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 are homeless”.  

(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 service.

 

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.

 

 

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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.

 

NB: This original article was the first of three in a series on the work of the UK Royal College of Psychiatrists’ “Enabling Environments” initiative. These three papers appeared first in  the Journal of Mental Health and Social Inclusion,

 

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 itself .

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”