Supported living and people with behaviours that challenge services

We have long called for improvements in the quality of supported living arrangements for people in this group, and an end to the use of institutional care (whether provided by the NHS or social care agencies) as a long term housing and support solution. This interest had led to a number of NDTi papers recommending new policies both at the national level, and for local commissioners. Ultimately, however, these policies are played out in the lives of individuals, one person at a time, each on their own journey. For some, it is admission to a residential placement for lack of better alternatives; for others, the journey back to the community and the start of a new life.

Recent NDTi involvement in one person’s story (we’ll call him Brian) has underlined some important messages about the factors that will help to make that journey a success. The commissioners of Brian’s service sought to take a positive approach to improving his service and life. They engaged an independent external review to consider whether his previous service was acceptable, then resourced support to develop a person centred support plan – in partnership with his family. As a result, they invested in an individualised service, close to his family, that involved intensive support and a ‘fresh start’.

In the six months since Brian moved to supported living there have been measurable improvements, for example in the use of PRN medication and physical restraints, and Brian clearly states that he likes his new home. It has, nonetheless, been a difficult and challenging time. To a large extent this is inevitable: it was never realistic to expect ‘miracles’, and some events could not have been predicted. However, with hindsight it is clear that some things could have been done better.

With the agreement of Brian’s family and the commissioners of his service, we are publishing this short and anonymised paper in order to share some of the learning about things that, even with the best of intentions, might not go according to plan. The aim is that others learn, and that errors are not repeated elsewhere.