Supported living networks

1. Introduction

Version followed: WHO (2021) Supported living services for mental health: promoting person-centred and rights-based approaches (one of the seven technical packages accompanying the WHO Guidance on community mental health services), as the four services describe themselves. Hand in Hand (Georgia) and Home Again (Chennai) follow the WHO case studies. KeyRing and Shared Lives follow the organisations' own and partner pages, because the WHO sections on these two services are not drawn on [uncertain]. Home Again outcome data come from The Banyan's later impact report.

What it is. This is not a therapy. It is a group of supported living services: housing plus support that lets people with psychosocial disabilities (and, in some services, intellectual disabilities) live in ordinary homes in the community, with control over where, with whom and how they live. WHO describes these services as either giving people housing or helping them find and keep it, while respecting their legal capacity [source: WHO 2021 supported living package page]. The four models differ:

• Hand in Hand (NGO, Georgia): small staffed group homes of up to five adults, mostly people leaving institutions. Assistants are on site around the clock. In the WHO account, 30 adults lived in four houses in Gurjaani and two in Tbilisi. The acknowledgements name Amiran Dateshidze and Maia Shishniashvili as the NGO's founders [source: WHO 2021 package, §2.1].
• Home Again (The Banyan, Chennai, from 2015): rented homes in ordinary rural or urban neighbourhoods, each shared by an "affinity group" of 4–5 people with long-term mental health conditions who have been institutionalised or homeless. Locally recruited personal assistants support them, with a small case-management team [source: WHO 2021, §2.2; The Banyan impact report].
• KeyRing Living Support Networks (England and Wales, from 1990): about nine members, each with their own tenancy, live within walking distance of each other. A Community Living Volunteer lives locally rent-free and gives at least 12 hours a week. Members support each other, and paid staff cover the network [source: GovInt case study].
• Shared Lives (South East Wales Shared Lives Scheme): an adult is matched with an approved Shared Lives carer and lives with, stays with or spends time with that carer's household. Arrangements can be long-term, short breaks, emergency, sessional, hospital-avoidance or post-discharge. The South East Wales scheme has run a mental-health crisis alternative to hospital since 2019, with Aneurin Bevan University Health Board [source: Torfaen/SEW Shared Lives page; Shared Lives Plus 2025].

How change is thought to happen. Recovery comes from having a home, relationships and a valued role in the community, not from first being made "ready". Home Again explicitly drops "fit for discharge" and "community readiness" tests [source: WHO 2021, §2.2]. People gain skills and confidence by running their own daily lives with support: cooking, money, work and neighbours. Supported decision-making replaces substitute decision-making, and non-coercive relationships replace control [source: WHO 2021, §2.1–2.2]. KeyRing adds peer exchange and asset-based community development [source: GovInt]. Shared Lives adds the everyday life of a family household [source: Shared Lives Plus 2025].

Who this guide is for. A psychotherapist or mental-health clinician who refers clients to these services, works inside them (as a psychologist, case manager or Shared Lives worker), or works alongside them as the client's therapist. Clinician procedures not described by the services are marked [synthesis].

2. Framework

These services do not have treatment phases. The pathway below is assembled from the services' published processes. Its sequencing is [synthesis], and the content of each step is sourced.

Format and intensity (as published).

• Hand in Hand: houses of up to five people, though state funding is set for six. About 3.5 assistants per house work 24-hour shifts. Other staff: a coordinator, two service managers, a psychologist, a director, a finance manager and a handyman.
• Home Again (2019): 245 people in 50 houses. A team of four (programme manager, two case managers with MSW degrees, a nurse) supported about 60 people, plus 15–24 PAs.
• KeyRing: 10 people per network, one of them the CLV. Each CLV is backed by a Support Manager covering a cluster of networks.
• SEW Shared Lives: more than 200 carer households (300+ in 2025). The team has 12 Shared Lives workers, 3 coordinators and 3 managers.

[source: WHO §2.1–2.2; GovInt; Torfaen; Shared Lives Plus 2025]

Certification and regulation. None of the four is a licensed or manualised programme a clinician becomes certified in. Hand in Hand assistants must complete a six-module course (six days of five hours) developed with Georgia's Ministry of Health and Social Affairs. Shared Lives carers go through an assessment and approval process with training. Formal regulation and inspection of Shared Lives in Wales was not covered in the sources [uncertain].

