Mental health and housing : joined up thinking for 21st Century community mental health ....
The new operational guidance on developing a “Psychologically Informed Services”
has now been released. The full document is available to download here.
This operational guidance is the follow-up to the joint CLG/NMHDU guidance on “meeting
the psychological and emotional needs of people who are homeless” . This original
guidance paper is also known as the “complex trauma” paper, as it introduced the
suggestion that ‘complex trauma’ may be a better term than the clinical diagnosis
of ‘personality disorder’ which is otherwise used to describe the issues such individuals,
and such services, face.
The follow-up guidance was produced after many requests from frontline services in
particular for suggestions as to how in practice to develop services that are more
The Psychologically Informed Environment or ‘PIE’
What is a PIE?
A psychologically informed environment, or “PIE”, is a place or a service in which
the overall approach and the day-to-day running have been consciously designed1 to
take into account the psychological and emotional needs2 of the service users.
The term PIE first appeared in print in 2010, in “best practice” non-statutory guidance
on meeting the psychological and emotional needs of people who are homeless, which
was published jointly by the UK Department of Communities and Local Government (CLG)
and the National Mental Health Development Unit (NMHDU) - now disbanded.
Here the term PIE was first used to identify some of the underlying features in a
number of services, cited in the guidance itself as examples of positive or innovative
practice in homelessness outreach and resettlement work, in work with the after-effects
of “complex trauma”.
NB: this work gave rise subsequently to a book on new ways of working with trauma:
“Complex trauma and its effects: perspectives on creating an environment for recovery”,
editors Robin Johnson and Rex Haigh, and published by Pavilion Publishing in March
A companion website is now on-line, with further material on complex trauma, on PIEs
and other “enabling environments”.
PIEs and “Enabling Environments”
The CLG/NMHDU guidance however attributes the original term PIE itself to a (then
un-published) paper, “Social Psychiatry and Social Policy for the 21st Century -new
concepts for new needs, Part One: the ‘Psychologically Informed Environment’ by Robin
Johnson (of RJA) and Dr Rex Haigh, Clinical Adviser with the National Personality
Disorder Programme within the UK Dept of Health.
With the consent of the publishers, Pier Professional, this paper is now available
in full, here.
The term PIE has since been adopted by CLG as a key marker of constructive practice,
which then led to further work, in response to requests from frontline homelessness
services, to develop a more operational definition. This further guidance - produced
by the same writing team - is published in March 201, and is available here.
For more background on the origins of the term “PIE”, click here.
1 For these purposes, “designed” includes “re-designed”. It is one of the key features
of a PIE that it will continue to evolve as awareness, needs and opportunities evolve.
2 For these purposes, “needs” also includes a recognition of the positive capabilities
of service users.
PIEs and reflective practice
Both the original “PIEs” paper and the CLG/NMHDU guidance suggest that action learning
and reflective practice are the keys to developing as a PIE.
The paper also suggests that a PIE needs to be steeped in shared social values, and
not in psychology alone – those contextual values being provided, in the case of
UK homelessness work, by an existing commissioning and quality assurance framework.
Social psychiatry and Social Policy for the 21st Century: new concepts for new needs:
Part One -
‘the psychologically informed environment’
Johnson & Haigh (2010)
J. Mental Health and Social Inclusion
“As to how any service may approach the task, however, at this stage the field is
entirely open. There is as yet, at least, no single or particular school of thought
or of human understanding that necessarily underpins or informs the thinking in fostering
a PIE. . ….
Wherever that more psychological thinking can then be translated meaningfully into
a carefully considered approach to re-designing and managing the social environment,
then we have a PIE. It is these changes in day-to-day running, derived from reflective
practice, that mark the development of the PIE...
But for the moment, at least, the definitive marker of a PIE is simply that, if
asked why the unit is run in such and such a way, the staff would give an answer
couched in terms of the emotional and psychological needs of the service users, rather
than giving some more logistical or practical rationale, such as convenience, costs,
or Health And Safety regulations.
Although training may well help, the key to psychological thinking here is not received
wisdom, or even acquiring new skills, but reflective practice.”