‘Homewards’ bound — Why it is important in a PIE to focus on ‘homes’ and not ‘houses’ to #EndYouthHomelessness…

04.08.2023: As I write this week’s PIE blog, as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity — Centrepoint, I would like to take this opportunity to highlight a particularly exciting new development in Centrepoint’s strategy to #endyouthhomelessness. This is a collaboration with other partners in the sector, led by our patron — Prince William and the Royal Foundation of the Prince and Princess of Wales, entitled ‘Homewards’. This initiative was recently launched in one of the London boroughs that Centrepoint is operating within (including the PIE Team through the newly commissioned Lambeth Emotional Wellbeing Service — LEWS; see recent PIE blog here: https://drhelenmiles.medium.com/time-to-let-lews-introducing-the-new-pie-informed-lambeth-emotional-wellbeing-service-in-8ee75b82f24c). It is a ‘five year locally led programme that will demonstrate that together it is possible to end homelessness: making it rate, brief and unrepeated’. More information on this initiative is available here: https://royalfoundation.com/prince-william-and-the-royal-foundation-launch-uk-wide-programme-to-end-homelessness/.

Two of the key aspects of this programme, that really struck me from a PIE perspective is the focus on ‘prevention’ (more on this in the next PIE blog!), whilst the other is the focus upon the ‘notion of home’ (c.f. https://twitter.com/HomewardsUK/status/1673206122809896960). If we want to end youth homelessness, whilst we need to ensure we have sufficient housing availability for the young people of the future, we also need to make sure we are creating ‘homes’, whether in terms of good quality housing or independent living schemes as well as within our supported accommodation services. As is noted by Seager (2015), previous work in the homeless sector that is ‘non-PIE’ has tended to ‘automatically prioritise physical shelter, provided by a roof, over the psychological shelter and security that can only formed over time, in the mind, through relationships’. They go on to importantly highlight that ‘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’.

Consequently, for this week’s PIE blog I wanted to revisit a blog I wrote nearly two years ago now, because I think this is critically important when we think about what type of homeless services we want to create in the future, and ensuring that they have a PIE approach at their heart. This blog was written back in November 2021 in the cold of winter (although arguably we aren’t at the moment having much of a summer in the UK!) but was inspired by some graffiti I saw locally on an early morning dog walk (see picture below). So grab and cuppa, take just ten minutes from your no doubt hectic day, to reflect further what does it mean in a PIE, when we think about creating ‘homes’ for the homeless young people we are supporting…

‘On my walk this morning, I noticed some new graffiti that has appeared near a new development of housing. This graffiti has a simple but clear message that particularly resonated with me, working in the homeless sector, and feeling the biting cold this morning, that ‘every human needs a home’. It made me reflect on what does it mean to not have a ‘home’, what even is a ‘home’ and how can a psychologically informed environment or PIE create a ‘home’ for homeless young people in Centrepoint?

As discussed in previous blogs, and highlighted in various Centrepoint reports (e.g. see here: https://centrepoint.org.uk/media/4598/databank-report-2020.pdf) the scale of youth homelessness in the UK, given we are one of the richest economies in the world, is very concerning. At Centrepoint, we work with over 1000 young people every year, across our variety of support and housing, education and health services in London, Manchester, Bradford, Barnsley and Sunderland. However, this is just the ‘tip of the iceberg’ as an estimated 121,000 young people (aged 16–25 years) asked their local council for help with homelessness in 2019–2020. Moreover, even this figure is likely to be an underestimation of the true extent of youth homelessness in the UK because not every young person approaches their council for help (i.e. the so-called ‘hidden homeless’ where young people are ‘sofa surfing’ or temporarily residing with friends). This figure is also rising — see a recent article here: https://www.theguardian.com/society/2021/oct/18/youth-homelessness-up-40-per-cent-in-five-years-says-uk-charity-centrepoint.

However, what does it actually mean to be ‘housed’ if you are a homeless young person? It is just about getting a ‘roof over your head’ or does it mean more than this and why? Moreover, how easy is it for a young person at risk of homelessness to obtain safe and suitable accommodation? A recent study looking at data collected from young people aged 16–21 years living in a UK homeless hostel, found that much of youth homelessness was precipitated by violence and abuse at home (Ellis & Laughlin, 2021), an observation that our data in Centrepoint also supports. However, despite this many local authorities sought parental consent before providing provision to the young person! Many of the young people in the study described that they were often refused help and just “advised to go home” if they presented to the council to report that they were homeless even if this meant returning to potentially unsafe and traumatic situations — hardly what we can describe as a ‘home’. Moreover, even those young people in the study that were provided with accommodation were aware that the hostel or support accommodation was only temporary and described feeling worried about their longer-term future. Therefore, just being ‘housed’, if you are able to be, does not automatically create a sense of ‘home’.

For example, psychologists (Foster & Roberts, 1998) have noted that ‘homelessness is a political issues, a social issue and — in terms of the dynamics between the homeless and the housed — a psychological one’ (p.30). Recent psychoanalytic thinking (e.g. ‘The Unhoused Mind’: Brown, 2019 — https://www.routledge.com/Psychoanalytic-Thinking-on-the-Unhoused-Mind/Brown/p/book/9780367148478) has taken this concept further to explain why merely providing a roof over someone’s head is not sufficient to underdo the impact of being homeless upon them. In particular, psychologists and psychotherapists are now asking what it means to be ‘psychically housed’, and therefore why some individuals may struggle to engage with homeless services or accommodations and prefer to continue to ‘sleep rough’ (Heim, 2020).