3. Guiding principles

The WHO package organises every case study under the same five rights-based principles. The service-specific principles follow. [source: WHO 2021 package, §2.1–2.2 headings]

• Respect for legal capacity. The person makes the decisions about where, with whom and how to live, and about daily life, care and treatment; staff support rather than decide. Practice: discuss and agree every decision. Never "fix" the person. Residents keep their own documents and can change who is involved in their plan at any time (Hand in Hand).
• Supported decision-making, not guardianship. Georgia replaced guardianship with supporters appointed only with the person's consent. Practice: an assistant becomes a designated supporter only if the resident chooses them and there is a real bond [source: WHO §2.1].
• Non-coercive practice. No forced medication, treatment or restraint. Practice: learn each person's triggers and step in early. Hand in Hand repeats de-escalation training every 2–3 years. Home Again lets residents change PA if trust breaks down. Shared Lives offers a family home instead of admission [source: WHO §2.1–2.2; Shared Lives Plus].
• Community inclusion. Ordinary housing near shops, health care and cultural life, plus work, entitlements and neighbours. Practice: every plan has community goals, such as a job, festivals, a sports team or a theatre group, as well as support goals [source: WHO; Banyan; GovInt].
• Participation. People shape the service. Practice: Hand in Hand holds weekly meetings where residents can give feedback and complain, posts monitoring-body and Ombudsman numbers in each house, and consults residents on decisions. KeyRing members sit on the Board and selection panels and co-design network activities. Home Again peer leaders raise household issues [source: WHO; GovInt; Banyan].
• Recovery orientation. Strengths-based, person-led plans and positive risk-taking. Practice: back the resident's chosen risks, such as caring for hens or taking a hospital job, rather than eliminating risk [source: WHO §2.1].
• No readiness requirement. Housing comes first, not as a reward. Practice: do not ask for proof of skills or stability before a move [source: WHO §2.2].
• Small, chosen households. Hand in Hand takes at most five people per house, below its six-place state rate, to keep support person-centred. Home Again uses affinity groups. Practice: compatibility and choice of housemates matter more than filling places [source: WHO §2.1–2.2].
• Freedom to leave or change. Practice: moving out or changing house, housemates or PA is a right, never a sanction [source: WHO §2.1–2.2].
• Active Support (Hand in Hand). Assistants help residents take part in real household activity themselves rather than doing it for them. Practice: do things with the resident, not for them [source: WHO §2.1]. How Hand in Hand applies Active Support in detail was not described [uncertain].
• Mutual support and asset-based community development (KeyRing). Practice: every member both gives and receives help, about two hours a week each, and builds on the strengths of people and places [source: GovInt].
• Family life as the medium (Shared Lives). Support happens through ordinary household routines. Practice: treat people "as individuals, not patients" (Shared Lives Plus 2025).
• "Slow work" (Home Again). Rapport builds gradually, and staff move from paternalism to allyship. Practice: expect trust and independence to grow over months [source: Banyan impact report].

4. Intervention inventory

The services publish practices, not session scripts. Each entry gives the practice as published. Step sequences are the services' processes in my own words, with gaps filled and marked [synthesis]. All example language is illustrative.

4.1 Assessing fit and making the referral (clinician task)

• Purpose / when: the client lives in an institution, a long-stay ward, a hostel, or with family without support, or is homeless or isolated, and wants their own home or a household life.
• Steps: (1) Ask what the client wants: alone, with others, or with a family; urban or rural; which area. (2) Map this to a model: staffed small house (Hand in Hand), affinity-group home with PAs (Home Again), own tenancy in a peer network (KeyRing), or a carer's household, long-term or for a crisis (Shared Lives). (3) Check the published criteria in the Stage A table (§2). (4) Go through the client's chosen route: state social worker and application (Georgia), Banyan teams (Chennai), social worker (Shared Lives). (5) With the client's consent, share only the information the client approves: strengths, routines, support needs, triggers and early signs, and what has helped. (6) Arrange pre-move visits. [synthesis, built on criteria from WHO §2.1–2.2 and the Torfaen page]
• Example language (illustrative): "This isn't a reward for getting well. It's a place to live, with people around you. What would a home need to have for it to feel like yours?"
• Watch for: referrals written as deficit lists, and pressure from family or ward staff. The client must actually choose; all four services describe participation as voluntary or chosen.

