While homelessness is a complex issue, one of the main reasons people give for experiencing homelessness is relationship breakdown. There is a strong case to be made that relationships should be at the centre of homelessness service provision.
The Waterloo Project, described as “trailblazing” by the NHS and “revolutionary” by Third Sector, is an example of this. Part of the Thames Reach, a London-based homelessness charity, the project is run as a Psychologically Informed Environment (PIE). This means it takes into account the thoughts, feelings, personality and past experience of participants. Relationships are at the heart of the Project because residents work with individual key workers to determine what kind of support they need and one to one or group therapy sessions facilitate building confidence and a positive environment. The aim of the project is to help residents to become more self-reliant, find work, find a stable home and contribute positively to society.
While there is no all encompassing formula for PIEs, the main idea is that they are environments purposefully designed to facilitate the psychological and emotional needs of the service users. For any activity undertaken, or any feature of the environment, the question should be, “How does this help the person to overcome obstacles and develop?” They are also reflective and dynamic. Service users work together with providers to learn from experiences, in order to determine what plan is best for them. The relationships between service users, and between service users and key workers, are vital to the therapeutic process, as they help to build self confidence and openness.
Therapeutic communities such as PIEs have a long history beginning with the York Retreat, a Quaker community founded as an antidote to the inhumane treatment of people in asylums who were manacled, physically abused and cut off from society. The community used a number of techniques to rehabilitate people including occupational therapy, family-like social units, gardening and prayer.
Though the York Retreat began in the late 18th century, there are surprising parallels between the situations then and now. Today, those who find themselves in the position of being homeless are physically abused, ignored, mistrusted and misunderstood. But the PIE system helps people to recover their dignity and confidence through simple, flexible, non compulsory support.
The PIE approach has been largely effective. Government research has found PIE pilot programmes to be beneficial in a number of settings including prison environments. The Thames Reach has received a £1 million grant from Guy’s and St Thomas’ Charity. Those who have been helped by the service believe it should be the norm. It has been shown to help people with undiagnosed mental disorders, or who have a mistrust of health care professionals.
One of the people helped by the Waterloo Project was Jane. At first, she didn’t accept the support offered to her. She had previous experience with issues including domestic violence, drug addiction and self harm, and had been diagnosed with Borderline Personality Disorder. As a result of these and other challenges her children were taken into care. The most effective approach for Jane turned out to be indirect support, rather than direct therapy, given her mistrust of mental health services. After a while she began to engage in group therapy sessions and then individual therapy. As a result she has received help for her drug dependency, has moved into independent accommodation and has started a college course.
These and many other stories attest to the power of PIE. They show that innovation and creativity in homelessness support services are improving the lives of those who are homeless and have mental health problems. It also shows that homelessness is best addressed holistically, as all the issues surrounding homelessness are interrelated. People need to be shown the dignity of being seen as more than a collection of problems.
At New Hope, we take a similarly holistic approach to helping the people we support. Our community market garden is a good example, possessing many of the features of a PIE. In the garden service users work together to maintain and grow plants and vegetables and create art in various media. Workshops and open days are also regularly organised. Of the garden’s therapeutic benefits, one service user remarked, “Here you can switch off from the noise inside you. You are given a chance to wash yourself from the inside out.”