This chapter argues that the provision of "supportive frameworks" for staff is likely to be ineffective unless explicitly designed to explore practice in relation to management processes, which, in turn, are used to promote and sustain active reflexive interagency structures, or "care pathways". It looks briefly at the recent history of a specific area of social policy that has direct implications for health and criminal justice policy and, ultimately, for the communities people live in. The chapter presents the organizational case studies to illustrate the very real difficulties experienced in providing help to vulnerable and disturbed people, followed by an attempt to use the problems presented by these difficulties to develop a way forward. It talks about how the often unrecognized feature of the work can provide its most sustaining food for thought, and for decision making, and, therefore, promotes organizational sustainability.