Quick links : Relationships and complex needs

Working with and through the relationships we form is now seen as central to the idea and the practice of a psychologically informed environment *. This was not always the case.  (For the growing recognition of the central role of working with relationships of all kinds, see: The Centrality of relationships emerges : HERE.)

The centrality of relationships emerged as a core theme over many years of discussions in the homelessness sector in particular, where the need for more personalised approaches was most apparent. But it clearly has wider application; and it is not solely a matter of relationships with service users; the issues are more pervasive, through all human social life.


Relationships and complex needs

Psychologists and psychoanalysts have argued for many years that it is disruption of early, formative relationships that accounts for a good deal of the difficulties in relationships, complex needs and behaviour seen in later life. Both contemporary neuroscience and a growing wealth of epidemiology and public health research appear to confirm this.

The claim that relationships with support staff and therapists is central to recovery is, by its nature, harder to evidence with the same clarity; but it is the experience of many staff in many walks of life, and many who have their own stories of recovery to tell (HERE).

The capacity for empathy is the foundation of connectedness; and it requires good listening and often some resilience, to see beyond the behaviour that challenges services, to see the person behind it 'in the round'. Engaging with someone on their own terms is itself a form of empowerment (HERE).


Relationships and social exclusion

Research as well as lived experience confirms that Adverse Childhood Experiences and Adults facing Chronic Exclusion share more than a few initials. Those with difficulties engaging with care and authority figures are precisely those most at risk of falling through society's safety nets, with bruising encounters on all sides.

It was social inclusion policies in the UK at the turn of the 21st century, gradually infusing the policy frameworks of specific sectors (HERE) , that helped to bring together the thinkers and the practitioners, and underlay the discussions that came out in the concept of the psychologically informed environment, as a cross-platform issue (HERE).

Work on social inclusion is not, however, just a matter of the empathy and relationship-making skills of the individuals. It also requires management with conscious attempts to step outside of overly-narrow versions of what services are here to do, and what counts as success; and those who fund and regulate services taking a wider view.

Many services now attempt to develop  a 'No wrong door' approach - that is, to use any opportunity to engage someone at risk of exclusion, rather than addressing only the needs that their own service is originally created to meet.


Complex needs, relationships and systems

Meeting such complex needs can also mean encouraging closer working relationships and understanding between various agencies in any one area, each set up to meet specific needs. The PIEs approach - explicitly, in the case of the PIEs 2.0 framework - encourages services and service users alike to

The 'systems and pathways' element of the Spaces of Opportunity theme invites all services to consider and comment on the adequacy of the systems and pathways available for any individuals in the service, to make progress and move on in their lives.  Where service users can be involved, their feedback on these issues, from lived experience, is essential information for commissioners (HERE).

In the 'sector engagement' field, the PIE framework then suggests they consider how able staff and users are to talk with others about how their services is positioned in the networks of services in any one locality, to help to identify what might be improved. This can mean not just identifying gaps and blockages, but also more malleable issues, such as referral procedures, the protocols around informations sharing, and joint training opportunities (HERE).

Some more specific initiatives and roles such as system brokers and navigators, with an explicit brief to work across boundaries, and multi-agency gatherings of various kinds, to share experiences, agree and co-ordinate possible adjustments.


  • So central that we now have - here - this 'hub' page, located in the Footer menu. This means that it will appear on every page of the PIElink, allowing any reader/viewer at any point to quickly refer back to any related content. For more on the mechanics of site design and navigation, see 'Quick links and secondary menus': HERE)

Key links

Systems and system change

  • 'Joined up thinking' : HERE
  • Pathways, systems and system coherence : HERE
  • Whole systems evaluation and the public health paradigm : HERE
  • Navigators and 'system brokers' : HERE
  • Will there be a PIEs 3? : HERE

Working with relationships

  • The Centrality of relationships emerges : HERE
  • Relationships in the PIEs 2.0 framework :  HERE
  • Psychological awareness in action : HERE
  • Roles as the grounding of relationships: HERE

'Complex needs'

  • Psychological awareness 101 : HERE
  • Working with trauma : HERE
  • Trauma-Informed Care and PIEs : HERE
  • Pretreatment : HERE
  • A lived experience view of PIEs : HERE

'Complex needs services'

  • 'Complex needs?' : HERE
  • Roll-out and top-to-toe embedding : HERE
  • Service users' PIE assessments : HERE

Systems and system change

  • Pathways, systems and system coherence : HERE
  • Whole systems evaluation and the public health paradigm : HERE
  • 'Joined up thinking' : HERE
  • Navigators and 'system brokers' : HERE
  • Will there be a PIEs 3? : HERE


Library items

How relationships disrupt social disadvantage : HERE

Kindness, emotions and human relationships - the blind spot in public policy : HERE

Empathy, tenacity and compassion; an evaluation of relationship-based practice in Brighton & Hove :  HERE


Reaching out : an action plan on social exclusion (SEU) Report : HERE 

Three theories of the origins of homelessness : HERE

Implementing psychological formulation on complex needs : HERE

Beyond binary : domestic violence and complex needs : HERE

Do complex needs need complex needs services? (Part One) : HERE


Do complex needs need complex needs services? (Part Two) : HERE

Complex needs and available data : HERE

Enabling help : HERE

Conducting research and evaluation with people with complex needs in a person-centred way : HERE