The roots of the PIE concept

New ideas rarely if ever spring from nowhere; and in the case of the PIE concept, we can trace at least three main strands.

The first strand is the social model of disability, which gradually became translated into practical action by government, in the form of the social inclusion policies, for example, of the UK Labour Government around the millenium. This idea - that much of what is 'disabling', for 'disabled' people, stems not from their own characteristics, but rather from the way the surrounding society does, or does not, accommodate their needs, and that society and its institutions may themselves need to change - lay behind the ambition to ensure that those most excluded from mainstream society

The second strand was the development of two parallel developments in the understanding, firstly, of the nature of trauma, abuse and neglect, as copious new research in neuroscience was tending to conform the insights of attachment theory on the importance of early experience, and secondly of the prevalence in the population of high levels of poor mental health, in the form of un-diagnosed and un-treated personality disorder.

The Department of Health consequently instigated a series of exploratory developments to create new models of service for those with a diagnosis of PD; and it was striking to see how often the princiles on effectuve working that energedm inthe course of these pilots, seemd to echo many of the themes being discoveerd in homelessnesss ervices

The two are in fact closely linked, as in so many cases it is early trauma which is expressed later in life in the dysfunctional emotional dysregulation and chaotic behaviour that is then given, in clinical terms, the diagnosis of "PD"; but since much of this troubled and troublesome behaviour is not brought to mental health services - which in any case had deemed PD to be 'untreatable" - these problems were dealt with more often by other services, less well equipped to manage the underlying problems.

A third strand had been the re-invigoration of the therapeutic community as a model of psychiatric care - in its own more narrow sphere of influence, a predecessor, in its own way, of the idea that institutions themselves need to change. Although therapeutic communities - "TCs" - had been eclipsed by the advent of the major psychotropic medications, their influence never entirely died out, re-appearing in a number of guises, such as user empowerment practice. But a modest resurgence of TC ideas and practice

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The roots of the PIE

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