‘The impact of our physical environment on our psychological well-being — a psychologically informed reflection and response in homelessness’
18.09.2020: As I reflect on the past week as the Lead for Psychologically Informed Environments (PIE) at the national youth homeless charity; Centrepoint, I am writing this blog in my now half-finished kitchen, having finally been, after over 9 months(!), able to remove my temporary kitchen this week. Undertaking building work prior to a global pandemic and a COVID-19 national lock-down was probably not the best decision in hindsight(!), and it has meant that my ‘home’ has been far from ideal for many months. The positive impact on my mental state, and that of my wider family, having finally got back the arguably a key space in our home; the kitchen, has therefore been immense. This has led me to reflect again this week about the importance of the physical environment or the spaces around us, on our psychological well-being and the importance of these within a PIE.
A psychologically informed environment or PIE within the homeless sector naturally has to consider the relationship between our psychological state and our physical space. Many of our young people have been homeless or in temporary placements or accommodation for quite some time before they come to Centrepoint, and of course this will have an impact on their psychological well-being, which in turn impacts on their ability to move on positively with their lives and ‘change their story’. Therefore, thinking more about the type of physical environment that we provide within our supportive accommodation services for homeless young people to live in and for the staff that support them to work in, and ensuring it is fit for purpose and PIE informed, is something we need to continue to focus on within our organisation. This might not always be easy (i.e. liaison with partner landlords and accommodation providers where we have no direct control) or even cheap or straightforward (e.g. more significant building maintenance issues), but it is arguably a central and tangible given for a homeless charity providing supported accommodation such as Centrepoint.
Consequently, in order to continue our organisation’s wider PIE journey, we need to continue to focus on the physical environment. Specifically, the PIE Good Practice Guide (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) notes that ‘Designing and managing the social environment is central to developing a psychologically informed service. Thoughtful design, preferably one with service user input, based on thinking through the intentions behind a service, can result in useful changes in the way a building is used, and how it is valued by staff and clients’ (p.17). Moreover, ‘developing a psychologically informed service doesn’t have to involve large capital works-small and inexpensive changes can work equally well. Whether a building is redeveloped or redecorated, it can signal that there is a changed approach to the service, which is the key message for staff and clients’ (p.17).
There is also increasing research evidence that certain elements of our physical environment are linked to poor mental well-being. For example, it has been known for decades that high-rise living, issues with poor maintenance such as damp and noise exposure increase vulnerability for mental health issues (e.g. Evans et al, 2000; Kellet, 1989; Coleman, 1985; Ouis, 2001, Monahan et al, 1980). Good housing is arguably fundamental for positive general health and well-being (Dahlgren & Whitehead, 1991; Barton et al, 2002), with systematic reviews of the evidence (e.g. Clark et al, 2006; Evans, 2003) showing associations between our physical environment and our psychological health.
Of course, we all know this anecdotally as well, especially given the recent months I have experienced living in a building site! The difference perhaps however for me personally, as Chu et al, (2004) notes is that during this time, I have had some control over my physical environment. I have chosen to commence a building project, that whilst it has been delayed during to circumstances beyond my control (e.g. the COVID-19 pandemic and consequent lock-down), I can still ensure quality of design and maintenance and most importantly I have always had an ‘end in sight’! My recent situation has certainly increased my empathy and understanding for those not fortunate enough to be in that situation. For example, those homeless young people we are supporting who are rough sleeping or sofa surfing, or even those who allocated a service to move in to, but with little or no say in this process or with any way to personally take action to improve the physical environment that they find themselves within. Chu et al (2004) as well as Guite et al (2006) also highlight that a presence of valued space to ‘escape’ (e.g. a garden), minimising crime or fear of crime where you are living and ensuring that spaces create social participation or relationships with others without being overcrowded or too noisy, can influence the impact our physical environment has upon our mental well-being.
Consequently, when considering our physical environment, Codinhoto et al (2008) have defined a set of four factors which found to influence health outcomes, and which we are trying to focus upon and improve where necessary in Centrepoint. These include firstly: ‘Ergonomics’ (i.e. dimensions, shape and layout of the environment) or how you move around and use a space. Does this work practically? Is it safe? In recent months when I have had significant disruption to the layout of my house, with things I needed in different places from usual, it has been challenging! When we had open foundations, drains or walls, and building materials left lying around for several months in lock-down, this was a source of significant anxiety to ensure that our children were safe and our house was secure. It was also difficult to not have access to our outside space (e.g. garden) especially during a summer lock-down, highlighting directly to me how a lack of connection to nature and being able to get ‘outside’ safely can have an impact on our mental well-being.
