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Psychologically Informed Environments (PIE) Report

The publication of this evaluation of the three Dialogical Psychologically Informed Environments (PIE) that Fulfilling Lives Newcastle Gateshead piloted is timely because the PIE Community of practice has been growing both nationally and internationally. This research can contribute towards the growing evidence base for PIE as an innovative approach to working more effectively with people with complex trauma and multiple needs. In this blog, Ray Middleton (system broker) shares his thoughts on the research.

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I’m really excited to read the full report  of the Dialogical PIE’s we piloted at Fulfilling Lives (an executive summary is also available). It is encouraging that the findings are so positive in terms of social impact and the recommendations to scale up more PIE’s is a challenge to the wider system of services to reflect upon – to consider if they want to support developing PIE further?

Often people with complex needs do engage with accommodation-based services. PIE helps staff and clients to reflect on their practice and increase their understanding of the thoughts, emotions and stories which underlie challenging behaviour and difficulties forming relationships. Relationships are valued as the principle vehicle for change in an open dialogue approach where uncertainty is tolerated, everyone’s viewpoint is valued and it is accepted that no one knows all the answers but through democratic dialogue new pathways into recovery journeys can be formed.

The five elements of PIE are;
1. Reflective Practice (Staff Training and Support)
2. A Psychological Framework
3. Focus on Relationships,
4. The physical spaces,
5. Evidence generating practice.

These interventions to improve services for people with multiple complex needs brought together two innovations – the development of Psychologically Informed Environments (PIE) combined with applying key principles of the Open Dialogue approach.

To increase the understanding of PIE I interviewed the originator of PIE, Robin Johnson, in this film where he explains the 5 key principles of PIE. PIE was a response to an identified long standing and nationwide systems failure of statutory secondary mental health services to engage effectively with those with complex trauma histories and multiple needs (combinations of mental health, addiction, offending and homelessness)

Open Dialogue is a new approach to mental health taking a whole system/social network approach, this short film explains more about the current open-dialogue pilots in 6 UK NHS Trusts headed up by Dr Russell Razzaque, Consultant Psychiatrist and Associate Medical Director of NELFT.

There is growing interest in developing PIE in services to develop workforce skills to better meet the needs of those with complex trauma histories.

Taking an open dialogue approach to implementing the PIE’s we listened to staff’s difficulties in being freed up to attend training off-site and in response made some films that could be viewed on-line, such as this film explaining how open dialogue and PIE principles can be combined. We also developed a framework, Ladder4Life, which was relevant for people with multiple needs, which formed a basis for our open dialogues.

There is growing interest in developing PIE in services to develop workforce skills to better meet the needs of those with complex trauma histories. To help those interested in going further on the PIE journey we produced a series of training films, including an interview with Phil Conn, the manager of Basis@336 where Dialogical PIE had been introduced and with author Jay S. Levy from the USA on his 5 principles of pre-treatment for engaging rough sleepers.

For commissioners, there is a film interview about PIE with Victoria Aseervatham, Westminster City Council’s Commissioner for Homeless and Rough Sleeping services. If anyone is interested in learning more about PIE you can join a free community of practice – – with an accompanying film explaining the site.

I hope this evaluation can contribute to the growing evidence base around PIE and I’m really looking forward to hearing any reflections you have on this research evaluating Dialogical PIE.

Do feel free to email me at or follow me and comment on this blog on Twitter @Dialogical_Ray