The Power of PIE

Thursday, 23 October 2014 - 9:45am

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

When Jane first arrived at Thames Reach’s 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, but her only previous 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.

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, fulltime members of staff.

The Project is run as a psychologically informed environment – or PIE – a model developed by the Royal College of Psychiatrists, 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 wellbeing, 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 – often entrenched and self-harming, 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 bury 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 evolve and move on.

I’ll sign off by offering two pieces of validation of the Project, which should hopefully speak for themselves.

The first is that this year 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.

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


Claire and colleagues are running a masterclass at our December conference to look at psychologically informed environments from the perspective of commissioner, provider and mental health professional.

Join us in London on 11 December for No Return to the Streets to explore how Psychologically Informed Environments can

  • help to prevent repeat homelessness
  • address inequalities in health and social care
  • support integration of health and social care services
  • successfully support people for whom other services have not worked.

Talk To Us

Claire Ritchie

No One Left Out: Solutions Ltd

Claire also has her own consultancy No One Left Out: Solutions Ltd which specialises in supporting services to become Psychologically Informed Environments.