In the days of workhouses, asylums, debtors’ prisons and fever hospitals, it was easy to see who was considered part of their community and who had been removed from the community, for support, punishment or a combination of the two. Most of the most obviously institutional buildings have gone, but the ideas behind that divide between those inside and those outside the community remain invisibly woven into our public services which provide long-term support.

Maintaining that divide can feel comforting, particularly during times in our lives when we do not find ourselves needing state-organised or funded support. Most of us prefer to feel that there is little possibility of state involvement in our lives. People who require long-term support are doubly stigmatised: once through being labelled with the names of stigmatised conditions such as mental ill health, and again, through being seen as having lost capacity, independence, full citizenship. The popular perception of many kinds of support service remains rooted in folk memories of people in uniforms that came to ‘take you away’ and forbidding Victorian buildings. Ignoring state services is, however, a luxury which few of us can afford to maintain throughout our ever-lengthening lives.