1. Psychologically Informed Environments
Developing homelessness services that recognise emotional and psychological needs

2. 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.

3. 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.

4. 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.

5. 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.
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.

6. 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.

7. 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

8. Psychologically Informed Environments
There are particular issues to consider around 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Five principles Social space Staff support Psychological framework
Managing relationships
Evaluation

18. 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

19. Setting up a PIE Social space Training and support Reflective practice
Psychological framework
Organisational buy-in

20. St Mungo’s model 4 training modules: Recovery
Managing relationships 1
Managing relationships 2
The Escape Plan
Enabling management
Recovery
Access to psychodynamic psychotherapy
Facilitated reflective practice

21. Evaluation Outcomes monitoring Client and staff experience
Wider impact
Organisational learning

22. 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

23. Contact details Helenkeats@gmail.com nm10@soton.ac.uk

24. Five principles Social space Staff support Psychological framework
Managing relationships
Evaluation