Psychiatric care and environments
Returning to the roots
As you might expect, in work with services for people with complex needs, the history and the origins of the psychologically informed environment approach is quite multi-faceted.
But one of the more significant strands in this history was the development, in the second half of the 20th Century, of 'social psychiatry', and the therapeutic community movement. From here came the inspiration, the practice and many of the actual ideas that later fed into the original recognition of the emergence of the psychologically informed environment, as a phenomenon (see for example 'In search of the enabling environment) .
Psychiatric care also illustrates many of the challenges, in articulating a new way of thinking and working (see for example: 'Memes - a cautionary tale': and also 'Key learning from the CPA in mental health').
History tells how a similar spreading of the ideas had happened earlier with the therapeutic community approach, which later morphed into enabling environments, which in turn was one of the more immediate origins of the PIE.
Currently this thinking seems to be morphing again and broadening still further, into the growing recognition of 'relational practice'.
Then and now
Charting how psychologically informed environments seemed to work, in practice, began in the context of homelessness services, But very quickly it began to branch out to realise the relevance in many other related areas. The therapeutic community model has largely died out in mainstream psychiatric care services. But with a growing number of psychiatric in-patient services now showing an interest in the PIE approach, we are seeing a return of these ideas and principles to their origins.
It would be very interesting to hear more from these services about how in practice this re-introduction goes; and any examples of changes in ward practice, stemming from these discussions.
For the moment, though, much of the focus seems to be on attempting to introduce - or re-introduce - a culture of enquiry, through reflective practice at ward or unit level. In some cases, this may take the form of, or be combined with, 'formulation' discussions - an attempt to move beyond diagnosis and the medical model, towards an approach rooted in psychology.
We have little information so far on examples of actual changes to the physical or social environment of wards, where many of the rules and roles - in PIEs 2 terms, 'the Three Rs' - are still quite 'orthodox', and responsiveness is often still seen primarily in either clinical or 'critical incident' terms.
Further background reading/listening/viewing
Introducing PIEs through reflective practice in Bristol mental health services (video)
PIElink pages
Is it all just about homelessness? : HERE
A single framework : HERE
From PIEs 1 to PIEs 2.0 : HERE
Library items
(Please note: you will need to be registered and logged in, to access items from the members' Library.)
Is a PIE just about homelessness? : HERE
Social Psychiatry and Social Policy for the 21st Century - new concepts for new needs, Part One: the ‘Psychologically Informed Environment’ Johnson & Haigh, 2010
The 'complex trauma guide (DCLG & NMHDU 2010) : HERE
Memes: a cautionary tale, Part One (on TCs and the PIE as ideas) : HERE
Key Learning from the history of the CPA in mental health : HERE
Relational practice specification (draft): HERE
Implementing psychological formulation (NB: in hostels`) : HERE
Podcasts
The therapeutic community model in mental health (Johnson, 2015)