In the first installment of this year’s Homeless Spotlight feature, Ypeople, the trading name of YMCA Glasgow, showcases its ground breaking Pathways service in South Lanarkshire, which supports people with highly complex needs and is the first service in Scotland to be based on the principle of a psychologically informed environment.
Renzo Cardosi is Ypeople’s Operations and Business Manager. He is responsible for managing the Ypeople Pathways project, where people who have experienced homelessness and have multiple and complex needs are supported in one of Scotland’s first Psychologically Informed Environment’s (PIE) and through wraparound Reach Out community support.
It’s a cold January morning in East Kilbride and the memory of Christmas lingers in the air. As I approach the Pathways HUB I can see through the reinforced glass doors into the atrium and beyond, through the large window, into the staff office. Katie, one of the Senior Support Workers, pops her head up and she waves hello.
Until recently, the atrium of this building was a dark, bleak place. When a visitor or resident arrived they would be buzzed into a drab corridor with an almost institutional feel, where they waited for a staff member to walk from the office at the opposite side of the building. If a resident was under the influence of drugs or alcohol, staff often felt nervous about what they would find when they opened the door; residents were frustrated, and tensions were high. Unsurprisingly, this small room was the source of the vast majority of incidents recorded within the service.
I wave hello back to Katie and let myself in. The atrium is now unrecognisable from that cold corridor. A large window – dubbed the Welcome Window – has been installed in the wall facing the door, allowing staff to see out, and service users to see in. Through the window I can see that Katie is having a meeting with two of her colleagues. There is a large, comfy couch, pictures on the walls, and music can be heard faintly from the radio. Since changing the layout of the atrium, incidents here have halved.
Pathways began its journey towards becoming a PIE some time ago. A PIE is any service in which the emotional and psychological needs of service users are given primary consideration in the design and delivery of both the support and the physical environment. For Ypeople’s Pathways service, this has meant not only changes to the layout and feeling of the building – such as redecoration, art work, and softer lighting – but it has involved a significant change to the way that staff interact with both service users and each other.
Katie is in the middle of a micro-team meeting. Staff in Pathways work in micro-teams based on the model of a Listening Triad, a model often found in person-centred and humanistic counselling settings, consisting of a Speaker, a Listener and an Observer. Staff are Key Workers for individual service users, but all three members of the triad will have a thorough knowledge and understanding of each other’s clients, ensuring consistency and continuity in case of absences. The triad will support each other through reflection and peer support, as well as having the wider support of the staff team at meetings and development sessions. Service users are treated with unconditional positive regard, and Pathways is a supportive place, free from judgment.
I walk upstairs to the second office, stopping to chat to residents as I pass. The people supported by Ypeople Pathways have complex needs and are among the most vulnerable people in society. In order to be referred they must meet strict and multiple criteria; many have been rough sleepers, have mental health issues, and a large number have active addictions, mostly all caused by experiences of past or current trauma. In 2014 we took the decision to train both staff and service users in the administration of Naloxone, an opioid blocker used to reverse the effects of overdose, and a supply is kept on site. It has been used twice to save the lives of residents.
One of the service users who chats to me is Stevie*, a 28 year old man who was sleeping rough before being referred to Pathways. Stevie had been through significant trauma by the time he was a teenager, losing both his parents by the time he was 16. He tells me that he’s just getting ready to go to the gym, and, laughing, tells me to feel his biceps. Stevie has bipolar disorder; he has been working closely with the NHS Lanarkshire CPN who visits Pathways weekly, and hopes to get his own home soon so that he can see his young daughter. He had one blip in his journey a few months back, when he found himself back in prison after getting into a fight with an old friend. His Key Worker from Pathways met with him in prison to continue the support, and to plan for his release. This ‘stickability’ is a key feature in developing relationships and ultimately working towards positive outcomes for service users. Stevie is working on his anger issues, and finds that the gym helps his mood.
I have a busy morning ahead, including a team meeting and a service user forum. Staff have commented on how the change of approach has meant that their work is more positive, more fulfilling, and criticism is constructive and valued. As well as seeing a reduction in incidents since becoming a PIE, we have found that service users have been more engaged in one-to-one and group sessions, and relationships have improved across the board.
Katie pops her head around the door and, smiling, hands me a piece of paper. It’s a feedback form from Jay*, who uses our Reach Out support service in the community. Described on referral as being ‘impossible to engage’ and requiring two staff to visit him at home, he was one of the most complex people we had ever supported. On his form he has written, ‘Thank you to staff for respecting me and treating me like a human being,’ and I’m reminded of the labels he was given on referral.
‘Enduring mental health problems.’
‘Impossible to engage.’
We only apply one label in Pathways, and I’m glad that Jay has recognised it.
*Names have been changed