‘‘Psychologically Healthy Systems’ or applying a Psychologically Informed approach to the wider organisation…..’

03.07.2020: For the theme of this week’s blog as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity; Centrepoint, I have decided to use the image above that our PIE Team came across this week as my starting point for reflection. This image is what we envisage as important in a psychologically informed or ‘healthy’ system or organisation, as it is one that is informed by the impact of past trauma or adversity, and it recognises the important of ‘relationships’. Moreover, I think the image is a useful visual representation to underpin wider discussions with our colleagues about current challenges and developments (e.g. the ‘People Strategy’ and the employee focus groups planned for next month).

Consequently, what is this image and why does it capture a psychologically informed approach so well? This image has been adapted from the concept of ‘Circles of Security’ by the ex-colleagues of one of our PIE Team Psychologists, Lou, who kindly circulated it this week as a point of reflection and discussion for our PIE team meeting. It immediately resonated with me, because it is underpinned by Attachment Theory (e.g. Bowlby, 1977; 1980), which Centrepoint have adopted as the theoretical basis for our PIE framework. As noted in previous blogs, we have utilised this universal theory of psychological development and relationships because of the importance of recognising the early attachment disruptions and difficulties that many of our homeless young people have experienced either within family or care systems before coming to Centrepoint. Moreover, this theory helps explain the subsequent, often negative, impact that these insecure or disrupted attachments have upon their thoughts about themselves, their world and other people, and their resulting emotional and behavioural responses.

As noted by Bowlby “Intimate attachments to other human beings are the hub around which a person’s life revolves, not only as an infant or a toddler or a schoolchild but throughout adolescence and years of maturity as well, and on into old age. From these intimate attachments, a person draws strength and enjoyment of life and, through what he contributes, gives strength and enjoyment to others. These are matters about which current science and traditional wisdom are at one” (Bowlby, 1980). Consequently, it is the relationships or ‘secure attachments’ that our staff develop with the homeless young people, through the key working and support they offer, that enable those young people to thrive, to be motivated to #changethestory and results in them achieving their goals of a ‘home and a job’. ‘Relationships’ are therefore the key ‘ingredient’ in any PIE, as highlighted by Keats et al (2012) who commented that ‘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).

Specifically, this image highlights the key elements of a ‘secure attachment’ relationship, and as noted above, is adapted from the original ‘Circles of Security’ attachment parenting approach that is utilised when working with parents and carers (c.f. https://www.circleofsecurityinternational.com/circle-of-security-model/what-is-the-circle-of-security/), particularly those who adopt or foster, or for other reasons may need additional support to develop their connection with their children. The concept helps caregivers reflect upon children’s attachment needs in order to understand how to interact with their children to promote the formation of secure attachments (and as such is also relevant for our support staff to consider how they can also form secure attachments with the young people that they work with). A summary of the ‘Circle of Security’ is available in this short video here: https://vimeo.com/122770192

In the original image, the hands on the circle represent the caregiver or key attachment figure. As the child moves away from them (i.e. their ‘secure base’) to go out around the circle exploring their wider world, they are safe in the knowledge that they have an attachment figure that they can return back to (i.e. their ‘safe haven’), should they need to seek support or protection. The attachment figure is bigger and stronger than they are, but is also wiser and kind, and knows when to encourage a child to ‘go out’ around the circle and when to support them to ‘come back’. Missing the ‘needs’ of our children (i.e. holding them too close and not allowing them to explore, or not being available for support when they need us) can cause pain and frustration, and doesn’t allow the development of secure relationships or attachments. Luckily, for most of us parents, especially at the moment(!), we don’t have to be ‘perfect’ at recognising our children’s needs on the circle, just ‘good enough’.

So how does all this apply to organisations? The principles of attachment or ‘circles of security’ are relevant throughout our lifetime within all of our adult relationships. We continue to need to feel psychologically ‘held’ by others as adults in order to be secure enough to venture out from these relationships into the wider world, with the knowledge we can return to them for support if needed. We can therefore apply the same principles to organisations or employers as shown in the image above. In order for our employees to flourish in a psychologically healthy or psychologically informed organisation, an employer needs to be a ‘secure base’ or ‘safe haven’ for their employees. Their ‘holding hands’ are created through the actions and attitudes of managers within our relationships with them, the policies and procedures that are employed and the systems that employees operate within. All of these should be encouraging, inclusive, trusting, fair, transparent and curious, thereby maximising the potential of the employee to act to the best of their ability. Moreover, employers should also strive to provide space for the employee to feel protected, supported, and connected through open, human and reflective processes. This kind of relational or psychologically informed work practice fosters agency, connection, meaning and trust within the work system, which ultimately helps the whole system to thrive or flourish, producing better outcomes for all those within it.

