Psychologically Informed Environments Developing homelessness services that recognise emotional and...

Psychologically Informed Environments

Developing homelessness services that recognise emotional and

psychological needs


• A presentation by Helen Keats, National Rough Sleeping Advisor, Dr Nick Maguire, Southampton University and Peter Cockersell, St Mungos

• It will outline the key themes of the PIE guidance, explain what PIEs are and describe how St Mungos is changing its services into ones which are psychogically aware.


• Recent research suggests that behaviour which can increase the likelihood of homelessness may be associated with mental health problems such as:

• • personality disorder• • post-traumatic stress disorder• • complex trauma; or• • conduct disorders in children.


• Research carried out by Dr Nick Maguire at Southampton University on behalf of the Department of Communities and Local Government (DCLG) 2009/10 identified that up to 60% of adults living in hostels in England have diagnosable personality disorder compared with about 4.4% in the general population.


• The research led to the publication of non statutory guidance: “Meeting the psychological and emotional needs of homeless people” July 2010 and development of the concept of Psychologically Informed Environments.

• www.nmhdu.org.uk/complextrauma

• The concept of a PIE was originally developed by Robin Johnson and Rex Haigh, as part of the Royal College of Psychiatrists’ Enabling Environments initiative.


• Psychologically Informed Environments (PIEs) recognise and tackle the ways in which people with complex trauma can behave, and which can often result in eviction, exclusion and rough sleeping.


People who have experienced homelessness and whoexperience complex trauma can prove difficult to engage with, demonstrate volatile, irresponsible, risky or antisocial behaviour and use drugs and alcohol as a form of self medication.

They may behave and think in particular ways whichperpetuate their problems. This makes key workingvery hard and at times frustrating for both clientand worker


• There are particular issues to consider around 16-17 year-olds who may have had traumatic and abusive childhoods. On top of the problems of adolescence which affect young people generally, they may also exhibit behavioural problems such as conduct disorder, often associated with antisocial behaviour which can lead to homelessness


• Some people may for example:

• • self-harm or have an uncontrolled drug and/or alcohol problem• • appear impulsive and not consider the consequences of their

actions• • appear withdrawn or socially isolated and reluctant to engage

with help which is offered• • exhibit anti-social or aggressive behaviour• • lack any structure or regular daily routine• • not have been in work or education for significant periods of time• • have come to the attention of the criminal justice system due to

offending


The initial guidance on the PIE concept has been followed by an operational guide for commissioners and service providers which explains how to develop PIEs.

It can be found atwww.homelesshealthcare.org.uk

Psychological Frameworks

• Number of different psychological frameworks available:– Cognitive-behavioural, Dialectical behavioural– Psychodynamic– Person-Centred approaches

• Main aim is to enable people to reflect on internal experiences (thoughts and feelings)

• Enable choice about behaviours• Work through interpersonal relationships

Functions of psychological thinking

• Staff: – Enable reflection to make more considered

decisions around client behaviour• Choice

– Enable reflection on difficult emotions (anger, anxiety, hopelessness); reduce burnout, rumination about difficult situations;

– Increase confidence establishing and maintaining interpersonal relationships

Functions of psychological thinking

• Service users– Enhance individuals’ abilities to make meaningful

change– Increase in ‘functional’ behaviours; reduction in

‘asocial’ behaviours– Increase in quality of interpersonal relationships– Manage emotions

Psychological frameworks

• Emotion dyregulation a key issue– Relationship between early abuse and

maladaptive behaviours

• Enabling people to better regulate emotions beneficial in terms of consequent behaviour

• Achieved in a number of different ways, e.g.– Skills teaching and rehearsal– Interpersonal relationships

Enabling psychological thinking

• Thinking psychologically is a skill• Training useful• Must be accompanied by rehearsal of that skill– One of the functions of regular supervision

Summary• Staff can learn skills through training and

reflective practice• To more effectively:– Help themselves– Help their clients engage in change

• Psychological thinking can inform design of environments– http://www.healinglandscapes.org/resources/

ebd.html– http://www.healthdesign.org/

Five principles

• Social space

• Staff support

• Psychological framework

• Managing relationships

• Evaluation

Managing Relationships

• Complex trauma arises from abusive relationships• Healing relationships need to be managed, and take

care, and time• Relationships have an impact on both/all parties• Group dynamics affect individual group members’

relationships• Setting up PIEs is also about managing relationships

Setting up a PIE

• Social space

• Training and support

• Reflective practice


• Organisational buy-in

St Mungo’s model

• 4 training modules:– Managing relationships 1– Managing relationships 2– The Escape Plan– Enabling management

• Recovery• Access to psychodynamic psychotherapy• Facilitated reflective practice

Evaluation

• Outcomes monitoring

• Client and staff experience

• Wider impact

• Organisational learning

Setting up PIEs

• It’s about creative, not directive, support• Beware of technical language, it divides • Clinical input is part of the team approach• Power changes can produce powerful

resistance, and/or big changes• Positive client outcomes are what we’re trying

to achieve

Contact details

[email protected]

[email protected]

[email protected]

Five principles

• Social space

• Staff support


• Managing relationships

• Evaluation

Psychologically Informed Environments Developing homelessness services that recognise emotional and...

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