PurposeThis paper seeks to discuss the association between homelessness and poor health, both physical and mental. A pilot project run by St Mungo's suggests that adding clinical mental health interventions, notably psychotherapy, makes existing social care interventions several times more effective, enables deeper recovery, and frees people to move on across all the domains of their lives.Design/methodology/approachSt Mungo's was awarded a grant by the Cabinet Office as one of the national pilots working with “adults facing chronic exclusion” (jointly funded by the Department of Work & Pensions, Ministry of Justice, Department of Health, Department of Communities, and Department of Families and Children – because these clients impact on the remits of all these departments). The aim of the project was essentially simple: to test the hypothesis that, if chronically excluded adults were excluded because of their psychological disorders, then could a psychotherapeutic intervention reduce their exclusion?FindingsRecently, 274 people have attended for therapy; 30 per cent of these are women, 70 per cent men, with 68 per cent white and 32 per cent black. In total, 30 per cent did not come to the initial assessment session, and there are many reasons for this, for example, people abandoning or being evicted from their accommodation, death, imprisonment and resettlement. Some were also referred without proper consultation, so that when they were contacted it turned out they did not want psychotherapy or, in a few cases were already accessing it elsewhere. Of those who did attend assessment, 80 per cent went on to attend four or more sessions; most clients attended either two to four sessions, or more than 12. Attendance overall was 76 per cent, and non‐attendances were noted on 11 per cent of occasions.Originality/valueMany homeless people become caught in the “revolving door” of hostels, prison, hospitals and the streets, often for many years. This paper argues that this form of homelessness affects people because of their mental health, and that social solutions alone are not sufficient, which is why the door continues to revolve. Offering appropriate clinical interventions alongside existing social ones could begin to transform this situation.

PurposeThe purpose of this paper is to describe an example of a practical evidence‐based approach to improvement in the current climate of funding cuts.Design/methodology/approachThe paper describes synthesizing insights from leadership, change management and psychodynamic theory to inform a practical change programme to develop services that meet the needs of clients more efficiently.FindingsThe paper finds that rather than simply doing less – cutting staff or reducing services to meet the constraints of funding cuts – it is worth taking a long term and strategic review approach and doing something quite differently.Practical implicationsNew ways of working can improve client outcomes and deliver better services and the funding cuts can provide an opportunity to thoroughly re‐examine existing provision; but, significant changes will only be accomplished by change processes that pervade the whole organisation – they cannot just be add‐ons/afterthoughts. The implications of the new way of working are that: even when funding increases, old ways of practice will not be restored; that the use of theoretical approaches from a variety of disciplines can deliver innovative responses that are likely to be sustainable in the medium term; and to improve service standards and outcomes into the future.Originality/valueThis paper finds value by looking to neurobiology, clinical psychotherapy, recovery‐oriented practice, change management theory and practice, and client involvement to try to resolve the current housing crisis.

Purpose The purpose of this paper is to consider evidence for the effectiveness of the psychologically informed environments (PIEs) approach to working with homeless people in the five years since the national guidance was published. Design/methodology/approach The author reviewed the intended outcomes of the original guidance and then looked at a range of data from evaluations of current PIE services in UK and Ireland. Findings The findings were that the PIE approach is effective in meeting the outcomes suggested by the original guidance; in reducing social exclusion and improving the mental health of homeless people; and in improving staff morale and interactions. Research limitations/implications This is a practice-based evidence. There needs to be more practice-based evidence gathered, and it would be useful if there were some standardised measures, as long as these did not limit the richness of the data which suggests that PIEs have a wide, not narrow, impact. Practical implications The implications are that homelessness services should use the PIE approach, and that they should be supported by clinically trained psychotherapists or psychologists; and that wider mental health services should look at the PIE approach in terms of working effectively with socially excluded people with complex needs/mental health problems. Social implications PIEs are an effective way of working with socially excluded people with mental health problems/complex needs, enabling the reduction of social exclusion among this very excluded client group. Originality/value This is the first review of evidence, much of it so far unpublished, for the effectiveness of PIEs, despite the fact that this approach has been increasingly adopted by both providers and commissioners in the homelessness sector.

Social exclusion is associated with complex trauma and is a process that happens in the interface between the social and the individual. Inclusivity therefore needs to take these factors into account, particularly through healing relationships between clients and staff.

Purpose The purpose of this paper is to describe research into attachment styles of rough sleepers and considersthe implications for practice. Design/methodology/approach The research was structured interviews with a cohort of rough sleepers analysed through evidence-based techniques, and the implications were drawn out with reference to current best practice. Findings The rough sleepers in the cohort had a very different pattern of attachment styles to the housed population, with 100% insecure vs c35%, and 50% insecure disorganised vs >15%. Research limitations/implications The limitation is that the cohort was relatively small, n = 22 and was a sample of convenience. The implications are that homelessness services working with rough sleepers need to be attachment-informed as much as trauma-informed. Practical implications Practical implications are that homelessness services need to have a more rounded psychological perspective such as psychologically informed environments rather than just a trauma-informed approach. Social implications Rough sleepers suffer from deeply pervasive and severe attachment disorders, and this may be causal to their becoming rough sleepers and is certainly a factor in whether or not they are successfully rehoused. Originality/value There is almost no other original research published into the attachment styles of rough sleepers or homeless people. The current trend is for trauma-informed services: the call for attachment-informed ones is original.