There has been increasing attention paid over recent years in how organisations and work places can create a psychologically healthy and safe environment for staff. For example with the British Psychological Society Report (2017) on ‘Well-being at Work’ (c.f. https://www.bps.org.uk/sites/www.bps.org.uk/files/Policy/Policy%20-%20Files/Psychology%20at%20work%20-%20improving%20wellbeing%20and%20productivity%20in%20the%20workplace.pdf) or the UK Government’s review of mental health and employers (Stevenson & Farmer, 2017), which proposed a set of ‘mental health core standards’ (c.f. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/658145/thriving-at-work-stevenson-farmer-review.pdf). However, I would argue that creating psychologically healthy workplaces is not just about diagnosing mental health issues or just providing interventions or ‘mental health standards’, all of which locates the issues in the individual rather than the wider system. Instead, it is also about considering how our policies, processes and interactions with each other may impact on all of our psychological well-being.

For example, the recent and ongoing COVID-19 pandemic has given many organisations, including Centrepoint, pause for thought as we had to react quickly to adapt to the ‘new normal’. There is now significant learning and reflection that can be undertaken for the future development of our charity to ensure that we are meeting the needs of all the participants in our system, both staff and service users. With only a small amount of effort, we can develop some knowledge, tools and confidence to understand and look after our own well-being, and the well-being of those around us. Moreover, employers need to recognise that supporting their employees’ psychological well-being so that they can be the ‘best they can be’ is time and money well spent. This is because of the wealth of evidence that doing this helps develop and retain them, thereby building up the skills and knowledge in the organisation, and also results in increased productivity as well as more effective and efficient outcomes (e.g. Danna & Griffin, 1999; Harter et al, 2003; Grawitch et al, 2006). I would also argue that this is never more important than in the homeless sector, both due to the nature of the work in terms of the emotional burden and impact, as well as the critical importance of building and maintaining relationships in order to ensure we get our outcomes right when working with some of the most vulnerable young people in the UK.

So how do we do this? Critical is co-production with all the relevant stakeholders, as per a PIE approach, so that we can understand and hear what actions are needed by those who are most effected. Specifically, “real change happens when those who need it, lead it” as I hope our recently formed Black, Asian & Minority Ethic (BAME) staff working groups will demonstrate. Sharing findings of these co-produced conversations both celebrating what we do well but also acknowledging what might need to change or where mistakes have been made in the past is important, and hopefully will lead to action plans for the future. Of course, we might find that we need different things in different areas or places as even as a national charity, we often (and appropriately) have localised responses reflecting localised needs or issues. We also need to support leaders to ensure that their decisions, as well as the development of policies and procedures create ‘Circles of Security’ and not inadvertently negatively impact on the psychological well-being of staff (or homeless young people). As Keats et al (2012) have noted, the “definitive marker of a PIE is simply that, if asked why the unit is run in such and such a way, the staff would give an answer couched in terms of the emotional and psychological needs of the service users [or staff], rather than giving some more logistical or practical rationale, such as convenience, costs, or Health And Safety regulations” (p.5).

When thinking about this further this week, I reflected that sometimes in my psychology career to date, I have learnt that the best ideas may not always come from the ‘top’. For example, I can recall incidences when an Assistant Psychologist or new Clinical Psychology Trainee has been able to ‘see’ an issue or process that perhaps I had missed or become complacent to and I have had to learn to be open to that challenge or observation rather than see it as threatening my position or power. However, I have also learnt that it is often those in positions of power and influence that hold the actual ‘levers’ that can effect change. Consequently, working together across all levels of an organisation will be the most helpful in bringing about positive and meaningful change in accordance with their values and strategic aims.

Moreover, having a work environment where employees and employer are respectful and considerate in their interactions with each other, with clear role expectations and sources of support, development and training opportunities is key. Put another way, if our staff have positive psychological well-being and feel securely attached to the organisation, then they are more likely to model this to those homeless young people that we support to positive effect. Sometimes events can change or shake this (e.g. the recent COVID-19 pandemic), but as per a PIE, creating space to reflect on what we are doing and why to ensure that we are continually improving, learning and adapting is so important. Centrepoint as a charity has been around for 50 years now, and has therefore had to change and adapt during that period to ensure that we keep meeting the needs of homeless young people in the UK, as well as working towards ending youth homelessness through our campaign work (c.f. https://twitter.com/CP_Policy/status/1273541862859644929).

Finally, organisations should also consider what impacts on an employee’s psychological well-being within a particular system, such as flexibility, opportunities, benefits or work-life balance. Sometimes these conversations may be difficult to start with, as we acknowledge that we have made mistakes in the past or can’t offer everything that everyone ‘wants’ all the time. However, simply opening the dialogue with a ‘solution focused’ rather than a ‘blame’ approach can give the psychological safety to explore these issues and find possible solutions where we can. If we don’t, then sadly the result is often a ‘crises’ and ultimately staff will vote with their feet and leave, disrupting vital attachment relationships they may have formed with colleagues, and even more critically with the homeless young people they support. Therefore, I am looking forward to continuing to develop our People Strategy over the next few months, working alongside my colleagues from across the organisation to hopefully increase staff psychological wellbeing, morale, and retention, and I remain optimistic that this will lead to some positive psychologically informed changes in our organisation. Whatever these changes, this will be an ongoing process that just like creating secure attachments may take time and effort but ultimately will support our further development as a ‘psychologically healthy’ system to the benefit of all those within it…