The short answer
- A support worker helps with the week, not the treatmentStructure, getting out, the post, food and company. They prompt medication and never change it, and they are not a therapist or a crisis service.
- The clinical side has its own teamThe GP, the community mental health team, a named worker or care coordinator where one is allocated, and the crisis team.
- When a relapse is coming, use the crisis planThe team writes down the early signs and who to ring. Following it is quicker and safer than working out a new plan in the moment.
- Section 117 aftercare is freeAnybody who has been detained under section 3 or certain other sections of the Mental Health Act is entitled to it, and support at home can be part of it.
If somebody needs help now: in England, call NHS 111 and choose option 2 for the mental health line, which is open day and night and takes calls from family too. Call 999 or go to A&E if a life is at risk. Samaritans answer on 116 123, free, at any hour.
What a support worker does
What a support worker does in an ordinary week
This page is about the practical ground between a hospital ward and managing alone. It is written for families arranging support, and for anybody reading it about their own life. The support is built around the person's week and what they want from it, and it looks different for a person with schizophrenia than for a person living with severe depression or bipolar disorder.
Some shape to the day
A regular starting point
Getting out of the house
At the person’s pace
Prompting with medication
Prompting, not administering
Appointments
The GP, the clinic, the team
The post and the bills
Done alongside, not taken over
Keeping the tenancy going
Rent, repairs and the landlord
Shopping and cooking
Food that gets eaten
Company on the bad days, and noticing
The same face each week
None of this needs the person to be in crisis, and most of it is about keeping an ordinary life going between appointments. The best arrangements are written down with the person rather than for them, including what they want help with and what they would rather do alone. A support worker who comes at the same time each week gets to know what a good week looks like, which is what makes the noticing possible. Why the same carer at every visit matters explains why continuity carries so much weight.
This kind of help sits within the wider picture of support for a disabled adult at home. If mental health is one part of a picture that also includes a learning disability or autism, autism support at home covers the overlap, and for an older relative whose low mood or anxiety is new, mental health in later life is the better starting point.
Where the line sits
What a support worker does not do, and who does it instead
A support worker is not a therapist, a care coordinator or a crisis service, and they do not change or manage medication. Saying this plainly at the start protects the person, because it keeps the clinical questions with the people trained and responsible for them. It also protects the support worker, who should never be the only plan for a bad night.
A support worker at home
Stays with the clinical team
Medication
A support worker at home
Prompts at the agreed times, notices a missed dose or a box that is not going down, and says so to the person and, with their agreement, to the family.
Stays with the clinical team
Prescribes, reviews side effects, and decides on any change of dose or medicine. Depot injections and blood tests stay with the nurse or clinic.
How the person is feeling
A support worker at home
Listens, keeps them company and takes them seriously. Talking about a hard day is part of being there, and it is not therapy.
Stays with the clinical team
Talking therapies, psychology and psychiatric review, arranged through the GP or the mental health team.
The plan
A support worker at home
Works to the parts of the care plan that are about daily life, and passes on what they notice through the agreed contact.
Stays with the clinical team
Writes and reviews the care plan and the crisis or safety plan, with the person and, where they agree, the family.
Appointments
A support worker at home
Helps keep the diary, goes along if the person wants company, and helps them remember what was said afterwards.
Stays with the clinical team
Runs the appointment and decides what happens next. The named worker is the first point of contact between appointments.
When things are slipping
A support worker at home
Notices the early signs the person has listed, and follows the crisis plan: usually the named worker in office hours and the numbers on the plan out of hours.
Stays with the clinical team
Assesses, adjusts treatment and, where needed, brings in the crisis team, which can treat people at home as an alternative to hospital.
An emergency
A support worker at home
Rings 999 if a life is at risk, stays with the person if it is safe to, and tells the family.
Stays with the clinical team
The emergency services and the crisis team take over. A support worker is not a crisis service and should never be the only plan for one.
Titles vary by area. The Care Programme Approach used the title care coordinator, and NHS England now asks that everyone under a mental health team has a named worker as their first point of contact. The crisis plan the team writes names who to ring locally.
Medication is the area where the line is easiest to blur, so it helps to be exact. Prompting means a reminder, an opened box that has already been sorted by the pharmacy, a drink, and staying while the tablets are taken. Deciding how much to take, or stopping a medicine because of side effects, is not prompting, and nor is filling a pill organiser from loose packets. If side effects are the reason somebody is missing doses, that is a conversation for the GP or the prescriber, and the support worker can help the person get to it. What prompting means, and when a carer can give medication sets out the difference in more detail.
Talking is the other place the line matters. A support worker will hear a great deal, and listening kindly is part of the job. What they should not do is offer diagnoses, suggest treatments, or become the person the family reports to instead of the team. If something they hear worries them, the plan should say who they tell.