4.2 Admission assessment and compatibility matching (Hand in Hand)

• Purpose: form a household that works.
• Steps: (1) The coordinator and manager assess personality, communication, support needs and compatibility with current residents. (2) Current residents and the coordinator discuss the newcomer. (3) The applicant visits the house before moving. (4) The state fund confirms the place. (5) After the move, the resident may change house or leave at any time. [source: WHO §2.1]
• Example language (illustrative): "Before you decide, would you like to visit and have a meal with the people who live there?"
• Watch for: existing residents feeling overridden, or the newcomer feeling inspected. Both sides should have a real say.

4.3 Person-centred planning with MAPS and PATH (Hand in Hand)

• Purpose: turn the resident's own dreams into a plan the people around them commit to.
• Steps: (1) The resident invites whoever they want to the planning meeting. (2) Use MAPS to explore history, wishes and general goals. (3) Once goals are clear, use PATH to work back from the goal to concrete strategies, steps and who does what. (4) The coordinator helps write and update the plan; assistants carry it into daily support. (5) The resident can change who is involved at any time, and staff discuss the reasons with them. [source: WHO §2.1] MAPS and PATH are established person-centred planning tools. Their facilitation steps are not given in the WHO text, so learn them from their own training materials [uncertain].
• Example language (illustrative): "Who would you like at your planning meeting? It's your meeting; you can invite anyone, or no one from staff except me."
• Watch for: staff-written goals such as "comply with medication". The plan should be in the resident's words.

4.4 Active Support in daily living (Hand in Hand)

• Purpose: build autonomy through real household participation.
• Steps: residents prepare food, keep the house and garden, buy household products, contact neighbours and choose what and when to eat. They usually eat together, and assistants accommodate special diets. Assistants help with appointments, leisure, relationships with housemates and household tasks, and support the resident to do each task rather than doing it for them. [source: WHO §2.1]
• Example language (illustrative): "Do you want to chop or stir? I'll do the other."
• Watch for: assistants taking over to save time. It works when residents start tasks unprompted.

4.5 Supported decision-making and the designated supporter (Hand in Hand / Georgia)

• Purpose: respect legal capacity after Georgia ended guardianship.
• Steps: (1) Discuss decisions about daily life, care and treatment, and reach agreement. (2) If the resident wants a formal supporter, they choose one. An assistant may serve only where a real bond exists. (3) The resident keeps their documents safely in the house, and their information stays confidential. [source: WHO §2.1] The WHO text notes that the reform is only partly implemented. Supporters are unpaid, so staff are sometimes appointed without a meaningful connection to the person.
• Example language (illustrative): "What options do you see? Do you want my view, or would you like to talk it through with someone else first?"
• Watch for: a supporter who decides for the person. This is substitute decision-making under another name.

4.6 Trigger identification and de-escalation without coercion (Hand in Hand)

• Purpose: prevent crises without force.
• Steps: (1) Learn each resident's triggers and early signs, with them. (2) Step in early by reducing demands, offering space, or bringing in a trusted person [synthesis on specific tactics]. (3) Staff repeat non-coercive and de-escalation training every 2–3 years. (4) No forced medication or treatment. WHO records that involuntary hospitalisation has occurred in rare cases. [source: WHO §2.1]
• Example language (illustrative): "You've told me noise gets too much before things go wrong. It's loud tonight. Do you want to go for a walk, or have the quiet room?"
• Watch for: escalating rules after an incident. Review the incident with the resident instead.

4.7 Positive risk-taking and strengths-based goals (Hand in Hand)

• Purpose: recovery through valued roles.
• Steps: identify strengths, back the resident's chosen activity (examples in the source: caring for hens, working at a hospital), and plan the support needed to make it workable rather than forbidding it. [source: WHO §2.1] Writing down the agreed risk plan with the resident is [synthesis].
• Example language (illustrative): "Let's work out what you'd need to make that job work, rather than whether you're allowed."

4.8 Community inclusion and work (Hand in Hand)

• Purpose: life beyond the house.
• Steps: outings, sport, cinema, religious events, a community theatre group, and a 10–14-day holiday every year. Support into jobs: about half of residents work, several in social enterprises making wooden toys and household goods. Media work that raises residents' visibility, with residents involved in producing it. [source: WHO §2.1]
• Watch for: activities that are only group outings with staff. The aim is individual community ties.

