When Kimberley Repp saw how high the suicide rates were in Washington County, Oregon, she vowed to do something about it. Repp is the supervisor of the county’s public health program and the county’s epidemiologist, which makes her responsible for tracking and responding to diseases that affect public health, such as annual flu outbreaks. She never imagined that investigating suicide would become a key part of her work.
The number of people dying by suicide in Wash- ington County began climbing dramatically in 2009. That year, 55 people died by suicide. The numbers continued to climb until they hit a peak of 96 people dying by their own hand in 2012 – or approximately 18 per 100,000 people. That is well above the nation- al average of 13 per 100,000.
“That’s not just kind of bad,” says Kimberley Repp, Washington County’s epidemiologist. “That’s just…astronomically bad.”
Starting in 2014, Repp began accompanying the county’s death investigators to death scenes to see what clues or evidence were present in the room where a person was last living. She visited more than 200 scenes in a two-year period.
From these visits, she developed a list of 46 risk factors that contributed to a person’s risk of death by suicide.
Among the list of risk factors are those that one might expect: depression, social isolation, and problems with drug addiction or family or money. But one leaped out to Repp–and others. It was a quiet social problem that has started to drastically affect increasing numbers of poor people in recent years: eviction.
Repp found that eviction was a prevalent risk factor in 104 suicides in Washington County between 2014 and 2018. That included people who had experienced an eviction in the last two weeks of their lives or in the years shortly before. “I was really, really surprised by how prevalent eviction, as a crisis, and ongoing housing issues were […] directly impacting our suicide rates in Washington County,” Repp admits.
Evictions are stressful, especially for low-income people who do not necessarily have money saved to pay for moving costs, a security deposit and their first and last month’s rent. If someone is forcibly removed from their home as the result of an eviction, which happens to about 1 per cent of the Oregon population each year, it caps off, at times, months of worry and stress about the loss of one’s home.
People are most often evicted due to non-payment of rent, for illegal acts carried out on the rental property, or for continuous or recurring problems, such as with a pet, or loud noises.
But Oregon also allows no-cause evictions, which means that a landlord can give a renter notice to move without providing any reason. In Portland, due to reforms passed in 2015, renters who are given eviction notices must now be given 90 days’ notice to move. In the vast majority of cases, a landlord can simply send the renter an eviction notice and the renter has to move. In cases of non-payment or compliance issues, the landlord and the renter make arrangements to solve the problem.
But in cases where that does not happen, a landlord can file the eviction in court and pursue a court order to legally require the renter to move. A renter can challenge the eviction in court to have the eviction revoked or to have the move-out date changed. If the court sides with the lawyer, the renter can then be removed from the property. A notice is then attached to the front door of the rental, stating the move-out date.
From that point, the process only becomes more stressful and harried for renters. Renters have four days to move. If they do not, sheriff’s deputies
can go onto the property and forcibly remove the person, giving them only a few minutes to collect some belongings. It is typical, from that point, for the renter to be locked out of the home and to be allowed to retrieve their belongings only with a sheriff’s deputy present.
Lavar Edmonds is a sociologist and researcher at the Eviction Lab, which is based at Princeton University and maintains the first national database of evictions, with records of evictions dating back to 2000. He argues against a “dangerous assumption” that once someone is evicted, they will simply find another place to live.
“That’s not necessarily how it works,” he says, noting that an eviction is on a person’s court record and will show up on any background check that a future landlord makes. Oftentimes, he tells me, people who are evicted move into more substandard housing or become homeless. “Homelessness is not much of a leap in mind,” he explains, since many renters are forcibly evicted because of not paying the rent.
The Eviction Lab and the work of its founder, Matthew Desmond, author of the Pulitzer Prize-winning book Evicted, has raised awareness over the last few years about eviction as a dire social problem. Desmond’s research has shown clear links between eviction and increased rates of stress, depression, anxiety and other mental illnesses that last for up to two years after an individual is evicted.
The first comprehensive study analyzing eviction as a risk factor for suicide was published in a 2015 study in the American Journal of Public Health. The researchers identified 929 suicides that had eviction and foreclosure as the precipitating event leading to the death.
Nearly 80 percent of the suicides took place before the person actually lost their housing, and 37 per cent of people had experienced eviction or foreclosure within two weeks of their deaths. One of the main conclusions of the study is that during times of economic crisis, suicide prevention measures need to be increased.
In January 2016, a town hall meeting was held to discuss the increase in homelessness and lack of affordable housing in the Portland area–a crisis that had quickly escalated in Portland that year. At the meeting, Marissa Madrigal, Multnomah County’s chief operating officer, told a story about her friend Paul.
Paul lived in a small, dark basement apartment with his cat. It was not much, Madrigal explained, but “he had carved out a safe home after many, many different struggles.”
He had lived there, near Southeast Hawthorne Boulevard, for 10 years. The apartment had prob- lems with mold, so he told his landlord and asked that repairs be made. The landlord gave Paul a no- cause eviction.
Madrigal helped him get a lawyer. The apart- ment’s air was tested. She and other friends helped him as much as they could. They made a plan for Paul to stay at another friend’s in case he had to move. As long as someone checked on him, Mad- rigal said, “there was an outlet” for him to manage the stress and feel that things would be okay in time.
Their efforts were unsuccessful. The day before he had to move out, Madrigal said, the landlord posted another eviction notice on the door. Paul died by suicide the next day.
“The struggle and the pain of it just wore him down,” Madrigal said, when she spoke about eviction at the town hall meeting. “This is a life and death issue. This is not just an annoyance or an inconvenience.”
When Repp accompanies Deputy Medical Exam- iner Charles Lovato on death scene investigations, she says that she can “feel the suffering” in the rooms whre people ended their lives. People often leave eviction papers on their dining room or coffee tables – out in the open, where anyone can see them, as if the person had just set them down there.
In some cases, the papers were still nailed to the front door.
In response to what she learned in her research, Repp has worked with the Washington County Sheriff’s Office, which delivers court-ordered evictions, to have the phone number for a crisis line printed at the top of all eviction paperwork that a renter is given.
Members of the Washington County Mental Health Response Team, which intervenes when people are experiencing mental health crises, will now go along with a sheriff’s deputy who is serving an eviction if they know that the person is likely to be extremely upset. Since the intervention was implemented, the number of those who die by suicide in Washington County with eviction as a risk factor has fallen by 25 percent each year.
Since Washington County’s suicide intervention efforts began in 2015, about five deaths with eviction as a risk factor have been prevented each year.
“It could be life-threateningly bad news,” Repp says, of eviction. “If putting a piece of paper [in eviction paperwork] saves even one life, we’re going to do it. It could mean the difference between life and death to someone.”