Psychologically Informed Environments and the “Enabling Environments”
initiative
Rex Haigh, Tom Harrison, Robin Johnson, Sarah Paget, Susan Williams
NB: this paper was originally published in J, Housing Care and Support 15.1 and is
here used by permission.
Abstract
Purpose
This paper describes the origins of the concept of a Psychologically Informed
Environment or PIE, as now adopted and applied in homelessness resettlement,
placing this in the context of work recently carried out under the aegis of the Royal
College of Psychiatrists’ Centre for Quality Improvement to recognise and promote
“enabling environments” in all areas of social practice.
Design/methodology/approach
This paper gives an historical account of the contemporary development of new
thinking and practical applications for enhancing community mental health and wellbeing.
Findings
The concept of an Enabling Environment arose out of efforts to up-date for the 21st
Century the post-war concept of a therapeutic community, for all services working
with the same basic core values and psycho-social awareness. The EE approach now
applies this framework more flexibly, yet with a clear operational focus in each
sector, to a wider range of organisational contexts, social practice and agencies
outside the therapy and care services world. From the outset, homelessness
resettlement and social housing practice was seen as a key part of the overall
ambition.
Practical implications
Understanding the values base behind social-psychological approaches in social
practice environments helps to translate these ideas into service-led improvements in
actual frontline services practice. In particular, the Enabling Environments approach
offers a handy tool for self-assessment and service improvement, which is fully
compatible with the PIEs philosophy.
Originality/ value
The concept of a PIE is currently acquiring momentum within homelessness
resettlement work in the UK. In helping to establish the underlying values framework
for psychologically-informed services; and also provide tools for such services to use,
this paper makes a contribution to help inform developing practice.
.
Keywords –
Enabling environments, community mental health, values-based practice, quality
standards, therapeutic communities.
Paper type – Conceptual paper/ case study of development work
…………………………….
PIEs and other “enabling environments”
The concept of a Psychologically Informed Environment, or PIE, is currently being
taken up with some enthusiasm in homelessness resettlement in the UK. The term was
first used in guidance, published in 2010 jointly by the Dept of Communities and
Local Government and the National Mental Health Development Unit (NMHDU,
2010), on meeting the psychological and emotional; needs of people who are
homeless. Further guidance by the same team has since been developed and is
currently being distributed (Keats et al, 2012), focusing on the practice of developing
PIEs in homelessness services.
The concept of a PIE offers a way to recognise good practice in resettlement that
reflects the true complexity of the work, and the emotional nature of the issues to be
tackled. This seems long overdue. But the PIEs approach does this without simply
proposing a standard set of solutions, or a good practice model based on what works
elsewhere. Instead, the PIEs approach demands locally situated initiatives, arising out
of reflective practice within a service’s staff team, whilst building upon a new-found
recognition and awareness of service users’ psychological and emotional needs.
What might perhaps appear at first to be missing, in this approach is an explicit appeal
to the values that underlie good practice. These values are promoted in the UK via the
funding regime of the “Supporting People” programme (CLG & SITRA, 2009); but
this will be less familiar to some readers. It may therefore be valuable at this stage to
understand the roots of the PIEs concept – and the approach to values and standards
that is embodied in this approach.
The idea of a PIE arose originally out of development work being done in the early
years of the 21st Century, under the aegis of Royal College of Psychiatrists’ Centre for
Quality Improvement (CCQI). This work aimed to develop a process, leading
potentially to an Award, to recognise services’ commitment to putting relationships at
the heart of their approach. This approach became known as “enabling
environments”, which is used as a generic term to describe good practice across a
wide range of sectors of contemporary social life. Here therefore we describe the
nature of the approach being developed by the Royal College team, in their efforts to
develop a more humanistic approach to social psychiatry and community mental
health for all (Johnson & Haigh, 2010, 2011a).
Up-dating Therapeutic Community ideas for the 21st Century
In 2002 the Association of Therapeutic Communities and the CCQI developed a
network of services1 that identified themselves as Therapeutic Communities (TCs) .
