Multiple complex needs in context

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Why develop Psychologically Informed Environments?

The PIE [Psychologically Informed Environment] originally arose out of the need to recognise and to work with the levels of emotional trauma that accompany, and in many cases precede, an individual becoming homeless” Johnson and Haigh (2011)

Understanding multiple complex needs and complex trauma

Published literature has found that people who are homeless or experiencing unstable housing experience major health inequalities and complex co-morbidity including:

  • Histories of childhood adversity
  • 60% complex trauma
  • 60-70% features of Personality Disorder (Interpersonal Issues)
  • 54% drug addiction & 58% alcohol addiction
  • 42% Psychosis
  • 41% severe Depression
  • 80% forensic histories
  • Nine times more likely to die by suicide than the general population
  • Life expectancy 43yrs

Stating your case for PIE

Due to the complex needs of this population, they can struggle to access services in planned sustainable ways and instead fall into cycles of presenting in crisis and avoiding planned care.

Homeless people are 3.2 times more likely to have a hospital admission than the general population and cost, on average, 1.5 times more; a gross cost of £76.2m pa (£85.6m when outpatient and A&E included).

Government recommendations and trauma literature call for services to address the unmet psychological needs and trauma that precede, accompany and perpetuate homelessness, chaotic lifestyles and criminal justice contact using ‘Psychologically Informed Environment’ (PIE) and ‘Trauma Informed Care’ models.