Psychologically informed support for homeless people: what it means and why it’s crucial

26 January 2017

Mental health problems affect large numbers of homeless people and those who were homeless and now live in supported housing. Neglect, abuse and the ongoing impact of traumatic experiences in childhood are all factors which lead to this higher risk of mental ill health.

The complex traumas people have experienced, and how they may be expressed, often make accessing and staying engaged with services especially difficult. In spite of the complexity of the problems people face, services that adopt a psychologically informed approach can enable people to move on and thrive in life.

Psychologically informed environments (PIEs) are services where the day-to-day running has been designed to take the psychological and emotional needs of people with these experiences into account.

The approach has been developed in recognition of how crucial it is that services do all they can to create environments that aid and do not hinder in people's recovery, understanding what they may have experienced and how this could impact how they relate to services.

There is no structure set in stone, or specific recommended policy that defines a psychologically informed environment. Rather, PIE is a mode of working that places people and their individual needs at the centre. This translates meaningfully into the day-to-day running of the service. The social environment created is one that enables and sustains recovery.

What might an uninformed environment look like?

A person comes into contact with a homelessness outreach service having experienced childhood trauma. In this uninformed environment, none of the staff or volunteers are aware of the consequences or effects that trauma could have had on this person.

The trauma could be unintentionally reinforced and continued. The person is misread as reluctant to receive help or engage with the service because of their extreme social anxiety (a result of the trauma they have experienced). The signs of trauma go unnoticed and the person's experiences go unaddressed for too long, making the effects more difficult to treat in the future.

How can we make PIEs work?

There is no single formula to making a PIE work; different approaches can be applied to suit individuals. However, there are some core elements to consider, such as staff training, the design of a service and reflective practice. A good marker of whether a service operates in a psychologically informed way or not is how staff articulate how their service is run and why:

"For the moment, at least, the definitive marker of a PIE is simply that, if asked why the unit is run in such and such a way, the staff would give an answer in terms of the emotional and psychological needs of service users, rather than giving some more logistical or practical rationale." (Johnson & Haigh, 2010)

There’s a growing awareness of trauma and resulting mental health problems in the homelessness sector and, with it, a demand for better understanding of how services can improve the psychological wellbeing of the people they support. That’s why it’s essential that we build a movement based around the PIE concept. I’m delighted to be chairing Homeless Link’s event to advance understanding of the need for psychologically informed support for people experiencing homelessness and those living in supported housing.

By marrying practice and research together at this conference, we can showcase practice that is backed up by evidence and develop the research agenda further, informed by practice. We can begin to build services that fully understand the challenges facing them and continue to develop and transform the way these services are delivered.