The Community of Communities (C of C) was developed to identify the crucial
elements of these services and to provide a common language by which their work
could be understood, especially by service managers and commissioners unfamiliar
with the model. Although internationally recognised, and seen by many (WHO,
1953: Hinselwood & Manning, 1979: Campling & Haigh, 1999, Johnson & Haigh,
2012a, 2012b) as the standard bearer in the 20th Century for a more humane approach
in psychiatry and a more socially-engaged community mental health, TCs in the UK
had been struggling both to demonstrate their “evidence-based” credentials, and to
specify their working methods in a way that suited contemporary commissioning of
high-cost healthcare (RCPsych, 2005) .
After a successful national lottery bid, a set of core operational principles or standards
was drawn up which could be taken to identify the fundamental of the TC in the
language of the modern age. With them came, soon after, a statement of the
underlying values, which expressed the worldview of “the new social psychiatry”
(Haigh, 2009), and were, most importantly, reflective of the developing evidence base
for contemporary psychology, psychotherapy, and social policy.
A second successful lottery bid to develop the Community of Communities in other
areas, specifically Addiction services, and Learning Disability, identified numerous
services that, whilst not identifying with the TC model, were clearly providing a
similar value based approach. It was felt that there was a need to recognise that the
therapeutic approach differed in intensity and purpose but that the fundamental values
of TCs were being used successfully in a number of areas.
Initial meetings to discuss these ideas outside the TC world identified many further
areas such as the prison service and the criminal justice system, acute service
healthcare, and homelessness, that also needed to be addressed and included. These
were sectors where pure TC model principles (Rappoport, 1960; Clarke 1965) might
perhaps not so readily be applied, but where there was still the potential to develop
services that would use the full potential in day-to-day living, social processes, and
the power of a high quality of relationship to enhance personal growth, social learning
and change (Main, 1946; Lewin, 1948; Jones, 1968a)
For these diverse settings, a somewhat different approach was needed, with a different
language. This was to be an attempt to find or create a much broader vision of
constructive relationship-forming to aid and inform service developments that did not
rely primarily on themes and theories of treatment or care. A small development
group was brought together, comprising representatives from a range of sectors,
including rehabilitation psychiatry, therapeutic communities, faith communities, the
prison service, housing, and childcarei. For their work, the development group
adopted the term “enabling environments”.
Housing and homelessness services were an integral part of this broader vision from
the outset. It was understood that many homelessness resettlement services operated
with some sophistication in the way they set out to manage the psychological and
emotional difficulties that many of their service users brought (Seal, 2005: Johnson
2008; Dept Health/Cabinet Office, 2010; Cockersell 2010). Similarly, it had been
argued, sheltered accommodation could be seen as an effective attempt to respond to
the underlying emotional strains of ageing, fears of infirmity, and the erosion of older
forms of community, with maximum value extracted from informal social capital, and
without the undue ‘medicalisation’ of anti-depressant or anti-anxiety treatments
(Johnson, 2006: Blood & Pannell, 2012).
From a common language to a quality measure
The Enabling Environments project emerged as an ambitious and imaginative
initiative, building upon the work done by the Community of Communities . The EE
project Development Group – now called the EEDG - also looked for underlying
principles which had a sound research evidence foundation, but were essentially
values-based. This reflects, it was argued, the need to find successful practice not in
specific activities, but in wider social goals (Fleck, 1979; Gadamer, 1996:
Woodbridge & Fulford, 2004: Fulford, 2010).
These principles should be able to be expressed as generic standards for practice, and
then operationalised, and customised with more sector–specific operational criteria
where needed, yet always with an explicit recognition of the need to evidence the
application of values as the central aim (Johnson & Haigh, 2011a, 2011b). The EEDG
then developed an approach to promotion of positive mental health– using a “common
core” of 10 essential elements (see below) – and with the possibility of different levels
of engagement within the overall EE framework.
