‘Creating a place of ‘safety’ — The importance of psychologically informed relationships when providing a home this Christmas…’
09.12.2022: Writing this week’s PIE blog, as the lead for Psychologically Informed Environments (PIE), at the national youth homeless charity; Centrepoint, I am again travelling up very early to Manchester to deliver reflective practice to our amazing frontline teams in this region. However, at the end of this very long day, I will return to the safety and comfort of my ‘home’ (and bed!) back in London. As our six-month sponsorship of our Ukrainian guests is officially due to end this month (although for various reasons they will be staying with us on into the New Year), I have been reflecting further on the importance of creating a ‘safe’ home, particularly for individuals who are fleeing or recovering from traumatic experiences. This is especially true within Centrepoint’s supported accommodation services wherein many of the homeless young people we support are coming from previously traumatic experiences in their original ‘homes’. So how is this relevant to a PIE, and how does a PIE approach support the creation of a ‘place of safety’ and/or offer a ‘home’ and not just a ‘roof over your head’?
For a long time, the focus in the homeless sector was naturally on the importance of ‘housing’. But does a ‘house’ automatically make a ‘home’? What really makes somewhere a home for someone? Of course, being physically safe within a shelter is important. However, as Seager (2015) notes, non-PIE homeless work has ‘automatically prioritised physical shelter, provided by a roof, over the psychological shelter and security that can only be formed over time, in the mind, through relationships. Without the right psychological conditions, the offer of a roof alone can never be enough and may even be damaging because it signals a failure to understand and honour the depth of emotional damage behind the homelessness’. Therefore, a physical shelter is just the beginning, and too much emphasis upon this alone does not enable the psychological conditions to break the cycle of homelessness or undo the potential past trauma of that homelessness experience.
To be homeless is extremely unsettling at best, deeply traumatic at worst. Research highlights that moving house is actually one of the most traumatic things a human being can do (Legal & General, 2022; Cohen et al, 2019), even when that move is planned and wanted. Thus, what happens if that move isn’t? For our Ukrainian guests, and for many of the homeless young people that Centrepoint supports, residing in an unfamiliar location, with unfamiliar people that are not their family, or even necessarily their choice to live with, can be extremely anxiety provoking and potentially re-traumatising. It is therefore important that we understand and empathise with that experience, and try as much as possible to create a psychologically safe ‘home’ rather than just provide accommodation or a physical house.
Critical in any PIE approach is the understanding that healing and recovery from trauma comes from relationships with supportive others (e.g. Keats et al, 2012; https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf). The (relatively) easy part of supporting our Ukrainian guests or the homeless young people in Centrepoint is the provision of a place to live in that is physically safe. What can be more challenging is to ensure that the accommodation is also ‘psychologically safe’ for them. This comes from creating relationships that enable that individual to be able to feel supported and empowered despite the perhaps disempowering experience that lead to them being with us in the first place.
Principles of trauma informed care (c.f. Sweeny et al, 2016) are therefore critical in a PIE approach to building these relationships. For example, giving that individual as much choice and control as possible, and ‘doing what we say we will do when we say we will do it, or explaining why we cannot’. Systems that might seem to make sense to us might be challenging for someone not used to navigating them. However if we follow these principles, then through these trusting relationships, a previously traumatised individual can start to feel psychologically safe and heal from their past aversive experiences. Ideas about how to create these relationships have been discussed in a previous PIE blog; see here: https://medium.com/@drhelenmiles/psychologically-informed-relationships-make-the-world-go-around-ca51decf2c31.
But how do we know if we are creating psychologically safe relationships? I would suggest we know when that person can be honest with us, can be their authentic self and is willing to show us who they really are, and share with us what they are really thinking and feeling. Sometimes we might also see it in their behaviour — when someone feels ‘safe’ they do not fear rejection so can express themselves honestly in that moment. For those of us that have children with secure attachments to us, this is something that we might notice when our child’s behaviour is different at school versus at home with us. Often children can seemingly behave ‘badly’ when they come home from school, after having been on their ‘best behaviour’ all day for their teacher. This is frustrating as a parent(!) but is arguably because they feel safe with us and therefore, are able to express their true feelings (i.e. tiredness, frustration, anxiety etc.). The young Ukrainian boy that is staying with us recently demonstrated this to me by ‘arguing’ with me about dessert– noting that my offer of just fruit was “annoying”. Whilst his mother was mortified with him, I was actually pleased that not only had his English language skills improved to such an extent that he could articulate his disappointment at my lack of ice-cream, but moreover, that he felt safe enough with me (a stranger just 6 months ago) to express how he really felt!
