Supported living is a type of social care designed for people with different needs, such as autism, learning disabilities, mental health conditions and physical disabilities. Residents typically live in their own flats or shared houses, with support staff available to help them live independently in the community. People are usually referred to this service through local authorities, who assess their needs and help them find a care provider. Some may only require this support for a short period of time, while others stay for years, even decades. The process is individual and intended to offer autonomy while also providing support when needed.
When I began working in this field, I understood my role in rather straightforward terms. I was meant to support with daily tasks and routines, navigate appointments and build stability. It was about practical support, community interaction and day-to-day life. It was emphasised to me by seniors that we were not a “mental health service”; instead, our remit was neurodivergence and learning disabilities.
As I began to learn more about the lived experiences of those I supported, I quickly realised that this statement was false. Many people relayed experiences of growing up in a society that stigmatised and ostracised them. Some had been sectioned and stripped of their agency. It was difficult to find a resident who had not experienced some form of psychological distress, and this was understandable. They had lived lives that were not easy, experienced adversity and had been pathologised accordingly.
Officially, we were not there to provide mental health care. In practice, distress shaped almost everything.
People expressed their distress in different ways. Some experienced suicidal thoughts and tried to act on them. Others stopped taking their medication and began to hear voices. Soon we were in contact with crisis teams, psychiatrists and the wider mental health system. While we waited for resources to become available, we were managing emotional crises without adequate training or emotional support.
Distress was documented thoroughly, risk was constantly assessed, and people were regularly checked on. The underlying experiences and trauma often seemed to be overlooked. Instead, the narrative was frequently individualised and surface-level, focusing heavily on diagnosis and symptoms and too little on the external factors that contributed to a decline in wellbeing.
I remember one resident I supported early in my role who was extremely isolated. He barely saw his family; his friends from school had moved away and started their lives, and he had no clear sense of purpose. Yet when I finally managed to sit with him and engage, he opened up about his passions and dreams. He loved music and spoke about wanting to craft songs; he also had a deep affection for the 90s because it reminded him of his childhood. We tried to help him reconnect with a sense of community and spend more time outdoors.
Yet it often felt as though some just saw a complex diagnosis. Support became inconsistent, and sustained engagement wasn’t there. When he pushed support away, some interpreted it as resistance rather than discouragement. I felt that if he had been able to reconnect with his passions consistently, we might have made a positive change. Instead, he gradually deteriorated, stopped taking his medication and began hearing voices. He was taken away by ambulance, and I never saw him again.
Seeing him get sectioned left me feeling uncomfortable and resentful. He was going away to receive treatment. But would he truly be better? His symptoms may have reduced, and his voices may have quietened, but what had been done to address his circumstances? The isolation, the broken family relationships, the absence of meaningful community resources. If those systems remained untouched, what exactly was the hospital treating?
After these experiences, I began to view supported living as occupying a strange in-between space. We were not a mental health service, but we were expected to manage a crisis. We were not nurses, yet medication adherence was essential. Our role was, in many ways, to occupy a space that other services were unable to fulfil. Yet instead of distinguishing ourselves from those services, it often felt as though we mirrored them. There was pressure to uphold the status quo of “stability”, something that looked good on paper but did not reflect complex realities.
Stability became a measure of success. Fewer incidents meant fewer safeguarding referrals, fewer crisis calls and fewer admissions. On paper, it made the service appear effective. But stability did not mean that somebody felt less alone, less judged or more hopeful. It meant that distress had been managed, contained and documented.
Many of us tried to be more holistic, focusing on community engagement and helping people rebuild connections. Much of this was overshadowed by financial constraints, administrative demands and safeguarding concerns. Did this person’s support hours align with the event they wanted to attend? How much would a taxi cost if no driver was on shift? Had risk been assessed, and was the outing financially viable?
A missed community group could mean further isolation. A cancelled outing reinforced the sense that autonomy was conditional, dependent on budgets and rotas. Despite empowering language in care plans and official documents, the reality often remained restrictive. While some of us pushed and made it work, others could not, and residents continued to feel isolated. Once again, they were facing another external source of distress, this time shaped by administrative limitations.
In this sense, supported living was not just responding to distress; it was inadvertently reproducing it. When suffering re-emerged under these conditions, it was interpreted clinically. The constraints themselves were rarely addressed.
Addressing this would require more than papering over cracks. It would mean questioning the kind of environment we are fostering and how we expect people to be truly “well” within it.
Supported living was designed as an alternative to institutional care. In many ways, it offers that. But when stability becomes the primary marker of success and autonomy is conditional, are we truly moving on from those dynamics?
Saying we are not a “mental health service” may protect organisational boundaries. But it disregards how we continue to mirror psychiatric narratives while overlooking social and relational causes of suffering.
Steering away from the psychiatric narrative is about more than changing language in care plans. It would mean centring external and relational factors alongside symptom management. It would mean changing the questions we ask: instead of “What is wrong with someone?”, we might ask, “What does this person want, and what is worsening their distress?”
It is easier to view distress as the result of an illness because it offers the promise of a simple solution. A more holistic approach requires greater effort. It means getting to know someone on an individual basis, listening to them, and allowing them to lead where possible. It means fighting to secure additional funding for community activities and spaces. It means greater coordination between siloed medical teams to build collaborative, well-rounded support for the future.
It is too easy to fall into power imbalances that mirror clinical relationships. Yet when we ask the right questions, we often find that people have the self-knowledge to move towards a way forward that aligns with their values. In time, they may tell us what they are missing, and in that admission, we can find solutions that are far more meaningful than surface-level symptom management.
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Mad in the UK hosts blogs by a diverse group of writers. The opinions expressed are the writers’ own
The post Supported Living – We Were Not a Mental Health Service appeared first on Mad in the UK.
May 30, 2026
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