At minimum, the framework needed to sum up and articulate the shared values
between frontline services and the communities they serve. This formula could simply
be a way to describe what mattered, and to help identify what made for a good place
to be, whether a workplace, a school or hospital ward, a place of worship, even a
leisure centre or a housing complex. The EEs values could then aim to offer a
statement of a shared vision or aspiration for what people wanted from their
relationships within group or organisational settings.
Even this minimum might be especially valuable, to provide a common core for and
between diverse services when, for example, different agencies must work together to
improve the conditions of those who are in their care. Just as the discovery of the
Rosetta stone, with ancient Babylonian Law inscribed in three local languages,
allowed historians to decipher scripts they had never before understoodii, so the EEs
framework would attempt to find – or create - a common language in which all
services could recognise their own best practice.
But it would then, perhaps inevitably, start to operate in practice as a kind of checklist
of issues that any services or community group might want to address, if it was to
provide a constructive, nurturing and welcoming, enabling environment. It would
become an agenda. It could provide a yardstick, against which to self-assess – or
indeed for peer review assessment, when services or groups wanted to see how their
efforts looked in other’s eyes. This was the second level of more active engagement.
For this kind of self-evaluation, the group would produce a way to focus on practical
expressions of what matters – and a process for checking actual practice against these
core values. The development group proposed a distillation of standards and criteria
which could be used by groups and services to identify and record tangible examples
of activities that reflected their service’s or community’s values– and draw attention
to areas where there was actually little specific to show, and where perhaps further
work needed to be done.
Finally, for these services or agencies that really wished to demonstrate that they were
aiming for excellence, the EE framework could provide a kite mark, a quality
measure, objectively and externally assessed – an “Enabling Environment Award”.
Here there would be a portfolio-based assessment process giving the community the
opportunity to demonstrate their excellence in their own unique way, mapped against
the standards. The process would include trained assessors visiting to talk through the
work with the staff and other stakeholders – including service users – and when
appropriate, to recommend the project to the awarding body. This could then be the
third level of in-depth engagement
Nevertheless, the principle was established that developing operational criteria and
offering evidence required customising in each service, and to their particular
circumstances. Furthermore, adoption of the EEs approach should be entirely
voluntary, not externally imposed. In an age when performance management and
quality assurance bodies tend to look at the “product” delivered, rather than the
quality of relationships or the environment as whole, the EE framework might then go
where other quality measures simply did not go. Since the Royal College is itself an
accredited quality assurance body, the college could itself act as an assessing body.
Furthermore, this would create a viable business model for the whole project, so that
there was the prospect of this becoming a fully self-sustaining enterprise.
There were, therefore, three ways to use the EEs framework for self-improvement
within services, dependent upon the amount of time and energy services and groups
were willing and able to invest in self-assessment. However, it was also envisaged
that there could eventually be, in effect, a fourth tier. This would comprise the
membership of services that had worked through the portfolio and achieved award
status, and which then formed a community or commonwealth of sorts, of services
which had earned the right to be involved in some fashion in future roll out and
development of the project. How that might operate would be left until the time was
ready; but the idea that the “awardees” were also a community and a resource, to the
project and to each other, had obvious appeal.
The Enabling Environments core elements
There is and probably can never be a single, un-contested concept of community and
common purpose in how people may live, work and be together in the social world
(MacIntyre, 1985: Hoggett, 2009). But a reading of the ‘grey literature’ of policy
statements from government departments and statutory regulatory bodies, indicates
certain recurring themes, cutting across or running through the different ‘jurisdictions’
of a wide range of sectors. Some identifiable principles or standards seemed to
consistently underlie and articulate what were seen to be the main issues in positive
practice. These could then be mapped across and combined with a generic adaptation
of TC values and research from the field (Williams 2007). As a result, the
development group found that a positively enabling environment would be one…

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in which the nature and the quality of relationships between participants or
members would be recognised and highly valued;
where the participants share some measure of responsibility for the
environment as a whole, and especially for their own part in it;







where all participants – staff, volunteers and “service users” alike - are equally
valued and supported in their particular contribution;
where engagement and purposeful activity is encouraged;
where there are opportunities for creativity and initiative, whether spontaneous
or shared and planned;
where decision-making is transparent, and both formal and informal leadership
roles are acknowledged;
where power or authority is clearly accountable and open to discussion;
where any formal rules or informal expectations of behaviour are clear; or if
unclear, there is good reason for it;
where behaviour, even when potentially disruptive, is seen as meaningful, as a
communication to be understood.