This is also something that often comes up in reflective practice sessions with staff in our frontline supported accommodation services. Staff can naturally feel frustrated or annoyed with the homeless young people that they support when they display challenging behaviours towards them, when there is no evidence of such behaviour when they are attending employment or educational settings. However, although this can be difficult for staff, this highlights that that young person feels ‘safe’ enough within the relationships they have formed with staff to express their inner world to them, perhaps as an attempt to seek support and communicate their needs in that moment. Time and time again I see positive outcomes for the homeless young people that we support coming as a result of the effort that our staff put in to building these ‘safe’ relationships with young people. Relationships or attachments that allow that individual to feel secure to be themselves, to process past trauma and understand that they are of worth, that others are to be trusted and that they can engage with the wider world (Bowlby, 1967) are invaluable in creating the conditions for healing from past traumatic experiences such as homelessness.
This week I also observed in one of the services that I visited that these ‘safe’ relationships do not just abruptly end when a previously homeless young person moves on to their own accommodation. This can be a difficult transition and many of our previously supported young people can struggle to adjust to living by themselves and sustaining their own tenancies. If we reflect back to our own experiences of leaving ‘home’, we did not just stop speaking to our families when we moved out! Instead, we often returned home (not least to do our laundry if we were a student!) for comfort, assistance or advice, socialising and more. During a reflective practice session, an ex-young person from the service returned to see staff. It was clear that they remained very vulnerable and potentially quite lonely moving on from a busy supported accommodation service to their own tenancy. They also had a pile of household correspondence and bills that they needed support to address. Staff at the service were clearly ‘going above and beyond’ to continue to support this young person and it was clear that this was highly valued by them. The supported accommodation service (and staff therein) was continuing to serve as a place of ‘safety’ for this young person at least in the short term as they adapted to living more independently. This highlighted to me that although the young person had not been without their challenges when living in the supported accommodation service, staff had built positive psychologically informed relationships with them, that enabled them to feel safe to return as and when they needed. This ongoing ‘floating support’ is likely to be vital in ensuring that the young person is able to maintain their tenancy moving forward and reduce their risk of future homelessness.
Of course creating a place of ‘safety’ is not just about the relationships that we form with those we live with. Within a PIE, it is also about ensuring that those we live with can understand us and react appropriately to meet our psychological needs. In Centrepoint, this is being achieved with the provision of psychologically informed training for staff, as well as the provision of regular monthly team reflective practice for our frontline staff. These are both critical ‘ingredients’ in a PIE (c.f. Keats et al, 2012), because they ensure those that support the homeless young people in Centrepoint’s services have the latest evidence based psychological or therapeutic ‘tools’ to work with this population as well as the space to think about or reflect on their work. We know that both improve outcomes for both clients and staff (e.g. Cockersell, 2011; Stronge & Williamson, 2014; Phipps et al, 2017) and are therefore are an important investment in their staff from any homeless sector organisation.
Finally, in a PIE, the creation of a place of safety or a ‘home’ is also impacted by the physical environment (c.f. see recent PIE blog here: https://medium.com/@drhelenmiles/reclaiming-spaces-83f9347ae78f). As I have been travelling around our supported accommodation services over the past week, it has been lovely to see the fruits of Centrepoint’s significant investment in the physical environment since we began our PIE journey. I recently saw the impact of a new kitchen in one service in London in terms of bringing staff and young people together for cooking sessions and celebratory meals together. In other services, simple uplifts in furniture and basic decor are resulting in communal areas are being utilised more (e.g. young people watching the current football world cup) as the spaces feel like a ‘normal lounge’ and place of safety and comfort rather than a ‘clinical institution’ or traditional impersonal hostel space. Moreover, in one of our larger services in the North, staff and young people are in the process of utilising some PIE funding to create a ‘winter wonderland’ in lighting and Christmas decorations for those young people that are unable to go ‘home’ for Christmas.
As this year ends, many of us reading this blog are planning where we will spend our Christmas holidays. Many of us will be returning ‘home’ to family or inviting family and friends to come to our ‘home’. We will be safe and warm, surrounded by relationships with those we love. However, for a not insignificant number of young people in the UK, as highlighted in this recent Centrepoint film (c.f. https://twitter.com/centrepointuk/status/1597670479585607682), they do not have a place of safety or a ‘home’ this festive season. They do not have psychologically ‘safe’ relationships that ensure their mental well-being. For those homeless young people living in Centrepoint supported accommodation, I know that our wonderful frontline staff especially those working over the Christmas period will do their upmost to create a ‘home’ or a place of both physical and psychological safety, perhaps for the first time, for them. And it will be those psychologically informed relationships that our staff have formed with the homeless young people that they support, rather than any turkey served or the Christmas tree decorated, that will give them that place of psychological ‘safety’ that will help them to move on from the trauma of homelessness in the New Year…