It could seem odd to those of us who have a sense of what a ‘home’ is, and of course live safely and comfortably in our own homes, that any young person experiencing homelessness would struggle to live within our supported accommodation services or even not be grateful for the assistance and help we offer. Certainly, this has been a theme that regularly comes up within the staff reflective practice sessions that our PIE team facilitates in our Centrepoint services, and which understandably can lead to staff frustration (Heim, 2020). However, as noted by Campbell (2019), this aversion to be housed within a Centrepoint ‘home’ can be understood as a result of past traumatic experiences within their family (or the social care system) and the unconscious association that a young person may therefore make between being at ‘home’ and being unsafe or persecuted. Many of our homeless young people in Centrepoint have had adverse childhood experiences (ACE’s) and are therefore unlikely to have an internal psychological sense of what a ‘home’ actually is. Offering them as place to live, albeit temporarily, is thus only the first step in their psychological recovery from the experience of ‘homelessness’.

Therefore, apart from the physical structure and safety of a place to stay, or a ‘house’, what do we need to focus on in order for them to thrive and create a psychological sense of ‘home’? As I am sitting here writing this blog and looking around my home, I have been reflecting on what makes this physical space my home. Of course, having a place where my basic needs are met is important. For example, being warm (especially at the moment!), having ready access to food and water, and feeling safe when I sleep are all critical. However, my home is also full of positive memories; it is where my children were born and raised, and following last year’s significant (and stressful!) renovation, it is now nicely decorated to our family’s personal taste wherein everything is finally in working order (i.e. in the kitchen / bathroom). These simple things can often be overlooked in more impersonal temporary accommodation or hostel spaces, and it why a co-produced physical environment is so important in a PIE (c.f. previous blog here: https://drhelenmiles.medium.com/the-impact-of-our-physical-environment-on-our-psychological-well-being-a-psychologically-3ae63b740dd2). Helping homeless young people to co-create their ‘home’ as far as possible, including giving them opportunities to personalise their space is therefore so important.

Moreover, my ‘home’ is safe. When the external world can seem threatening or overwhelming, it is where I can retreat to feel psychologically (and physically) safe to re-charge for the next day. For example, I know who will be in my home when I return from work (i.e. my family and/or friends that I have invited to visit) and that if I need support or talk about my challenging day, this will be available. For many of our homeless young people who live in our supported accommodation services, they may return to their rooms and see unfamiliar staff in the office (e.g. locums covering a shift) or be around other homeless young people that they would perhaps not normally choose to live with or are unfamiliar or feel threatening to them. Therefore, the onus is on us as staff to provide that psychological safety by engaging with the young person as much as possible even informally or ensuring we are introducing ourselves if we are new or locum staff. We also need to ensure that we are working as a team to support all the young people in the service so they can ask for help from anyone of us, whenever they need it, even if we are not their allocated ‘key-worker’. We might also consider activities and opportunities for all the young people in the service to ‘come together’ and get to know each other, as well as sensitively managing any risk issues or incidents that may occur between the residents.

Building these safe and supportive therapeutic relationships with the homeless young people we work with is arguably the most important aspect of creating a PIE or a ‘home’. As Keats et al (2012) note ‘a focus on managing relationships is perhaps at the heart of what makes a psychologically informed environment different’ (c.f. https://eprints.soton.ac.uk/340022/1/Good%2520practice%2520guide%2520-%2520%2520Psychologically%2520informed%2520services%2520for%2520homeless%2520people%2520.pdf; p.24). These relationships can provide a homeless young person, perhaps for the first time, a sense of ‘home’ that enables them to move from this unhoused psychic state to a housed one. Homelessness is a traumatic experience, that is often experienced as a consequence of past experiences of trauma (Johnson & Haigh, 2012; Maguire, 2006) but the good news is that trauma can be overcome, as shown in research that notes the healing potential of current positive healthy relationships (e.g. Perry, 2005).

A independent evaluation of Centrepoint’s pilot Housing First project in London, has highlighted this key role of relationships in enabling very vulnerable traumatised homeless young people with extremely high support needs to create their first ‘home’. This project, highlighted here: https://www.cypnow.co.uk/blogs/article/housing-first-safety-net-to-save-vulnerable-people-from-falling-through-the-cracks, has had very positive success rate unlike previous approaches that just focused on ‘housing’ this population, which failed. Of note, the evaluation of the project emphasised the significant role that our amazing staff team had in ensuring the positive outcomes noted. It was therefore not just about providing housing to this population, but instead it was about how much the staff built supportive relationships with the young people in order to create a sense of ‘home’ in their new housing, which also enabled them to maintain their tenancies in the face of many ongoing challenging issues.

Finally, reflecting back on the graffiti I noted on my local street in Lewisham, I found it interesting that the artist chose not to write under the new housing development that every human needs a ‘house’. I like to think that they chose the word ‘home’ deliberately, perhaps because they understood the importance for all humans of having more than just a roof over our heads. Working in the homeless sector, I think it is important, as per a PIE, to keep the focus on creating ‘homes’ and not just providing housing. Yes, we of course need to build more houses in the UK right now (c.f. https://www.bbc.co.uk/news/uk-58747051), but the physical construction of buildings are just the first step. When working with individuals who have experienced homelessness, we need to create the psychological conditions, through supportive relationships and a careful consideration of the physical environment, that allow their mind to feel safe and ‘housed’.

Therefore, I think it is important that those of us working in this field, regularly take a moment to reflect on what a ‘home’ means to us, and ensure that we are working at all times to create something similar for those we support as much as possible. In addition, if we do not think we could live there — the ultimate test of whether a service is PIE, we need to think why we could not and consequently, what we need to do about this. On which note, I will leave the final word in this blog to the ‘PIEineers’, a group of homeless young people who helped developed the Centrepoint PIE approach back in 2019; who can articulate this need far better than me — “When we are in Centrepoint, we want to feel like we belong, and we are ‘home’”… ‘