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Historically, social security has been related to medical knowledge in many ways. For instance, medical expertise is incorporated into the granting and assessment of welfare state support measures and social policy fields of application shape medical knowledge practice. This paper deals with health assessment practices in Berlin community mental healthcare institutions. Based on a praxeographic approach and ethnographic research conducted between 2011 and 2017, two characteristics of the assessment process are elaborated: on the one hand, the assessment is distributed over different persons, forms of knowledge and artefacts as well as over time. On the other, it focuses on the beneficiary as a case and tailors the assessment of the person and his or her need for support to existing care services. The aim of this contribution is to first locate health assessment processes as situated and contingent knowledge practices in the context of welfare state support measures and second to clarify their effects on the establishment of living conditions of psychiatric service users.