Claire Ritchie

No One Left Out

Claire Ritchie

A commissioner, responsible for the strategic development of services for rough sleepers, Claire Ritchie is the founder of No One left Out: Solutions Ltd. Claire is intrigued and inspired by the role of psychological understanding in managing trauma. A desire to end rough sleeping is what drives her.

Two years ago, Claire told us about what could help solve trough sleeping and the impact of Psychologically Informed Environments (see below). She gives us an update of what her organisation has achieved to date.

Rough sleeping is on the increase. 7,581 individuals were seen on the streets in 2014/15. 43% are British nationals [1] and 67% slept rough for the first time. Longer term rough sleepers have shown the greatest annual proportional increase at 20%. The forecast isn’t hopeful.

Let me give you some good news. Increasing numbers of homeless services are implementing a psychologically informed approach to their work, and commissioners are requesting Psychologically Informed Environments (PIE) as part of their contract tenders. The Big Lottery Fulfilling Lives project is implementing and evaluating the impact of PIE in some of their complex needs projects, and in February the Mental Health Foundation published a literature review which recommended the need for more research, review and an evaluation framework.

“PIEs are a promising development.” [2]

On a personal level I have continued to develop my own understanding and appreciation of the approach and was commissioned by Westminster City Council and Connections at St Martin’s to develop a toolkit.[3] Based on the original 2012 guidance it provides practical guidance and examples of how to create a personalised PIE service. I developed a training course for service managers and commissioners to evidence the potential social and economic impact and value it can have for staff and clients, as well as public services such as health and the criminal justice system. This has been well received and I am booked to visit Leeds, Plymouth and Southampton this spring to share the knowledge and learning.

Increasingly I am asked if PIE could be applied in other sectors. The answer is yes. As a non-prescriptive model and approach it’s a way of working and the culture of an organisation which can be applied anywhere.

PIE is based on what I now refer to as the PETER principles:

  • - Having a Psychological understanding of your service users needs and behaviours.
  • - Consciously considering how the physical Environment can influence behaviours, thoughts and emotions.
  • - Training and support for staff working with people who frequently exhibit challenging behaviours.
  • - Evidence generating practice – identifying what works and its impact
  • - Using Relationships as a key tool for behaviour change
  • And the very best thing? It doesn’t have to cost a penny, simply time, effort and commitment.

For more information about training, webinars and blogs please visit https://www.homeless.org.uk/search/site/PIE and don’t forget to join PIElink.net

[1] Combined Homeless and Information Network (St Mungos) Jan 2016
[2] Psychologically Informed Environments: A Literature Review Research paper 2016 - The Mental Health Foundation
[3] Creating a Psychologically Informed Environment: Implementation and assessment.

ORIGINAL INTERVIEW

Ogunte: Claire, tell us about your methodology "PIE" and the impact it makes?

Claire Ritchie: Psychologically Informed Environments (PIEs) are services designed and delivered to support positive change. They deliver increased impact, and sustainable benefits for users. The core elements are:

- A healthy and welcoming physical space
- Staff are trained and supported to think and behave in a more considered and reflective way. They are given time to examine their own emotions and behaviour, how this impacts on themselves and others.
- A therapeutic framework - at the minimum a basic understanding of psychological thinking

The Story of Jane

Jane has a diagnosis of “Emotionally Unstable Personality Disorder”. A victim of domestic violence, a history of self-harm, alcohol and drug dependancy, Jane was initially difficult to engage. As she was suspicious of services since her children were taken into care, indirect support from the psychologist via the staff team was initially most effective. After 6 months Jane began to trust and engaged in group, and then 1:1, therapy sessions.

Consequently she stabilised on a methadone script, moved into less supported accommodation, began studying and accepted longer-term psychological therapy.

O: How could you apply PIE in other environments, relationships, work, public sectors, how would that work, for instance?