What is more, within each specific area of human social activity, there now appears to
be considerable direct and/or corroborating evidence for the validity and efficacy of
these underlying principles. With a distinct hint of insouciance, the EEDG have
suggested that “we hold these truths to be well-evidenced…..”.
Within this broad framework of shared values, more specific features and processes
can then be identified, which might be more suitable for one setting or another, and in
varying degree. For example, the balance of acceptable risk and individual initiative
will be very different in a prison setting than in a housing estate or old persons’ home.
There is clearly a debate to be had about how far any care environment (such as a
playgroup or a residential care home) should be protective and controlling, or how far
it needs to be permissive and supportive of risk-taking and experimentation. The core
concern is therefore about a balance of risk; but the appropriate balance may need to
vary according to the setting.
It is essential therefore that within each community or setting, the participants in that
setting should be able to agree between them the kind of environment that they would
wish to see, and their own most suitable demonstration of this. The adoption of any
local set of standards by any group or community would need to be a voluntary
action. To that extent, therefore, the stress on shared reflection from the PIE approach
appears to be just as valid here – though the nature and format of that reflectiveness
needs to vary, according to the opportunities in the situation. The extent to which, and
even the means by which, the ground rules of participation and belonging are open to
discussion and re-negotiation will vary from primary school, to homelessness hostel
or hospital ward.
Piloting the Quality Mark and use of the portfolio
Work then began on developing a template portfolio, and a formal assessment
process. With the underlying principles and method established, the overall approach
of promoting discussion and providing evidence of operational policies and practices
based on these 10 underlying principles, was piloted with a number of services in
different areas – including the Northern Housing Consortium (2009).
The pilot feedback was encouraging. Not only did the pilot services generally find the
standards-with-evidence approach affirming, but they found the actual process of
sitting down together to work through the portfolio of evidence – including the
expectation of service user participation - was itself a useful and rewarding experience
in its own right. The stress, in the EE approach, on valuing the quality of experiences
for both staff and service users alike was also appreciated.
The development group also noted that the combination of a rigorous portfolio
assessment, staff and service user questionnaires and an assessment visit seemed to
provide a a solid indicator of the quality of relationships in the environment. Hence
they became increasingly confident that this was a product that might occupy the
“gap” where current QA systems do not go, and based on what really matters in
services..
Meanwhile, members of the EEDG involved in other areas were looking to find new
applications of these principles, and more focussed concepts that could be used to
develop practice in specific sectors.
EEs, PIPEs and PIEs
Within the criminal justice system, motivated by widespread concerns about high
levels of mental health needs in the prison service (Singleton et al 1998; Bradley,
2009) , a proposal was being developed for a small number of pilots of prison units
and probation hostels (“approved premises”) which would be informed by
psychological theories and psychodynamic thinking on the importance of
relationships and organisational resilience (Trist & Murray, 1990; Hinshelwood &
Hogstad, 2000; Ballat & Campling, 2011; Dartington, 2011). To distinguish this
fresh start from earlier attempts to develop TCs in the prison service, for these
initiatives the term “Psychologically Informed Planned Environments” had been
proposed; and a programme of research to evaluate these pilots was being devised .
At the same time, in the field of homelessness resettlement, there were similar (NSIP,
2009; Dept Health/Cabinet Office, 2010) attempts to identify the psychological and
emotional needs of homeless people, which eventually culminated in the “complex
trauma” guidance issued in 2010 jointly by CLG and NMHDU (2010), which aimed
to recognise the levels of need, and the innovative practice being found in a number of
frontline services in responding to these needs. The complex trauma guidance quotes
many examples of a diverse range of services, all working creatively, in their own
way, to develop their particular service is an manner sensitive to and able to manage
challenging psychological and emotional needs.
