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The Power of PIE

Putting relationships at the heart of service provision can make the difference between success and failure in attempts to support people out of homelessness. 

In this blog, first written for Homeless Link in 2014 Claire describes her belief in the power of PIE to help address chronic homelessness and social exclusion.

When Jane first arrived at the Thames Reach Waterloo Project, she rejected most of the support on offer. She had been diagnosed with Borderline Personality Disorder, following a long history of self-harm, domestic violence, risk taking, and dependency on opiates and alcohol. Her only experience of mental health services had been when her children were taken into care. This had left her with a deep mistrust of the profession and support services.

Instead of direct sessions with mental health staff at the Project, the most effective approach for Jane was indirect support from the psychologist, delivered by the staff team. This helped Jane begin to trust and engage initially in group sessions, and eventually in 1:1 therapy.

She has come a long way since then. She has stabilised her opiate dependency, moved into more independent accommodation, started a college course, and she is about to start longer-term psychological therapy. Jane is one of many people whose lives today are evidence of the impact of the integrated health and social care model run by the Waterloo Project.

It’s all about relationships

Described as “trailblazing” by the NHS and “revolutionary” by Third Sector, this unique homelessness hostel employs psychologists from South London & Maudsley NHS Trust as onsite, full-time members of staff. The Project is run as a psychologically informed environment – or PIE – a model designed to put relationships at the heart of everything a service does.

Authors of the approach, Robin Johnson and Rex Haigh, describe a PIE as one that “takes into account the psychological make-up - the thinking, emotions, personalities and past experience - of its participants, in the way it operates.”

PIE is about providing the necessary conditions to allow people to change in a sustainable way. With more services throughout the UK buying into the approach, it is clear that there is no single formula to making it work.

The Power of PIE

As in Jane’s case, the success of the service is demonstrated by the outcomes its residents achieve. Using official health and social care tools, including Outcomes Star and CORE, we’re able to measure increased engagement with mainstream health and addiction services, improved health and well-being, reduced antisocial behaviour, and improved tenancy sustainment.

In themselves, these are results we expect from any homelessness service, but it is important to remember that here they are being achieved for individuals who might have been living on the streets for decades – experiencing chronic exclusion and self-harm, their needs unmet by existing systems.

This is the true success of the project. The conditions of many people it works for are often undiagnosed before they arrive. Others come to the service with an unhelpful historical diagnosis and a mistrust of professionals, self-medicating to mask the complex trauma they are experiencing. But in spite of the complexity people face, and the years of trauma they have experienced, the approach enables people to thrive and move on. I’ll sign off by offering two pieces of validation of the project, which should hopefully speak for themselves.

1. The first is that this year (2014) we have received a grant of more than £1 million from Guy's and St Thomas' Charity to continue and develop the service. This will allow us to pilot the approach in 2 very different projects – a 69 bed mixed gender hostel, Graham House, and a new 5 bed supported housing project for women.

2. The second comes from people who have been helped by the service, who often tell us “this should be the norm.”