Introduced by Johnson and Haigh (2010) specifically for application in homeless settings, PIE arose out of the Royal College of Psychiatry “Enabling Environments Initiative,” and is linked to the development of “Psychologically Informed Planned Environments,” the Offender Personality Disorder Programme, places where:

  • - Positive relationships promote well-being for all participants
  • - People experience a sense of belonging
  • - All people involved contribute to the growth and well-being of others
  • - People can learn new ways of relating

These principles can be, and often are, implemented under the guise of different approaches and definitions across sectors. In terms of PIE, I believe all homeless services should build on the core elements, many of which they already employ, and embed them in their strategies. PIEs can transform the way a service operates but require commitment from the top down and the bottom up.

More reading: Enabling Environments and Enabling PIE research report.

The Impact of Psychology

O: What should we all be aware of?

Every day we see people engaged in chaotic and harmful behaviours, unable to engage with existing services, labelled “untreatable.” Socially excluded, desperately poor, unable to manage their emotions and behaviour in a culturally acceptable way, their physical and mental health deteriorates. They sleep, live and die on the street.

I have witnessed some of these men and women begin to care for themselves, gain in confidence and self-esteem. They reduce self-harming, destructive behaviours. They learn to understand themselves and manage the trauma they experience. There is currently an appetite for PIEs, if you identify it please do get in touch!

Johnson, Haigh, myself et al are developing an on line platform, “HomelessInsight,” which will support, endorse and disseminate good practice. Encourage evidence generating and reflective practice and promote research. Refer https://pielink.ning.com/ for more information.

O: What has been the biggest learning curve for you growing this venture, in the past 3 years?

CR: Hmmmm, too many to mention! I think possibly the most valuable is the potential impact and value of psychology. I have been fortunate enough to meet some incredible practitioners who have taught and inspired m,; not only in my mission to improve services for vulnerable and excluded groups, but also for myself... by becoming an expert on my own behaviours and emotions. It was challenging but worth it!

O: What questions would you have loved investors/ supporting organisations to ask you that they forgot to ask?

CR: Questions like: "Where should we transfer the money? When can you start? Seriously though, I would have liked the opportunity to share more details about the amazing success of the project we set up in Waterloo (more info here), using certified medical and social measurement tools we found, such as:

  • - An increase in health and wellbeing (self-reported,) engagement with services and meaningful occupation.
  • - A reduction in levels of distress (self-reported,) anti-social behaviour, self-harm and serious incidents.
  • - People rough sleeping for over a decade have avoided abandonment or eviction and moved on in their journey to independent living.

Here's what people said during our service review:

“Would be great if this kind of service were the norm”. Service user

“Revolutionary! Able to succeed with clients I have been unable to reach before.”  Staff

“A trailblazing model with potential to be applied in other complex settings and partnership projects, such inpatient wards and working with the voluntary sector.” Head of Psychology for Psychosis Clinical Academic Group, South London & Maudsley.

O: What would you like your older self to prepare you for?

A future where all services are psychologically informed!

(And I see myself writing my memoirs from a warm and sunny place, there’s wine, cheese and juicy ripe tomatoes on a garden table, red gingham napkins. The people I love are chattering and relaxing nearby. Oh, and I have an adorable puppy sleeping peacefully at my feet.)

O: Finally, who are the top 3 women in the social innovation space who inspire you and why?

I’ve recently met a number of amazing women on or via the Public Service Launchpad Accelerator. I love and thrive being around people who are passionate about what they do.

1. Servane Mouazan. For her vibrancy and passion, her commitment to supporting female entrepreneurs and helping draw out their potential.

2. Lita Wallace – A founder of Thrive– For her amazing commitment, passion and insight for one so young! She also told me I changed her life by introducing her to a rough sleeper. Big ego boost!

3. Laura Willoughby – founder of Join Club Soda. We share the same sense of humour and outlook on the world over many things which matter.

No One left Out: Solutions offers an in-depth assessment of operational procedures and how they can be improved from a psychological perspective. This is complimented by a comprehensive, costed options appraisal, identifying where PIE can be implemented most effectively, and a project plan.

For more information please contact Claire Ritchie and visit their PIE Professionals' Facebook Page.

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