Health and Social Care Act

B3: Making PIEs

Speaker: Peter Cockersell

Director of Health and Recovery St Mungo’s Helen Keats

Specialist Advisor, Homelessness Communities and Local Government Chair: Caroline Hawkings

Policy Officer National Housing Federation

Making a PIE

Peter Cockersell

Director of Health and Recovery

St Mungo’s

• About 2000 beds: hostels to self-contained flats, including registered care

• Specialised drug, alcohol, mental health, dual diagnosis; older, women’s, and sexworkers’ projects

• Street outreach, 2 day centres, employment, training, substance use, health, and psychotherapy

• London, Reading, Oxford, Oxfordshire, Bath, Bristol, Hitchin, Welwyn Garden City…

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Mental health and homelessness

Population

• 1 - 4% schizophrenia

• 5 – 13% personality disorder

• 11% anxiety disorders and depression

• 1.3% have attempted suicide

Homeless People • 16 – 30% schizophrenia

• 50 – 70% personality

disorder

• 50 – 80% anxiety disorders and depression

• 42% have attempted suicide

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Behaviours associated with complex trauma

• Self-harm

• Uncontrolled drug or alcohol use

• Impulsive, careless of the consequences

• Withdrawn, reluctant to engage

• Anti-social

• Isolated

• Aggressive • Lacking daily structure or routine • Inability to sustain work or education • Bullying, or being a victim • Offending • Unstable relationships

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Homeless people’s experience

• “I did not access much of mental health services (they would not let me), but I used up hundreds of thousands of pounds of other budgets such as housing, social services and substance misuse”

• 70% had sought help: 11%

got help

• Majority have histories of compound and complex trauma,

not simple diagnoses. More people have more than one

condition than have only one

What is a PIE?

• Recognition of range of mental health problems encountered by homelessness staff

• Services need a degree of psychological awareness and support

• Hostels and day centres are highly managed and reactive environments focusing on risk assessment and crisis management. This has an impact on client outcomes.

• PIEs will identify, adapt and consciously use the managed environment to focus on the psychological and emotional needs and capacities of clients in a positive way

• PIEs use a therapeutic framework to develop clear and consistent responses to clients

• PIEs are not simply about containing challenging behaviour, but changing it

Places of conscious change

PIEs aim to create:

an empowering and calming environment where people can feel emotionally as well as

physically safe, and can gain an understanding of their behaviour and an ability to take

responsibility for themselves

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Key ingredients

•Psychological Framework •Social Spaces •Staff Training and Support •Managing Relationships •Evaluation of Outcomes

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

Staff support and training

• Clinical supervision

• Reflective practice

• Training: Attachment, psychological perspectives

Motivational interviewing, psychological techniques

The Escape Plan, client perspectives

Recovery, enabling management

• Corporate Commitment and Framework

• Client access to psychotherapy

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Client perspective

I didn’t want to go initially, thought I didn’t need to see a shrink. I gave it a go and the first few sessions were very informal, unthreatening. I grew to trust her, told her things I haven’t told anyone else. A lot of tears were shed, she didn’t drag it out of me, she listened. I got shit out of my system that I’d been carrying around a long time. There was an underlying burden in my heart that she knew what to do with. Everything I said wasn’t written down and I loved that. It was properly confidential. It was a hard one but it was a good one and if it wasn’t for her I’d be floating down the Thames now.

“

”

Psychological framework

Psychodynamic

Attachment

Cognitive

Recovery

Evaluation

• High (policy) level measures: e.g. reduction in offending, rough sleeping, use of A&E, etc

• Service level measures: reduction in antisocial behaviours, improved resettlement or employment outcomes; reduction in sickness, staff turnover

• Individual level measures: client experience, personal outcomes; increased job satisfaction, enhanced skills

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Summary

• It’s about creative,

not directive, support

• Beware of technical

language, it divides

• Clinical input is integral

• Power changes can produce powerful resistance, and/or big changes

• Positive client outcomes are what we’re trying to achieve

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www.nmhdu.org.uk/complextrauma

www.homelesshealthcare.org.uk

Peter.cockersell@mungos.org

Health and Social Care Act

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