Therapeutic environments have almost certainly existed since time immemorial, but it is a struggle to recognise their importance in a modern world where individualistic enumeration of all our activities has become paramount. In his grand sweep of anthropology and history, Harari persuasively argues that our forebears, as hunter-gatherers, and even Neanderthals, were more socially cooperative and community-minded than we are. Perhaps we have lost something that we need to rediscover – or reinvent - in order to improve our lives today.
The earliest documented accounts of a deliberately constructed therapeutic community, or enabling environment, is usually given as the village of Geel in thirteenth century Flanders – where those with ‘mental afflictions’ came as pilgrims to worship at the holy shrine of St Dymphna. Most of the pilgrims would probably be diagnosed with learning disability or epilepsy nowadays. When they arrived in Geel, they were taken into the care of the villagers, who were all engaged in working on the land. The success of their care was measured by an annual weighing ceremony, where those who had gained the most weight were the ones thought to be doing the best. An environment was constructed in which people with severe disabilities could be treated as human, and have their basic physical and social needs met.
Other notable events in history show the same interest in the ‘psychosocial environment’ – such as the implementation of ‘moral treatment’ by the Quakers in York at the end of the eighteenth century, progressive education and democratic schooling for troubled children since the end of the nineteenth century, the rehabilitation of battle-shocked soldiers at Northfield and Mill Hill in the Second World War, and R D Laing’s rather chaotic experiments with ‘unlabelled living’ in the sixties. Perhaps one day historians will add the current reform of penal institutions, with the realisation that attention to the same factors can make twenty-first century prisons more effective and humane.
The British criminal justice sector has been important at several points in devising the structure for ‘Enabling Environments’, on which most of this work is based. In 1998, the ‘Kennard and Lees Audit Checklist’ (‘KLAC’) was produced in order to be able to audit the prison therapeutic communities (TCs) as part of the Offending Behaviour Programmes Unit. The prison TCs were at that time seen as the only area for therapeutic communities which seemed to have a positive future, as all other sectors seemed to be closing them down or reducing their size. The KLAC formed one of the most important documents in setting the standards for all therapeutic communities when the ‘Community of Communities’ quality network was started at the Royal College of Psychiatrists in 2002. After the network had gathered much data over five or six years, the ‘core values’ were extracted and used to define the requirements for the ‘Enabling Environments’ (‘EE’) award. With this, the essential relational qualities of therapeutic communities could be used in any setting, without needing the whole apparatus of particular groups, specific staffing and suitable buildings – or the need to formally consider oneself as a ‘therapeutic community’. Therapeutic Communities remained the specialist and ‘pure’ implementation of a highly structured psychosocial therapeutic programme, but the ‘quality of relationships’ upon which they were built could now be replicated elsewhere.
This facilitated the development of ‘Psychologically Informed Planned Environments’ (‘PIPEs’) – which had a particular structure, defined by the National Offender Management Service – as part of the response to the Bradley Report on the management of Mentally Disordered Offenders. By this time the concept of ‘relational security’ was also becoming well known in high secure NHS settings. At the core of the PIPEs was a process which trained and supported staff to establish their prison wings or other units as Enabling Environments, and to work towards achieving the Royal College of Psychiatrists award to recognise that.
A parallel process, started in the government’s Department for Communities and Local Government, but without the continuing support or funding, established ‘Psychologically Informed Environments’ (‘PIEs’) for the homelessness sector. PIEs are more loosely defined than PIPEs, and do not require participating services to meet EE standards, but they have a clearly articulated structure which is based on the same relational values.
Once non-participating prison units saw the value of PIPEs, many of them decided to apply to become Enabling Environments, independently of the PIPEs programme. This has raised wider awareness of healthy psychosocial environments throughout the criminal justice sector, and at the time of writing two whole prison establishments are working towards becoming ‘whole prison EEs’, rather than just specific wings and units. At a conference in early 2016, the head of the National Offender Management Service affirmed the priority which is now being given to this work.
However, it is not easy. As well as the institutional inertia and the staff’s personal feelings of resistance to change and loss, there are major structural obstacles. The task for us in penal settings is to accommodate the very exacting and precise demands of policies and procedures, which allow no flexibility and very little individual discretion, alongside the recognition that basic humanity in relationships is required, in order to stop prisons having persistent negative effects on prisoners.
This book offers hope that it is possible to do both: to recognise the profound importance of the social matrix and milieu, while measuring, regulating and risk-managing all the necessary aspects of participants’ behaviour. Prisons and forensic settings are amongst the most socially controlled settings, where operational details of security must always trump therapeutic principles - and all the work must demonstrate metrics of outcome such as reduced probability of future offending. Yet this collection of chapters shows that it is possible to find space for humanity, in the way people relate to each other, in these difficult settings. If there is hope here, maybe there is hope for us all!
 Yuval Noah Harari (2014) Sapiens: A Brief History of Humankind. Harper Collins, New York