‘Holding the door open’ — Reflections on my Psychologically Informed Environment (PIE) journey in Manchester’…

03.03.2023: As I sit down to write this week’s PIE blog as the Lead for Psychologically Informed Environments (PIE), at the national youth homeless charity; Centrepoint, I am once again on an early train to Manchester. However, this will be my last face to face visit for a while because I am delighted to announce that Dr Joanne Wood (PIE Psychologist) has now joined our PIE Team one day a week to deliver our PIE offer in the city. She brings a wealth of experience and is passionate about PIE, so I am very excited to have her on board. Therefore, today’s visit is a handover and a ‘goodbye’ (complete with actual pie’s this time!), to all the amazing frontline teams that I have had the absolute pleasure (despite the early starts!) to support over the past few years. I therefore wanted to use this week’s PIE blog to reflect on my time working with the team(s) in the Manchester delivery hub as well as highlight the PIE journey that these unique, hard-working and passionate team(s) have been on since I started working with them.

When reflecting back, I can clearly remember my first visit to Manchester when I started at Centrepoint back in 2019. The then Operational Manager; Joe Lomas, now Head of Housing (North) showed me around Oldham Street and it was immediately clear to me that really important support was being offered to homeless young people in the city by dedicated and knowledgeable staff. Joe was rightly proud of his staff and passionate about their work. There was a team supporting local Rough Sleepers, as well as the Homeless Prevention and Reduction Service (HPRS) for young people homeless or at risk of becoming homeless and the Floating Support Team, supporting young people who had moved into their first tenancy in the city. Unlike in London, Centrepoint didn’t offer supported accommodation services in Manchester, but rather assisted homeless young people to access local accommodation options and gave them valuable support to remain in these housing options once obtained. I imagined these as the ‘book ends’ of the homeless pathway in the city, working in partnership with the other housing providers (‘the books’) that delivered actual accommodation services within the city (c.f. https://centrepoint.org.uk/what-we-do/housing/manchester).

One of my lasting memories of this first visit, apart from the warm and friendly greeting that I got from Joe and his team(s), was the state of the building at Oldham Street. Despite the hard work and energy of the staff to end youth homelessness within Manchester, the building was tired and in desperate need of repair. There was actually even a hole in the roof rendering much of the back offices unusable. Even as a southerner (!), I knew that Manchester was famous for being a ‘rainy city’, and therefore the current physical environment that the staff teams were attempting to deliver a service for homeless young people in Manchester within was not even basically fit for purpose, let alone a psychologically informed physical environment! I remember sitting on the train on the way back to London thinking if I was really to effect change in the physical environments of Centrepoint, a key part of any PIE (c.f. Keats et al, 2012), then I had to start at Oldham Street.

Roll on three years, and I have been proud that alongside many other colleagues within the organisation within the Property, Support & Housing and Fundraising Team(s), Oldham Street has been completely transformed (c.f. https://drhelenmiles.medium.com/reflections-on-our-newly-refurbished-delivery-hub-in-manchester-the-importance-of-physical-a7d3577cee4b). Moreover, that this transformation into a psychologically informed environment was co-produced with staff and young people that use this service, as per a PIE, with the support of our wonderful pro-bono interior designer (c.f. https://drhelenmiles.medium.com/co-producing-the-physical-spaces-in-a-psychologically-informed-environment-changing-the-story-9fbb7c74bfb5). The Oldham Street delivery hub is now a fantastic place to work, and for young people in the city to access support from — my personal highlight of which is the staff well-being garden on the roof, funded by our PIE Physical Environment Fund, and completed by Manchester staff and volunteers. I always, even if it is raining(!) try to spend some time up there whenever I visit Oldham Street, just to be amongst a tiny bit of nature with wide reaching views across the city, which I find always helps give me head space and shifts my perspective on whatever challenges are being faced.

Of course, it was not an easy journey to get to this point, with Centrepoint staff having to continue to deliver services to homeless young people in Manchester from various temporary offices and during the COVID-19 pandemic. Nevertheless, throughout this time, I have witnessed their perseverance, patience and dedication to the city’s young people, despite the professional and personal challenges that many of them have faced during this period. I have been honoured to walk a little of this journey with them, trying my hardest to offer psychologically informed support, training and reflective practice sessions to them both in person and remotely throughout this time.

Unfortunately, the need for Centrepoint’s services both in Manchester and nationally remain high, and with the cost of living crises and post-pandemic recovery, this need is growing (c.f. https://www.bigissue.com/news/housing/rough-sleeping-has-risen-by-26-in-a-year-amid-the-cost-of-living-crisis/). This work is not easy. Another of my reflections from this period was that it became clear that the complexity of the homeless young people they support in the city was significant. Many of the young people come with multiple and severe disadvantages and/or vulnerabilities, including relationship breakdowns, experience of the care system, mental health issues and substance misuse problems on top of their housing issues. My visit once a month to offer reflective practice sessions to the teams, as well as other ad hoc visits to offer PIE training and telephone 1:1 support in between was just not enough to manage these challenges. It was a hard lesson as a psychologist to accept the limitations of what I could offer when I wanted to do more, but hence my relief at getting funding for and the appointment of a locally based PIE Psychologist to support the team one day a week moving forward. I hope that this additional support will enable the team(s) to continue to undertake their support work even better than before for the young people in Manchester that find themselves homeless or at risk of homelessness.