To avoid contamination of the fully planned programme of research in criminal
justice (Johnson 2012b), it was agreed that the term used for these more flexible and
spontaneously evolving developments would be “Psychologically Informed
Environments”, or PIEs; that is, the term would simply drop the word “planned”. This
should reflect the fact that, in high secure services, all developments in operational
practice need to be agreed in thorough-going detail.
In other respects, nevertheless, there might well be some planning involved in service
re-design; just as of course there would be some spontaneous evolution within the
PIPEs. It was furthermore perfectly possible that same core principles, as identified in
the TCs and EEs work, would be applied, and even the same portfolio approach to
identifying the development agenda that the EEs project was developing.
The wheel finally came full circle when the Ministry of Justice decided to
commission work to develop the first six PIPE pilots, using the EEs approach, as the
route to becoming a PIPE.
Current state of development
Future developments with the EE project itself will include;
1: continual extension and broadening of the approach into new sectors, and with
further refinement of the vocabulary, the examples of evidence, etc. in each sector.
2: developing the “4th tier” involvement of established and accredited “EEs”, and the
promotion of successful services, not as “good practice” models to copy, but as local
cross-sector mentors for others.
3: further international promotion of the EEs framework, alongside the now agreed
UK standards for therapeutic communities themselves (with the possible option of
then working in partnership with other local groupings or QA bodies.)
Central to the fundamental principles behind the development of PIEs is the idea that
real development arises internally, from reflective practice, and that must come from
within the staff teams of these services, albeit informed by psychological and
psychotherapeutic thinking. There is no “correct” model, nor any way to get there,
that can be imposed from outside as “good practice”. But the same thinking underlies
the EE approach.
It must therefore be possible for any resettlement service to find its own solutions to
service re-design – including a simple valuing of relationships. (Johnson & Haigh,
2011b). Nevertheless, we would be very interested to see how far the EE approach –
the values, the language, the portfolio of evidence, even eventually the Award-level
recognition – could be helpful in assisting and even speeding the process of
improving services and communities.
For those services that are interested in exploring this approach, the Royal College of
Psychiatrists’ websiteiii has links to all the material needed. The full set of standards
and criteria can be downloaded for developmental use free of any charge. Only the
formal Award process incurs additional costs, for the staff time entailed.
Finally, we should point out that the underlying principles that gave rise to the PIEs
concept in homelessness, and the PIPEs development in criminal justice, are intended
to apply to a wide range of other, less institutional settings, including in the area of
supported and general needs housing. It would be particularly interesting to explore
now how useful this approach is with, for example, a sheltered accommodation
complex; or a Tenants and Resident Association, in a high-rise block of flats, or on a
new-build housing estate.
……………………………..
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i
The EEDG comprises Dr Adrian Worrall for the Royal College CQI itself; Sarah Paget as the College
lead for the Community Of Communities; Dr Rex Haigh, consultant psychiatrist and medical
psychotherapist, formerly Chair of the Association of Therapeutic Communities and currently national
clinical adviser on community personality disorder; Dr Susan Williams, organisational and quality
improvement consultant and co-founder of a therapeuticfaith community; Tom Harrison, medical
historian consultant psychiatrist in psychiatric rehabilitation; Kirk Turner, Ministry of Justice lead on
development of PIPEs; Jonathan Stanley, National Children’s Bureau, and Robin Johnson, formerly
CSIP national lead on mental health and housing, and now editor of the J. Housing Care and Support.
ii
For the history and importance of the Rosetta stone, see:
http://ancienthistory.about.com/cs/egypt/p/rosettastone.htm
iii
The website address is:
http://www.rcpsych.ac.uk/quality/qualityandaccreditation/enablingenvironments.aspx