Few developments in thought have one single origin or inspiration. This is clearly
seen with a concept such as the “psychologically informed environment” (or PIE).
The immediate origins of this phrase came in the work that RJA was then doing with
the Dept Communities and Local Government (CLG) in identifying some of the common
threads in operational principles in good or innovative practice.
These example were later published as part of the joint CLG/NMHDU guidance on-line
document, “Guidance on meeting the psychological and emotional needs of people who
(For further commentaries on this guidance, see Publications)
However two or three further sources and contexts must be factored in, to appreciate
the full meaning of the term.
Firstly, there was the working party convened under the auspices of the Royal College
of Psychiatrists – the “Enabling Environments Development Group” - which had been
providing the creative groundwork for new thinking on the nature and contribution
of the psycho-social and physical environment to health and well-being. This working
party was aiming to up-date the concept of a therapeutic community - a “TC” - for
the new world of 21st Century community mental health and public health.
Despite a number of attempts to develop “TCs” in areas badly in need of refreshment
- such as in the prison service - only sporadic and limited development had been
seen. The “TC” model seemed best suited to settings which were explicitly therapeutic;
and many of the most damaged and marginalised individuals in contemporary society
were being “managed” instead by institutions with no such aims or claims. The need
to reconsider the model and the terminology was becoming evident.
Secondly, within the prison service, as a direct spin-off of these discussions, the
term “psychologically informed planned environment” was being discussed, as a more
flexible term that could “go” where the more narrow approach of the therapeutic community
had failed to make lasting progress.
Thirdly, however – and of more immediate practical relevance within the field of
homelessness outreach and resettlement work - was the removal of the “ring fence”
around SP funding for “housing-related support” services. This merging of housing
support funds into the general pool of local authority funding for community welfare
creates serious risks for the sector (see Innovation , local engagement and leadership,
Johnson R & Robinson Z, 2008 ).
It also meant that it was no longer necessary to claim – as some had felt obliged
to do in the past – that there was a clear distinction between “support” and “care”.
The true level of psychological need being managed by, for example, homelessness
resettlement services could now be revealed, without threat to the funding of the
For a rather ascerbic description of this dilemma for services, see the RJA paper
published in the SITRA bulletin, “ This is not a pipe”, in the publications area
of this site. For a further analysis, see our review of the University of York paper
on evaluating the effectiveness of housing-related support.
We are seeing increasing pressure, from government and providers, and users and carers,
to see better integrated services, made possible by more integrated commissioning.
The alignment or outright pooling of budgets allows the conventional divisions between
health, care and support budgets to be overcome. Local commissioners can now fund
services which cross category boundaries, in pursuit of the needs of the client group.
Finally, we are seeing increasing concern to tackle what are now seen as “health
inequalities” - poor life expectancy, poor take up of services, etc - amongst the
most marginalised and excluded. A greater priority accorded to this group, and their
needs, provides the incentive to use the new commissioning flexibility to start to
meet those needs that were hardest to meet by more silo’ed services.
Taken together, these policy and practice developments mean that we can now look
more closely at the real nature of the work being done in the best of outreach and
resettlement services. This then lead to further work with CLG to encourage more
operational specification of the characteristics or markers of a PIE approach with
rough sleepers and others.
The original paper in which the term “psychologically informed environment” is now
available to download, here.
PIPEs, PIES, TCs and Ees
and a string of other new terms for environments
In the past few years, a veritable string of new terms has appeared, all attempting
to describe the importance, in different contexts, of the social and physical environment
for enhancing the therapeutic impact of support services.
Though each terms arises in a different context and for a particular purpose, there
is a need to clarify those differences, and to spell out the underlying continuities.
A brief outline of how some of these concepts are nested together appears in an article
published in the Journal of Housing Care and Support, referred to above.
However, a fourth potentially useful concept, the “prosthetic environment”, has since
been proposed, in Susan King’s chapter on “The Drama Triangle and other Unwanted
Repetitive Patterns”, in “Complex Trauma and Its Effects; perspectives on creating
an environment for recovery, editors Robin Johnson and Rex Haigh, (see below).
A “prosthetic” environment is one that does not seek to change the behaviour or roots
of behaviour of the individual resident, but rather, to design and manage the environment
in such a way as to make up for the deficits in the individual’s capacity to cope.
There are also two further useful concepts: the “intentional community” - of people
who chose to form a community, but not necessarily a residential community; and the
“existential community”, of those who choose to support each other in their decisions
- for example, to remain sober.
It is suggested, therefore, that much of residential care might be seen as offering
prosthetic, rather than therapeutic, environments. In practice, many therapeutic
environments will also blend in aspects of the prosthetic; a “dry house” for recovering
problem drinkers is an example.
Yet both prosthetic and therapeutic environments could be seen as enabling, insofar
as prosthetic environments, by reducing risk, can allow the individuals there to
live more freely. Both, of course, may be “psychologically informed”.
This discussion is continued in the companion website to the “Complex Trauma and
Its Effects: Perspectives on creating an environment for recovery”
The original paper in which the term “psychologically informed environment” was
introduced is now available to download, here.
Pt II in the series - on “Social Psychiatry and Social Policy for the 21st Century;
new concepts for new needs” - gives more details on the enabling environments approach
This paper spells out the key shared values that the RCPsych development group identify
as central to a sense of belonging and emotionally healthy connectedness.
This paper can be found on the RJA publications pages.
Part III - also appearing now in the publications section - continues and concludes
the exploration of social psychiatry and social policy by considering the links an
overlap between the enabling environments and those of public health, “the Big Society”,
and relational health.
The trilogy of papers is then rounded off - in true Douglas Adams, style, as the
fourth in the trilogy- by an article published in the Journal of Housing Care and
Support, "Psychologically informed environments and the 'Enabling Environments' initiative",
Haigh et al (2012); a copy of which can now be found on our Publications pages.
This paper traces the history of the concept, and its links with the PIEs and PIPEs
developments, in greater detail than the brief description here can do.
The origins of the term “a psychologically informed environment”