Psychologically Informed
Environments
Developing homelessness services
that recognise emotional and
psychological needs
Psychologically Informed
Environments
• 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.
Psychologically Informed
Environments
• 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.
Psychologically Informed
Environments
• 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.
Psychologically Informed
Environments
• 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
• 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.
Psychologically Informed
Environments
People who have experienced homelessness and who
experience 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 which
perpetuate their problems. This makes key working
very hard and at times frustrating for both client
and worker
Psychologically Informed
Environments
• 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
Psychologically Informed
Environments
• 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
Psychologically Informed
Environments
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 at
www.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.ht
ml
– 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
• Psychological framework
• 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
Helenkeats@gmail.com
nm10@soton.ac.uk
peter.cockersell@mungos.org
Five principles
• Social space
• Staff support
• Psychological framework
• Managing relationships
• Evaluation