Reflecting further on my time in Manchester, I was thinking about what the team(s) in this city have taught me. Of course, I hope I have also supported them in some little way but as a psychologist I acknowledge I am always learning, and sometimes the best lessons in life come from those you are helping whether they have been past clients I have worked with or staff I have supported. Ultimately, what has most struck me about the teams is that despite the wider systemic challenges and statutory service issues (e.g. housing, mental health) that they have had to operate within, despite the challenges of engaging young people who often are initially rejecting of help because of their past negative experiences of relationships, despite the frustrations and unpredictable crises that staff have had to manage, and despite the often not insignificant emotional impact upon themselves of this work, they have always held onto their empathy towards others. Even in reflective practice, which is a psychologically safe place for staff to share their thoughts and feelings, they have always wanted to try to help those young people that turn up at the door of Oldham Street and hold their compassion for those in need.

As a result, when I came across this poem this week about empathy it really resonated with me about the work that the Manchester team(s) as well as many of our other Centrepoint services staff teams, are undertaking each day:

‘EMPATHY:

Let me hold the door open for you.

I may have never walked a mile in your shoes,

But I can see that your soles are worn

and your strength is torn

under the weight of a story

I’ve never lived before.

So let me hold the door open for you

After all you’ve walked through

It’s the least I can do’.

Morgan Harper Nichols

Often the complexity and the challenges that the homeless young people we support in Centrepoint can feel overwhelming and we might not know where to ‘start’. Sometimes we might not know what we can do to help them when their circumstances feel hopeless. At times, I haven’t always known how best to support the teams in Manchester, as they struggle with losses, burnout or vicious trauma from the work, internal and external bureaucracy, unforeseen crises, a lack of resources and as noted above, even unsuitable or temporary working conditions. On reflection, as well as providing advice where I can, I think the most important thing that I have done was to offer validation and containment even when there are no obvious solutions, so that they in turn can offer this to the homeless young people they support. Sometimes, I have felt that all I have done is ‘hold open the door for them’ in our reflective practice sessions, so that they can enter a supportive space to explore, vent and validate their feelings, and to help them to understand that these are normal emotions in the context of the highly challenging work they are undertaking. It was the least I could do. Perhaps ultimately, this has enabled them to then ‘hold open the door’ for the young people that present at Oldham Street in need of their help.

Moreover, when I get back on the train to London at the end of each of my monthly visits to Manchester over the past few years, I have always left with a renewed sense of why I do this role at Centrepoint. This was reinforced recently in an email I received from a staff member in Manchester:

“I just wanted to say thank you for everything you have achieved at Centrepoint. In the nearly four years of being based in Manchester, I can see the impact PIE is having on the staff and wellbeing of the young people coming into the service. PIE has had a direct impact on the morale of staff and is quoted regularly. Small touches to the space in terms of soft furnishings and seating has created a softer environment to reflect and work in. It is a privilege to say I work in the Manchester office”.

Manchester is one of our significant ‘frontlines’ in the battle to #EndYouthHomelessness, our Centrepoint strategy until 2037. To win this ‘war’, we must undertake various different ‘battles’ on various fronts. We need to do them all to succeed in our aim. For example, this must start with getting young people off the streets and supporting them to access and maintain a ‘home’, perhaps for the first time in their life. Our work with young people on the streets of the Manchester, as well as through our HPRS service is therefore vitally important. It also remains vitally important to offer exemplary PIE standard supported accommodation to young people who would otherwise be at risk of homelessness and not have any support to fulfil their potential and achieve a ‘home and a job’, thus reducing their future risk of homelessness (c.f. https://centrepoint.org.uk/what-we-do/housing/#).

In addition, we need to be part of the conversation to devise unique psychologically informed housing solutions to those young people who are in employment, education or training but are still unable to access the private rental market via our Independent Living Scheme (c.f. https://drhelenmiles.medium.com/a-psychologically-informed-environment-pie-approach-to-living-independently-778c378f4578). And, of course, we also have to go ‘upstream’ and deal with or prevent the reasons why they become homeless in the first place, and I am excited about a new project that our PIE team is supporting within Centrepoint around prevention and early identification of young people that are at risk of homelessness. This is starting with our pilot in partnership with local schools within Manchester, so I am clearly not quite ready to say goodbye completely to Manchester yet!

Finally, I hope that the most important part of my PIE support to Manchester has been to enable them to feel ‘seen’ and ‘heard’ across the wider organisation. This is just as powerful to staff as it is to the homeless young people we support (c.f. https://drhelenmiles.medium.com/being-seen-a-psychologically-informed-reflection-on-the-value-of-even-brief-interactions-ddb3dcaf4a0b). When starting to develop our PIE offer in Centrepoint, it was really important to me that staff did not view PIE as a burden but as something that has helped them and has been flexible within their region to meet their needs. PIE doesn’t have a ‘one size fits all approach’ to the staff training, reflective practice and physical environment ‘ingredients’. To be truly psychologically informed, we need to be ‘person-centred’ (c.f. Rogers, 1951; 1959) in our approach and adapt to what the person in front of us needs at that point in time. I hope I have achieved these aims to date and that our PIE team can continue to adapt and evolve its offer to support the teams in the city in the future. I will miss my regular trips to Manchester and all the staff that work there, who will forever have a special place in my own Centrepoint PIE journey. I will however never forget them, and will continue to support their PIE journey from afar whilst continuing to advocate for the work that they do to end youth homelessness in the city. In other words, I will continue to ‘hold the door open’ for them just as they do every day in Oldham Street for the homeless young people they support…