately concentrated in a small number of neighborhoods, and even specific buildings within those neighborhoods, exemplifying the unfortunate reality that some landlords strategically deploy eviction “as a tool for rent collection and tenant control.” Thus, while building more affordable housing and implementing policies that increase incomes and income-eligible benefits are necessary to reduce eviction rates, we can and must do more: In particular, providing legal representation for people facing eviction remains an important step in the face of predatory landlord practices.

The Role of Public Health in Securing a Right to Counsel

Grassroots organizers and coalitions have worked tirelessly to advocate for a right to counsel in cities and states across the country. And yet, the intervention has remained largely ignored in public health, despite its effectiveness at reducing evictions and homelessness. Much of the public health literature has instead focused on COVID-19-era eviction moratoria and emergency rental assistance. This is perhaps due to the essential legal nature of right to counsel. However, there is evidence that medical-legal partnerships are incredibly effective as public health interventions. The National Center for Medical-Legal Partnership, which leverages legal services in clinics across the country to address social needs, reports benefits including improved access to housing needs, reduced stress, improved access to income and insurance needs, and fewer hospitalizations.

In addition, right to counsel laws are already advancing public health goals in other types of legal proceedings. For example, federal law requires that states receiving federal child abuse prevention and treatment funding provide legal representation for children in abuse or neglect proceedings. Some states guarantee legal representation in domestic violence proceedings, visitation and permanency proceedings for children in foster care, involuntary institutionalization for mental illness proceedings, and involuntary vaccination proceedings. Maryland provides a right to counsel for eligible people with disabilities who are suing or being sued, and Indiana provides a right to counsel for the subject of petitions for involuntary release of mental health records.

Statewide efforts to secure a right to counsel for tenants in housing court hold great promise. Evidence indicates that such efforts have the potential to directly reduce evictions and eviction filings while also securing greater benefits for those who are evicted. More broadly, such progress would help address the numerous, persistent health outcomes associated with housing instability and homelessness. As such, the field of public health should actively and enthusiastically support right to counsel efforts.

Conducting more and better research on the health effects of right to counsel measures, where implemented, is one place to start. Legal epidemiology, a subfield in public health that studies how laws influence the cause, spread, and prevention of disease, would be especially pertinent in this research.

Public health practitioners should also support advocacy efforts by lobbying legislators in states and cities that are voting on right to counsel (to find active legislation, consult the National Coalition for a Civil Right to Counsel status map).

Lastly, the field of public health can continue to integrate legal knowledge and expertise into its interventions and strategies, with recognition that collaborative approaches with the legal field often have immense benefit in advancing population health.

Source: Health Affairs - Right To Counsel In Eviction Cases: A Public Health Imperative