Presentation on theme: "Psychologically Informed Environments"— Presentation transcript:
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 MungosIt 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 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
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 behaviouralPsychodynamicPerson-Centred approachesMain aim is to enable people to reflect on internal experiences (thoughts and feelings)Enable choice about behavioursWork through interpersonal relationships
12 Functions of psychological thinking Staff:Enable reflection to make more considered decisions around client behaviourChoiceEnable 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 usersEnhance individuals’ abilities to make meaningful changeIncrease in ‘functional’ behaviours; reduction in ‘asocial’ behavioursIncrease in quality of interpersonal relationshipsManage emotions
14 Psychological frameworks Emotion dyregulation a key issueRelationship between early abuse and maladaptive behavioursEnabling people to better regulate emotions beneficial in terms of consequent behaviourAchieved in a number of different ways, e.g.Skills teaching and rehearsalInterpersonal relationships
15 Enabling psychological thinking Thinking psychologically is a skillTraining usefulMust be accompanied by rehearsal of that skillOne of the functions of regular supervision
16 SummaryStaff can learn skills through training and reflective practiceTo more effectively:Help themselvesHelp their clients engage in changePsychological thinking can inform design of environments
17 Five principles Social space Staff support Psychological framework Managing relationshipsEvaluation
18 Managing Relationships Complex trauma arises from abusive relationshipsHealing relationships need to be managed, and take care, and timeRelationships have an impact on both/all partiesGroup dynamics affect individual group members’ relationshipsSetting up PIEs is also about managing relationships
19 Setting up a PIE Social space Training and support Reflective practice Psychological frameworkOrganisational buy-in
20 St Mungo’s model 4 training modules: Recovery Managing relationships 1Managing relationships 2The Escape PlanEnabling managementRecoveryAccess to psychodynamic psychotherapyFacilitated reflective practice
22 Setting up PIEs It’s about creative, not directive, support Beware of technical language, it dividesClinical input is part of the team approachPower changes can produce powerful resistance, and/or big changesPositive client outcomes are what we’re trying to achieve