mental health and free choice”. This shift repositioned people without homes as “other” and “universally alienated” (p. 259). The notion of homelessness as an


individual’s responsibility is refl ected in current housing policy, where housing is typically allocated based on ideas of ‘deservedness’ and conditionality, with independent living as the ultimate goal (Homeless Reduction Act, 2017). These narratives have led to categorisations such as ‘intentionally homeless’ which are linked to resources and housing, and exclude many from both. In contrast, many areas of homelessness


services come from a position of human rights and ethics. The Housing First treatment model (summarised by Shelter, 2008) was established as a counter to a conditional model of treatment. This model views safe, secure housing as a basic, fundamental human right, rather than a reward for successful compliance. Informed by models of attachment, there


is an increasing awareness of the need for a ‘psychological home’ to be created for socially-excluded individuals who have experienced a lifetime of instability and disconnection (Seager, 2011). For service users in this ‘psychologically-unhoused’ state, person-centred and consistent support is needed to maintain stable housing. An example of putting this ethos into practice can be found in the psychologically-informed environments framework.


Psychologically-informed environments


This framework aims to support frontline


homelessness-services to eff ectively meet the social and emotional needs of their service users. The concept has been conceptualised by some as a new form of community mental health work that seeks to develop psychological awareness and emotional intelligence within staff teams and systems. Key to this framework is the salience of unconditional positive regard and healthy dependence within eff ective services and healing relationships. The concept originally arose from


the need to recognise and to work with the levels of emotional trauma that accompany and precede an individual becoming homeless (Johnson & Haigh, 2010). This literature highlighted the high percentage of rough sleepers and people in temporary housing who have


30


experienced complex and compound trauma. Whilst there are diff erent perspectives regarding exactly ‘what’ makes a psychologically-informed environment, the general consensus is that the key elements involve a psychological approach, environment, staff training and support, a focus on relationships and evidence generating practice.


Trauma-informed care Trauma-informed care or a trauma-


informed approach is a framework drawn on within PIE. The consensus- based defi nition (Hopper, 2010) states that trauma-informed approaches are strengths-based and grounded in an understanding of and responsiveness to the impact of trauma. Trauma-informed approaches emphasise physical, psychological, and emotional safety for both providers and survivors, that create opportunities for survivors to rebuild a sense of control and empowerment. In a trauma-informed service, it is assumed that people have experienced trauma and may consequently fi nd it diffi cult to develop trusting relationships with support staff , and feel safe within services. Accordingly, services are structured in ways that prioritise physical and psychological safety.


A paradigm shift Power is therefore not something we can


ignore or eradicate; we have to do something with it (Afuape, 2011). People with complex presentations


are often not well served by mainstream services, particularly services that address individual ‘symptoms’ or require people to fi t a specifi c criterion. Psychological and trauma-informed environments are part of a current movement that looks to provide an alternative to traditional psychiatric (medical) service models. The medical model of mental health is inherently tied with the current dominant political narratives, which place emphasis on the individual above the collective. These political discourses give power to frameworks that conceptualise struggles as originating from biology or cognitions and subjugate frameworks that formulate distress within a social context. The ‘Psy’ professions have been named


as one of the occupations that perpetuate systems of inequality through (mostly unintended) collusion with the idea that problems are created within individuals


and that ‘personal responsibility’ is key to change. However, eight years ago, the Marmot Review (2010) on health inequalities called on us to address the social causes of health and the ‘causes of the causes’. Moving beyond the (medical) ‘patient’ narrative to understanding people as ‘survivors’ of austerity, poverty, inequality and trauma brings the conversation to the negative infl uence of power upon people’s lives, and is inherently political (Johnstone & Boyle, 2018). Power is integral to the lives of us all and forms aspects of all our ongoing interactions; however, a choice is made by practitioners about how we position ourselves in relation to this power.


Is ‘PIE’ political? As with any framework, psychologically-


informed environments can be interpreted in diff erent ways, and the fl exibility of the framework is fundamental to its wide appeal across the homeless sector. Within the key element ‘psychological approach’, services can either draw on individually focused or more relational models. Given the arguments in this article, there is a strong case that all psychological approaches should be both relational and political. In practice this would mean services would seek to develop ‘outsight’, rather than ‘insight’ (Smail, 2005), in all attempts to understand the stories of peoples’ lives. Refl ective practice, team formulations


and staff training are central to creating and maintaining a psychologically-informed environment. These collective meetings are important opportunities to further develop awareness and formulate how ‘the personal is political’. These are also settings where behaviour that is challenging, or what are often called ‘symptoms’ of mental illness, can be re-authored as acts of resistance and responses to trauma. As Afuape (2011) discusses, when people are able to notice all the actions that constitute resistance to abuse, oppression and prejudice, and how congruent these actions are with their values, they are more likely to experience themselves as competent and capable individuals; an important stance for people both using and providing services.


Narratives of hope Our motivation to write this article


was grounded in our belief in the value of human connection in restoring hope within relationships. Against a backdrop of


Context 164, August 2019


Political PIEs: Learning from frontline housing services


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