Despite the best, and at times the worst, efforts of systems of care `to include', there remains a group of people whose refusal to be included remains a problem both for themselves and for society as a whole. Our discussion re-locates the problems arising from the anti-social stance at the heart of this refusal from the internal world of the refuser to phenomena associated with what we have called psychosocial dis-memberment and the ` un-housed mind'. We explore the complex reciprocal relationship between the housed and the un-housed, between society's members and those whom society dis-members and we consider some possible implications for individual workers, staff teams and organizations who are tasked with attempting to house, re-member or otherwise to accommodate such people. We conclude with a challenge to practitioners, academics and policy makers to reframe the philosophical basis of their approach towards these complex psychosocial problems.

Several domestic and international trials of the use of preexposure prophylaxis (PrEP) for HIV prevention are ongoing among groups at high risk for HIV infection. The objective of this cross-sectional study was to assess self-perceived risk of HIV infection and attitudes about PrEP among 405 sexually transmitted disease (STD) clinic attendees in South Carolina. Self-percieved risk of HIV infection and attitudes about PrEP were assessed using three questions from a self-administered survey. Ordinal logistic regression and logistic regression were used to evaluate differences in risk perception for HIV infection and attitudes about the use of PrEP among risk groups. Compared to heterosexual participants, homosexual participants were significantly more likely to have knowledge of PrEP (odds ratio [OR]=6.7, 95% confidence interval [CI]: 1.70-26.1). Compared to those participants who had 1 sexual partner in the past 3 months, individuals who had 2 to 4 sexual partners in the past 3 months were approximately 2.35 times as likely to have a lower level of agreement with the statement "I believe I am at risk of getting HIV" (p=0.0003). Compared to female participants, respondents who were male were approximately 2.8 times as likely to have a lower level of agreement with the statement "If I had to it would be very difficult for me (or my partner) to both use condoms and take daily pills to prevent HIV infection" (p<0.0001). These results suggest the need for the creation of PrEP implementation programs that are tailored to self-perceived risk perception, age, and gender.

Purpose -This paper aims to offer a critical analysis of the potentially traumatising nature of working with (dis)stressed and traumatised people with complex needs who are homeless. It also seeks to provide a commentary on the contribution of Psychologically Informed Services: A Good Practice Guide in addressing the impact of these difficult dynamics upon workers, teams and organisations.Design/methodology/approach -The paper is an invited piece and is based on the specialist experience and viewpoint of the authors working as psychotherapists with a background in therapeutic community work and of their experience of reflective practice and team development consultancy with teams working in homelessness services.Findings -With increasing demand and more restricted funding for homelessness resettlement services, the authors raise issues in the complex interaction of institutional and social and interpersonal dilemmas for staff ''stuck in the middle'' between the (dis)stressing nature of clients' ''unhoused'' minds and the (dis)stressed response of the systems of care. A group-analytic, systems psychodynamics approach is used to shed light upon the risks to workers when services do not make time to reflect upon these (dis)stressing and potentially traumatising dynamics. They also point towards some of the personal and professional characteristics required in consulting to staff teams and agencies working with such complex dynamics. Originality/value -The new operational guidance is welcomed, however, the authors suggest that the successful implementation of Psychologically Informed Environments (PIEs) is reliant on the capacity of any given organisation to build effective cultures and structures to support the development of reflective practice and team development.

Within homelessness services recent policy developments have highlighted the need for integration and improved collaborative working and also, the need for 'Psychologically Informed Environments' (PIES) in which workers are better equipped to manage the 'complex trauma' associated with homelessness. Drawing on the findings of an evaluation of a multi-site development programme, this paper demonstrates how both these policy aspirations might be implemented through a single delivery vehicle (a community of practice). The paper describes how organisational, educational and psychosocial theory was used to inform programme design and reflects on the utility of these approaches in the light of the evaluation findings. It is reported that communities of practice can deliver significant performance gains in terms of building collaborative relationships and opening-up opportunities for interdisciplinary education and learning. Filling an important knowledge gap, it also suggested how (professional) participation in a community of practice might work to improve outcomes for service users. Most likely we see those outcomes as being linked to tackling exclusion by sustaining the workforce itself, that is in motivating workers to remain engaged and thinking positively in what is an emotionally challenging and stressful job role.