The clinical team
The GP, the mental health team and the crisis team
Anybody with a serious and long-term mental health condition who is under secondary care has a team behind them, even if the family has never met most of it. Knowing who is who, and which number to use when, saves time on the days it matters.
| What they do | When to contact them | |
|---|---|---|
| The GP | Physical health, repeat prescriptions, referrals into mental health services, and a copy of the care plan. For some people the GP is the whole of their care. | Side effects, a medication review, a new worry about physical health, or a referral back to the mental health team. |
| The community mental health team | Nurses, social workers, occupational therapists, psychologists and psychiatrists working together, as the NHS describes the team. They treat, review and plan. | Through the named worker in office hours, using the number on the care plan. |
| The named worker or care coordinator | The first point of contact for the person and, where they agree, the family. Usually a nurse or social worker. The old Care Programme Approach called this a care coordinator. | Early signs of relapse, a change in the support at home, a question about the plan, or a review that is overdue. |
| The crisis team | Assessment and treatment at home during a crisis, as an alternative to hospital where that is safe. | When the crisis plan says so, or through NHS 111 option 2. The team is not a 999 service. |
The GP
- What they do
- Physical health, repeat prescriptions, referrals into mental health services, and a copy of the care plan. For some people the GP is the whole of their care.
- When to contact them
- Side effects, a medication review, a new worry about physical health, or a referral back to the mental health team.
The community mental health team
- What they do
- Nurses, social workers, occupational therapists, psychologists and psychiatrists working together, as the NHS describes the team. They treat, review and plan.
- When to contact them
- Through the named worker in office hours, using the number on the care plan.
The named worker or care coordinator
- What they do
- The first point of contact for the person and, where they agree, the family. Usually a nurse or social worker. The old Care Programme Approach called this a care coordinator.
- When to contact them
- Early signs of relapse, a change in the support at home, a question about the plan, or a review that is overdue.
The crisis team
- What they do
- Assessment and treatment at home during a crisis, as an alternative to hospital where that is safe.
- When to contact them
- When the crisis plan says so, or through NHS 111 option 2. The team is not a 999 service.
Titles and local arrangements differ by area. The NHS is moving away from the Care Programme Approach towards a single care plan with a named worker for everybody under a mental health team, so the letters your relative receives may use either term.
The Care Programme Approach was the framework used for many years for people with complex mental health needs, with a care coordinator, a care plan and regular reviews. NHS England has moved away from it, and in July 2026 it published a personalised care framework which asks that every person has a named worker as their first point of contact, a care and support plan, and a safety plan that records the early signs of relapse and what helps. Rethink Mental Illness explains the change from the old approach in its guide to the Care Programme Approach.
A family can only be told what the person agrees to share. If your relative is happy for you to be involved, ask the team to write that into the plan, with your name and number, so the named worker knows they can talk to you. The NHS page on treatment for schizophrenia describes the team and the care plan in more detail.
When things are slipping
When a relapse is coming, use the crisis plan the team wrote
The early signs of a relapse differ from one person to the next, and they can be small: sleeping badly for a week, not answering the phone, the post piling up again, or a return of thoughts they recognise. The crisis plan exists so that nobody has to decide what to do under pressure. Keep a copy where the family and the support worker can both find it.
- First signs
Notice, and write down what has changed
Sleep, eating, contact with people, the state of the flat, missed doses. Dates and small details help the team more than a general feeling that things are worse.
- The same day
Talk to the person first
Say what you have noticed, kindly and without alarm, and ask what they think. They may already know, and the plan may say what they want to happen next.
- Office hours
Ring the named worker on the plan
NICE tells professionals facing a suspected relapse to go to the crisis section of the care plan and the clinician it names. Families and support workers can do the same.
- Out of hours
Use the numbers on the crisis plan, or NHS 111 option 2
The mental health line on 111 is open day and night in England, for people of any age and for family calling on someone’s behalf.
- A life at risk
Call 999 or go to A&E
If somebody has seriously injured themselves or taken an overdose, or cannot keep themselves or someone else safe. Do not wait for the team to call back.
It is tempting to improvise when somebody you love is becoming unwell: to move in for a week, to hold the medication, to ring round everyone you know. The crisis plan is there to replace that, because it was written when the person was well, with their own wishes in it, by people who can act on it. If there is no crisis plan, or the one you have is out of date, ask the named worker or the GP for one to be written or reviewed. A person can also write down their own wishes in advance, and advance decisions and advance statements explains how.
Section 117 and funding
Section 117 aftercare, the Care Act and direct payments
There are three ways support at home is paid for, and it is worth working through them in order, because the first one is free and it is easy to miss.
- 1
Check whether section 117 aftercare applies
Free, with no means testSection 117 of the Mental Health Act applies to anybody who has been detained under section 3, 37, 45A, 47 or 48 and then leaves hospital, including on a community treatment order. A stay under section 2 alone does not qualify. The NHS and the council must provide aftercare, together, until both are satisfied it is no longer needed, and councils do not charge for it. - 2
If it does not, ask the council for a needs assessment
The Care Act routeAnybody who appears to need care and support can ask the council for an assessment, and it is free to ask. If the person is found to have eligible needs, the council looks at their income and savings. Above £23,250 in savings a person in England usually pays for their own support. - 3
Ask for the money as a direct payment
So the person chooses who comesA direct payment lets the person choose and buy their own support rather than take what the council arranges. Direct payments can also be made for section 117 aftercare, under the Care and Support (Direct Payments) Regulations 2014. - 4
Ask for a carer’s assessment for yourself
For the family member doing the caringA family member who helps can ask the council for an assessment of their own needs as a carer. The council must assess a carer who appears to need support.