Secondly, ‘Fabrics and Ambient Factors’ (i.e. materials, furniture, lighting, acoustics, temperature and humidity) are important. These factors make a building a ‘home’, by making it pleasant to live in. For example, at one point during our building project, we had no central heating, and the impact of just a few weeks in a cold spell of weather had quite a significant impact on everyone in the house’s stress and mood levels, as well as their physical health. We have also had to cope with continual building work noise when trying to live and work in this space, which highlighted to me the impact of ambient factors on stress and rest / sleep as well as our privacy and confidentiality. Personally, the reduction in noise has been the single thing I am most relieved about being over, especially when the drilling was heard by others during recent remote working / video conferencing!
The third factor is ‘Art and Aesthetics, including colour, design and art’. This is something perhaps those of us who are fortunate to own our own home or have a stable rental, can take for granted. I still do not quite have all my pictures and photographs back out on display, as I wait for the builder to finish the decoration and final touches, and so mentally, my house is still not quite my ‘home’ yet. Perhaps as you read this blog, think about your home and how your space is a reflection of your personalities, interests, relationships and past experiences as well as your sense of self and your value or worth? When we ‘house’ a homeless young person and give them a ‘roof over their head’, is this enough, or do they deserve to have more than small plain room with a bed and a wardrobe or desk? Would you not want your son or daughter, friend or family member to have a space that they can make their own, so they can overcome any past challenges, and grow to fulfil their potential in society, simply because they know they are seen as a valued and deserving member of that society?
Finally, our physical environment needs to provide the service it is intended or designed to do. In other words, it must be maintained to a basic standard, provide basic services such as running hot water, and be clean and hygienic. The latter issue has been particularly highlighted with the increased infection control measures we are all aware of post COVID-19. There is nothing like a building project to create mess or dust and I will admit that sometimes coming into our tiny temporary kitchen at the end of my working day, and having to clean it before even commencing cooking an evening meal was very depressing, demotivating and demoralising at times. I can understand how it might be difficult with a lack of appropriate facilities to cook a healthy meal and consequently take care of our physical health and diet as much as we all know we should!
Over recent weeks our organisation has again been asking for ‘co-produced’ (as per Keats et al, 2012; Phipps et al, 2017), ideas from staff and young people about what changes they need to make our supported accommodation services to feel ‘homely’. A ‘home’ is one-half of our key strategic objective of ‘a home and a job’ for every homeless young person referred to Centrepoint, and as I have outlined above, it is more than just providing a ‘roof over your head’. As a result, I have spent some time this week collating the responses and I am looking forward to working with colleagues from across the organisation in Support and Housing, Property Maintenance, IT, and Fundraising to make as many ideas as possible a reality in the coming months. Some of this work is more significant (e.g. requiring outside contractors and liaison with our partner landlords to implement) whilst other ideas are relatively simple and easy to implement. After all, not everyone needs to have a significant building project as I have been undertaking at home over the past couple of years to make meaningful or small changes to our houses in order to personalise them and make them feel like our home (e.g. our choice of decoration, furnishings, plants etc.).
Already, I have seen and heard about the powerful psychological impact that some of our previous small changes have made to our services, just in terms of décor and facilities. For example, one of our services has created a ‘chill out’ space for our young people by uplifting a small previously unused room; providing a stereo, beanbags and some positive messaging (e.g. wall art stencils) and colourful decoration. Another service purchased a new sofa, PlayStation and TV to improve their communal space and another has purchased outdoor garden furniture to enable young people to sit and utilise some previously neglected outdoor courtyard space in their service. Finally, another service supporting young parents, has uplifted a previous tired lounge with new furnishings, children’s toys and safe areas for small children to play whilst they can be watched by their parents who can relax comfortably.
All of these changes have been reported to have been invaluable to the staff and young people that work and live in these spaces, especially over recent months where we have been asked to ‘stay at home’ because of COVID-19. I have heard recently how young people have been more willing to socialise with their peers within their supported accommodation now that they have communal spaces to do this within, have displayed less challenging behaviours as they can get some space from others, and have increased their engagement with staff both formally and informally. These kind of small changes also send a very powerful message to previously homeless young people (who may due to their previous experiences have low self-esteem), that they are ‘worth something’ and ‘deserve’ to have the simple things that many of us take for granted. I am therefore looking forward to our second, more substantial phase, of the PIE Support and Housing Physical Environment improvement project within our organisation, which also includes a significant renovation of our Manchester Oldham Street Project. We want to create spaces that our staff want to work in, and our ex-homeless young people want to live in and which send a message to both that they are valued. This will not only improve our key organisational outcomes or Key Performance Indicators (KPIs) but as noted above, can create perhaps unexpected positive outcomes in terms of relationships, engagement, and psychological well-being…