4.9 Participation, feedback and complaints (Hand in Hand)

• Steps: weekly meetings with staff where residents give feedback and complaints, direct access to managers, monitoring-body and Ombudsman phone numbers posted in each house, and regular consultation on service decisions, including online. [source: WHO §2.1]
• Example language (illustrative): "If you're unhappy with how we're doing things, here's who you can call, including people outside this organisation."

4.10 Staff preparation (Hand in Hand)

• Steps: no formal qualification is required. A six-module course (six days of five hours) covers recovery-oriented care, managing conflict and agitation, Active Support, sex and disability, and service management. De-escalation refreshers every 2–3 years. Families and friends can attend training on supporting people with disabilities. [source: WHO §2.1]

4.11 Entry without readiness tests and affinity-group homes (Home Again)

• Purpose: move long-stay residents into ordinary homes.
• Steps: (1) Offer the option to eligible long-stay residents; participation is voluntary. (2) Form affinity groups of 4–5 people based on friendships and preferences. (3) Residents choose an urban or rural setting and their housemates, and can change later. (4) Rent ordinary houses near shops, health care and cultural spaces. (5) Residents set their own routines and house rules, move freely, and receive visitors. [source: WHO §2.2; Banyan impact report]
• Example language (illustrative): "Who on the ward would you want to share a home with?"
• Watch for: grouping by staff convenience. Affinity is the point.

4.12 Functional needs assessment and personal assistants (Home Again)

• Purpose: set the level of daily support.
• Steps: (1) Assess support needs with the Social Functioning Instrument (10 domains). Do not reproduce it; use the licensed or published version. (2) Recruit paid PAs locally, often people with lived experience and mostly women. (3) Give PAs a week-long induction, then on-the-job training and weekly reviews. (4) PAs accompany residents day to day and give hands-on help with daily living, in line with the residents' priorities. [source: WHO §2.2; Banyan impact report]
• Watch for: PA burnout. The Banyan reports that caregiving is physically and emotionally demanding and that PAs need more institutional support. Also watch for paternalism. A move from paternalism to allyship is the reported marker that the approach is working.

4.13 Case management: weekly visits and quarterly reviews (Home Again)

• Steps: case managers (MSW-trained) carry out biopsychosocial assessments, write personalised care plans with residents, visit weekly, hold quarterly reviews, run structured feedback, and arrange access to health and social care. They also attend doctor rounds; at one site peer leaders join these. [source: WHO §2.2; Banyan impact report] The content of the WHO case study's psychiatry and medication arrangements is not given [uncertain].
• Example language (illustrative): "Since last week, what's gone well in the house, and what's been hard?"

4.14 Conflict mediation and the right to change PA (Home Again)

• Steps: when household conflict escalates, the case manager or PA mediates. If trust in a PA breaks down, the resident can switch PA. Residents sign consent forms about the use of their information. They can phone senior professionals and the state Mental Health Commission directly. [source: WHO §2.2]
• Example language (illustrative): "Would it help to sit down together, all three of you, and each say what you need from the kitchen arrangement?"

4.15 Entitlements, work and livelihood (Home Again)

• Steps: link residents to disability entitlements and housing subsidies (in Tamil Nadu, the Department of Social Defence and District Differently Abled Welfare Offices). Support jobs (canteen, supermarket, construction, housekeeping, a government office) and courses (beautician training, typewriting). Partner social enterprises, such as idli-making, pay earnings directly to residents. [source: Banyan impact report] The report notes that work integration did not change significantly, and that employers' reluctance to pay, underpayment and discrimination are recurring problems.

4.16 Neighbourhood engagement (Home Again)

• Steps: welcome visitors and neighbours. Join festivals, temple events and weddings. Act together with neighbours on shared needs; examples in the source are chlorinating well-water and arranging municipal waste collection. [source: Banyan impact report] Reported signs it is working: neighbours treat residents as neighbours rather than clients, and social distance falls.

4.17 Family reconnection (Home Again)

• Steps: invite families to visit the home, where they often report feeling reassured about safety, and support regular visits or video calls. About 17% of residents reintegrated with family. [source: Banyan impact report]
• Watch for: family rejection. The report describes a resident whose family rejected him and who then had suicidal thoughts. Have a risk plan ready around family contact (§5).

