Everyone knows that the rent is too damn high, but for seniors in the Mission and all across San Francisco, the mental health implications born from the struggle to find stable housing can have dire consequences.

“Every single senior I’ve ever spoken with about evictions reports tremendous anxiety,” said Theresa Flandrich. Flandrich, who has experienced eviction, is an organizer at Senior and Disability Action, a SoMa-based organization that mobilizes and educates seniors and those with disabilities around social justice issues.

As housing prices in San Francisco continue to rise, so too does the number of people evicted. From March 1, 2017 to February 28, 2018, there was a 109 percent increase in evictions caused by capital improvements, and a 58 percent increase in evictions caused by the Ellis Act’s withdrawal of units. (The Ellis Act, passed by the California legislature in 1985, permits landlords to evict all tenants if they wish to exit the rental market altogether.)

This high-priced, competitive housing market takes a particularly high toll on the mental health of the city’s most vulnerable populations, says psychologist Tori Branch. Branch is the director of Clinical Services at the Access Institute, a nonprofit that provides therapy and psychiatric services to those who are underinsured and uninsured.

“Somewhere between 15 and 20 percent of the people who complete an intake with us mentioned something about feeling anxiety, or stress about money or finances, or specifically housing,” said Branch.

“Things have gotten far worse than they ever were,” said Tommi Avicolli Mecca, director of the counseling program at the Housing Rights Committee of San Francisco. Mecca, who has lived in San Francisco for 27 years, said he has been advocating for tenants’ rights for 19 of those years and has seen a definite change in recent years.

Data on the mental health consequences of housing instability are scarce, but tenants’ organizations and counseling groups, like those Branch and Mecca work for, said they are seeing the effects firsthand. And, in December 2010, a federal program found that safe housing is one of the basic needs crucial to good health, along with access to food and community design.

Branch sees clients facing a cascade of anxiety-inducing problems once their housing is threatened. The mere threat of eviction can lead to anxiety; the fight to avoid eviction can be stressful; and increased anxiety, stress or depression can affect job performance, which can lead to eviction. This is one cycle Branch has observed.

“It’s sort of like the chicken and the egg,” Branch said. “Once you lose something it’s hard to get it back.”

Flandrich’s own experience offers an all too common example. She fought to keep her own home in the face of an Ellis Act Eviction for nearly four years, until she was finally evicted in 2016.

She said she experienced fear and anxiety while going through the eviction, and now occasionally suffers post-traumatic stress while counseling seniors experiencing their own housing problems.

“There is this underlying anxiety that is always there,” said Flandrich, who now has a new home. “It’s also the horror of what has happened to this city, that people are treated this way, that homes are treated as coffee beans on the market.”

For 100-year-old Iris Canada, fighting several eviction attempts from her home of more than five decades in the Lower Haight was ultimately a death sentence, family members said. Canada had a unique lifetime lease on her apartment that was granted in 2005. In 2014, the owners sought to evict Canada to convert the building into condominiums. After a lengthy fight in court, Canada was granted the right to stay as long as she paid the owner’s attorney’s fees that racked up while Canada fought the evictions. The fees totaled more than $100,000. Canada was eventually evicted in February 2017. She died shortly afterward, in March.

“Her doctor wrote a lot of letters describing her stress relating to this,” said Iris Merriouns, Canada’s great-niece. “Whenever we would go to court, her heart rate would go through the roof. It would take a few days for her to come back down.”

But fighting sometimes is the only thing people can do.

“People ask me, ‘was it worth it to fight?’” said Flandrich. “It wasn’t just about me. It was about, you know, what’s going on in the city.”