Section 117 is the one to settle first. The duty is written in section 117 of the Mental Health Act 1983, and it covers services that meet a need arising from the person's mental health condition and reduce the risk of it getting worse and of going back into hospital. Support at home that helps somebody keep their tenancy, their routine and their appointments can fall within that. South London and Maudsley NHS Foundation Trust has a clear explanation of section 117 aftercare, including that it is free and that the person, and the family if they wish, should be invited to a meeting to plan it. If you are asked to pay for support that should be in a section 117 plan, ask the council and the NHS in writing why.
If section 117 does not apply, how to ask for a council needs assessment explains the Care Act route, and how direct payments work explains how to take the money and choose the support worker yourself. Personal assistants and direct payments sets out the two ways to take someone on, employing them or engaging somebody self-employed. A family member doing much of the caring can ask for a carer's assessment of their own, and for a parent who has supported a son or daughter for many years, planning for the time you can no longer be their carer starts with that assessment.
Choosing the person
Choosing a support worker, and what PrimeCarers checks
The relationship matters more here than the task list, because the person needs to trust whoever comes, and trust takes time. Where the person can choose, let them. The first meeting should be on their terms, somewhere they are comfortable, and short if that is easier.
What helps
- Let the person meet two or three people and make the choice
- Write down with them what the support is for and what they would rather do alone
- Put the crisis plan, or its contact numbers, where the support worker can find them
- Agree which early signs the support worker should mention, and to whom
- Keep the same day and time each week, so the visit becomes part of the routine
- Review it together after a month, in writing if that is easier
What tends to go wrong
- Asking a support worker to hold, sort or adjust medication
- Treating the support worker as the person the family reports to instead of the team
- Relying on the support worker as the plan for a night-time crisis
- Changing the person or the time every week, so nobody gets to know what a good week looks like
- Choosing somebody for the person without them in the room
- Assuming experience you have not asked about
When the person wants the same support worker each week, somebody they have chosen, it can help to read about people before meeting them. Search for carers near you and compare their rates, then read what each one says about their experience and message two or three. Questions to ask a carer at interview gives you a list to work from, and it is reasonable to ask how they would handle a bad day and what they would do if they were worried.
Be clear about what the checks are. PrimeCarers is an introductory service, not an agency or a care provider, and it holds no registration with the Care Quality Commission. Carers are self-employed. Before a profile appears, PrimeCarers checks identity and right to work, runs an enhanced DBS check on the Update Service, and interviews the carer online. Carers are insured while they work. PrimeCarers does not check qualifications, training or references, so anything a carer says about mental health experience is their own account, and references on a profile are for you to follow up. How carers are checked explains each check. Where somebody needs more support than visits can give, supported living or care at home compares the two.
Mind and Rethink Mental Illness are the two national charities to know. Mind gives information and support for anybody living with a mental health problem, and Rethink Mental Illness focuses on severe mental illness and on the families who support somebody through it.
Questions
Questions people ask about mental health support at home
In this kind of support the job is prompting: a reminder at the agreed time, opening a box the pharmacy has already sorted, a drink, and staying while the tablets are taken. A support worker does not decide doses, change them or stop a medicine. If side effects are the reason doses are being missed, that is for the GP or prescriber, and the support worker can help your relative get to that appointment.
No. A support worker helps with daily life and gives company, and listening kindly is part of that, but they do not provide therapy or treatment. Talking therapies and psychiatric care are arranged through the GP or the community mental health team.
It is free aftercare, from the NHS and the council together, for anybody who has been detained under section 3, 37, 45A, 47 or 48 of the Mental Health Act and then leaves hospital, including on a community treatment order. A stay under section 2 alone does not qualify. It covers services that meet needs arising from the mental health condition and reduce the risk of going back into hospital, and it continues until both the NHS and the council are satisfied it is no longer needed.
It can, where the support meets a need arising from the mental health condition and is in the aftercare plan. Direct payments can be made for section 117 aftercare under the Care and Support (Direct Payments) Regulations 2014, which lets the person choose who provides the support. Ask the council and the mental health team at the aftercare planning meeting.
Use the numbers on the crisis plan first, if there is one. In England you can also call NHS 111 and choose option 2 for the mental health line, which is open day and night and takes calls from family. If a life is at risk, call 999 or go to A&E. Samaritans answer on 116 123 at any hour.
An adult who has capacity can decide what the team shares with the family, and the team has to respect that. You can still tell the team what you have noticed, and you can still ask the council for a carer’s assessment for yourself. If your relative is willing, ask for your name and number to be written into the care plan so the named worker can talk to you.