4.18 Peer leaders and negotiated house rules (Home Again)

• Steps: residents act as peer leaders who raise household issues and escalate concerns about how the home is run (16 at one site). Replace blanket restrictions with negotiated arrangements. Example: one site replaced a smoking ban with an agreed schedule and a small personal allowance, which reduced secrecy and borrowing. [source: Banyan impact report]

4.19 Tapering support (Home Again)

• Steps: review PA input as residents grow more self-sufficient. Staffing typically falls after about 18 months; at one Sri Lankan partner site PAs fell from 11 to 4. [source: WHO §2.2; Banyan impact report] Tie each reduction to a review with the resident [synthesis].

4.20 Uncertain item: named therapeutic approaches at Home Again

One tool summary of the WHO case study listed Open Dialogue, Behavioural Activation and trauma-informed approaches among Home Again's methods. The Banyan impact report does not mention them, and the passage in the full text is not verified [uncertain]. Do not present these as part of the Home Again model without checking WHO §2.2.

4.21 Forming a Living Support Network (KeyRing)

• Purpose: independent tenancies without isolation.
• Steps: (1) Group about nine members, each with their own home, within walking distance of each other. (2) Recruit a Community Living Volunteer (CLV) who lives in the network area rent-free and is the tenth member. (3) Put the network under a Support Manager who oversees a cluster of networks. (4) Give members access to an out-of-hours service and, where needed, one-to-one support from trained staff. [source: GovInt case study] How people join and how members are assessed was not found [uncertain].
• Example language (illustrative): "You'd have your own flat and your own front door, and people nearby you can knock for, and who will knock for you."

4.22 The Community Living Volunteer role (KeyRing)

• Purpose: an ordinary neighbour who holds the network together.
• Steps: the CLV gives at least 12 hours a week. They help with bills and budgeting and with access to education, work or volunteering. They encourage members to help each other and build links with neighbours and local organisations. They lead by involving others and building local ownership. [source: GovInt]
• Watch for: the CLV becoming the only source of support. The model aims to reduce reliance on paid or single helpers.

4.23 Mutual support exchange (KeyRing)

• Purpose: each member both gives and receives help.
• Steps: members typically give and receive about two hours of mutual support each per week, such as help with a form, company to an appointment, or a shared meal. Members are encouraged to be good neighbours and offer their skills to the community. [source: GovInt; the specific examples are illustrative synthesis]
• Example language (illustrative): "What are you good at that someone in the network might need?"
• Working when: members contact each other without the CLV prompting. Members report a sense of belonging, confidence and status.

4.24 Community planning, hubs and small grants (KeyRing)

• Steps: members co-design network activities through local community planning. Where available, Community Hubs offer drop-in support, socialising, events and information. The Small Sparks fund gives small grants for members' community ideas, such as an allotment, a football team or a drama project. The approach follows asset-based community development, starting from the strengths of people and places. [source: GovInt]

4.25 Individual planning and member governance (KeyRing)

• Steps: each member has an individual planning process. Its content is not described in the sources [uncertain]. Members serve as Trustees with lived experience, sit on staff selection panels, attend national forums and present to local authorities. [source: GovInt]

4.26 Recruiting, assessing and approving Shared Lives carers (Shared Lives)

• Purpose: a safe, warm household.
• Steps: (1) Anyone may apply: single people, couples or families, with no formal qualifications needed. (2) Applicants go through an assessment, with training during it. (3) Once approved, the carer chooses which types of arrangement to offer, supported by an adult placement or Shared Lives worker. (4) Specialist training follows for individual needs, plus ongoing training. (5) Carers are paid a fee per arrangement. [source: Torfaen/SEW page] The SEW page does not describe an approval panel or regulator [uncertain].

4.27 Matching and the arrangement types (Shared Lives)

• Purpose: fit the person to a household, and the arrangement to the need.
• Steps: (1) The Shared Lives worker matches the person to a carer they are likely to get on with. (2) Agree the arrangement type: long-term (living in the carer's home), respite (short stays, often repeated with the same family), emergency (at short notice), sessional (day, evening or weekend support at home or in the community), hospital-avoidance, or post-discharge. (3) The carer shares family life, household routines and social activities. The person is supported to build skills, make choices and try new things. [source: Torfaen/SEW page] Introductory visits before a placement are standard in many schemes but are not described [uncertain].
• Example language (illustrative, carer): "We usually have tea around six. Join us if you'd like, or I can save you a plate."

