Developing Psychologically Informed Environments in our Hospitals

Psychologically Informed Environments (PIEs) can be described in many ways, but at its heart, a PIE aims to provide an evidence-based approach that supports people to effectively meet their needs and to improve their quality of life.

Our Learning Disability and Autism Hospitals are being developed to ensure a culture of reflective practice, where person-centred care plans and individual formulations advise a person’s care pathway. A key part of a person’s success is the daily support they receive, not just the therapy provided; as such, our aim is to ensure that care staff are given the opportunity to develop their clinical skills through a training programme that not only focusses on the core aspects of Positive Behavioural Support but also in helping staff to understand a particular person, not just the diagnosis.

Jane was 30 years old when she was admitted to our hospital under Section 37/41 of the Mental Health Act, following an index offence of Arson, and with diagnoses of Mild Learning Disability and Bipolar Disorder.

Jane’s behaviour was often challenging, with episodes of aggression and violence, engaging only sporadically with the team. Over time, she was able to develop some very positive and containing therapeutic relationships with the staff, and this led to a gradual decrease in her challenging behaviours.

As the service developed its psychological therapies functions Jane was able to start to engage in a range of additional therapies that aimed to support her to move on to the next stage of her life.

Jane engaged in regular individual psychology sessions and groups that helped her to develop a formulation of her behaviour, substance abuse work, and appropriate coping strategies and improved self-esteem. By this point, Jane also felt able to engage in trauma-focused work that she had been unable to consider previously. A consistent and care planned MDT approach supported her through this process and helped to contain and alleviate Jane’s anxieties. Alongside her psychology sessions, Jane benefitted from 1:1 nursing sessions which encouraged her to verbalise her feelings more, resulting in a further decrease in incidences of challenging behaviours.

In addition, Jane accessed a number of opportunities to develop her independent living skills, supported by the OT department. These sessions enabled Jane to increase her confidence whilst using public transport and to develop budgeting skills, which helped her to eventually obtain unescorted community leave, of which she felt incredibly proud. Jane then began to support the team in interviewing for new staff at the hospital and she also agreed to support staff inductions, as well as at hospital networking events across the country (even finding the confidence to present work that she prepared at a conference).

During this treatment phase, Jane was accepted for a supported living service in her home area. The team worked alongside the new service, community team and Jane herself to develop a robust treatment and transition plan. Jane benefitted from a lengthy transition period with her new care provider, which helped to alleviate her anxieties about moving on. Her new staff visited her at the hospital every day for three months, working closely with her and her existing team. Being able to develop therapeutic relationships before transition was vital for Jane given her experience and history of trauma. After eight years in hospital, Jane was successfully discharged into the community on a Conditional Discharge.

To quote Jane,

“Nobody thought they’d see the light at the end of the tunnel for me, they thought I’d be stuck in hospital forever, but I proved everyone wrong”.


Learn more about our Learning Disability and Autism services here.