4.28 Shared Lives as a crisis alternative to admission (South East Wales)

• Purpose: support during a mental-health crisis in a family home instead of on a ward.
• Steps: (1) A person in crisis is matched with a trained Shared Lives carer. Gender and trauma history shape the match; for example, a woman assaulted before admission was placed with a female carer rather than on a mixed ward. (2) The scheme works as part of the mental-health teams and shares information and responsibilities across health and social care. (3) The stay lasts as long as needed. Everyday activities, such as ironing or meals, rebuild self-esteem. [source: Shared Lives Plus 2025] Referral routes, eligibility and deterioration procedures are not published in the sources [uncertain].
• Clinician procedure [synthesis]: agree a written crisis plan covering early signs, who the carer phones and when, the clinical contact and medication arrangements. Agree how the home treatment or crisis team visits the carer's home. Set review dates.

4.29 Monitoring and support for carers (Shared Lives)

• Steps: each carer has a Shared Lives worker who visits the home to monitor and support the arrangement. Carers meet regularly across the region. [source: Torfaen/SEW page]
• Watch for: carer strain and the person's voice being lost. Ask the person directly, away from the carer, how the arrangement is going [synthesis].

4.30 Working alongside supported living as the client's therapist [synthesis]

None of the four services publishes a therapy protocol. This item is my own guidance.

• Steps:
  1. Get consent for the specific information you share with the service, and set a contact route (coordinator, case manager, Support Manager or Shared Lives worker).
  2. Align therapy goals with the client's own plan (MAPS/PATH, care plan or individual plan), so therapy serves the life the client is building.
  3. Write a non-coercive crisis plan or advance statement with the client covering triggers, early signs, what helps, who to call, and the client's preferences on treatment and hospital. Share it only with the client's consent.
  4. Use the client's real-life situations (housemates, neighbours, work, family contact) as therapy material.
  5. Expect transition stress after leaving an institution. Schedule more frequent contact in the first weeks after a move.
• Example language (illustrative): "Your plan says you want a job by spring. What gets in the way on a bad morning? Let's work on that."
• Watch for: the clinician becoming a parallel decision-maker. Support the client's decisions; do not overrule them through the service.

5. Handling problems

Each problem shows what the sources describe, then my own responses marked [synthesis].

• Housemate conflict.
  • Sources: case managers or PAs mediate (Home Again). Weekly meetings and the right to change house (Hand in Hand) [source: WHO §2.1–2.2].
  • [synthesis]: meet the housemates together and agree specific house arrangements such as kitchen times, noise and visitors. Offer a move only if the resident wants one, never as a punishment.
• Mistrust of a staff member or PA.
  • Sources: the resident can switch PA (Home Again), and residents choose their designated supporter (Hand in Hand) [source: WHO].
  • [synthesis]: treat a request to change worker as information, not as "splitting".
• Escalating distress or agitation.
  • Sources: identify triggers early and use de-escalation, with no forced treatment (Hand in Hand). Shared Lives offers crisis placements in a family home [source: WHO §2.1; Shared Lives Plus].
  • [synthesis]: follow the client's crisis plan, and lower demands and stimulation. Bring in the clinical team early. If you assess imminent risk of serious harm, follow your jurisdiction's standard risk-assessment and emergency procedures, using the least restrictive option. Debrief with the client afterwards and revise the plan with them.
• When safety needs exceed what the home can offer.
  • Sources: one Home Again team transferred a resident to an NGO with closer supervision. About 16.5% of residents returned to institutions. Hand in Hand records rare involuntary hospitalisations [source: Banyan impact report; WHO §2.1].
  • [synthesis]: hold the place or tenancy open where possible. Plan the return with the client from the first day of the transfer.
• Suicidal thoughts, e.g. after family rejection.
  • Source: the Banyan report describes this case.
  • [synthesis]: before family contact, explore the client's hopes and the possible responses. Afterwards, check in on the same day. Run a standard suicide risk assessment and safety plan. Agree safe storage of medicines and other means with the client and the household, and agree who the PA, carer or CLV contacts.
• Mortality and physical health.
  • Source: Home Again reports 7.5% mortality, higher at directly run sites [source: Banyan impact report].
  • [synthesis]: put annual physical-health checks, chronic-illness follow-up and access to doctors in every plan. Long-stay residents often have unmet physical needs.
• Non-engagement with activities or plans.
  • [synthesis]: the plan belongs to the person, so revisit it with MAPS-style open questions rather than pushing for compliance. Offer small Active Support steps. Accept rest. Ask whether the goals are still theirs.
• Paternalism and coercion drifting back.
  • Sources: Hand in Hand gives residents external complaint routes (monitoring body, Ombudsman). Home Again replaced restrictions with negotiated arrangements, such as the smoking schedule [source: WHO; Banyan].
  • [synthesis]: audit house rules every quarter with residents. Ask of each rule: would this rule exist in an ordinary home?
• Substitute decision-making disguised as support.
  • Source: the WHO text notes that in Georgia, supporters are unpaid and staff are sometimes appointed without a meaningful connection to the person.
  • [synthesis]: check that the client actually chose the supporter. Record decisions in the client's own words.
• Work problems: underpayment, discrimination, employers reluctant to pay.
  • Source: Banyan impact report.
  • [synthesis]: help the client know their wage rights. Partner with social enterprises that pay residents directly. Rehearse disclosure decisions in therapy.
• Neighbourhood stigma or exploitation.
  • Source: the Banyan report notes that some brokers linked rent rises to the homes.
  • [synthesis]: join in neighbourhood life before problems arise (§4.16). Name a staff contact for neighbours. Get advice on tenancy rights.
• Staff, PA or carer strain.
  • Sources: caregiving is physically and emotionally demanding (Banyan). Weekly PA reviews (Home Again), Shared Lives worker visits and carers' meetings (SEW), and Hand in Hand's training [source: Banyan; WHO; Torfaen].
  • [synthesis]: give PAs and carers protected reflective supervision and plan cover for breaks.
• CLV overload or isolation in a KeyRing network.
  • [synthesis]: the Support Manager rebalances the load by activating mutual support between members and community links, and by using the out-of-hours service rather than the CLV for crises.
• Shared Lives placement breakdown.
  • [synthesis]: if either side wants to end the arrangement, the Shared Lives worker meets the person alone and then with the carer. Agree a planned move with the person's say over the next arrangement. Avoid any gap without support.
• Limits of the models.
  • Source: Hand in Hand cannot take people with the highest personal-care needs or severe cognitive impairment [source: WHO §2.1].
  • [synthesis]: do not exclude by diagnosis alone. Look for services with higher personal-care staffing that still keep the same rights-based principles.
• Transfer to other settings.
  • [synthesis]: these models depend on local law and funding: Georgia's legal-capacity reform and state per-person rates, Indian state entitlements, and UK social care and health-board partnerships. When adapting them, keep the five WHO principles and redesign the funding and referral routes.

Sources

Sources:

• Supported living services for mental health: promoting person-centred and rights-based approaches (WHO 2021, copy on medbox.org; partial text: §2.1 Hand in Hand and part of §2.2 Home Again)
• WHO publication page: Supported living services for mental health
• Guidance on community mental health services (WHO 2021, copy on medbox.org; front matter and chapter 1 only)
• PAHO record: Supported living services for mental health
• The Banyan: Impact report (Home Again, 2014–2025)
• The Network is the Key: How KeyRing supports vulnerable adults in the community (GovInt case study)
• KeyRing in new WHO guidance (KeyRing news)
• South East Wales Shared Lives Scheme (Torfaen County Borough Council)
• A community approach to crisis: how Shared Lives is transforming mental health support in South East Wales (Shared Lives Plus, 2025)

Further reading (not drawn on): the WHO IRIS full-text PDF and the KeyRing-hosted copy of the WHO package. The WHO sections on KeyRing (§2.3) and Shared Lives (§2.4), the end of Home Again (§2.2) and Section 3, "Moving forward", were therefore not read [uncertain].

Cited documents:

• World Health Organization (2021). Supported living services for mental health: promoting person-centred and rights-based approaches. Geneva: WHO. ISBN 9789240025820.
• World Health Organization (2021). Guidance on community mental health services: promoting person-centred and rights-based approaches. Geneva: WHO. ISBN 9789240025707.