In this study, the effective practical components of family support for people with mental illnesses are defined as support elements aimed at improving the quality of life of both the people with mental illnesses and their family caregivers.

The literature search was conducted using MEDLINE and CINAHL, which are major academic databases in the fields of mental health and nursing. The search was limited to manuscripts written in English to ensure consistency in data extraction and interpretation. The search period was from 2015 through 2025 (March 31). We investigated manuscripts published over the past 10 years in order to identify recent trends. Search keywords were “family support,” “family intervention,” or “family nursing,” and “mental illness,” “mental disorders,” and “practice elements,” or “elements of practice,” or “practice.” An AND search was then ultimately performed on the search results for each. After removing overlapping manuscripts, screening was performed on the remaining manuscripts. The selection criteria required that manuscripts describe support for family members of people with mental illnesses and be peer-reviewed. Moreover, the full report had to be available for access. This study exclusively targets publicly available academic literature and does not involve any data that could identify individuals or human subjects; therefore, ethical review was deemed unnecessary. The handling of the selected literature was conducted with careful consideration to avoid copyright infringement, and efforts were made to remain faithful to the original texts.

Overlapping manuscripts (n = 6) were removed from the total number of manuscripts (n = 171) obtained from searches of the two databases. The remaining manuscripts (n = 165) were screened. First, the report title and abstract were screened to confirm whether they met the selection criteria. Then, manuscripts not meeting the selection criteria due to family members not being targeted for analysis, support not being practically implemented, or support details not being clearly outlined were removed. Ultimately, we were left with four manuscripts for analysis. The selection process is shown in a flow chart ( Figure 1 ). The included studies were appraised through discussion among the researchers using five quality criteria adapted from the Critical Appraisal Skills Programme (CASP): clarity of research aims, appropriateness of design, transparency of data collection and analysis, ethical considerations, and validity of findings. The degree of achievement for each criterion was evaluated collaboratively and represented in Table 1 using asterisks (*), where a greater number of asterisks indicates a higher level of achievement. We also compared the content related to family support and analyzed practical elements for supporting families of people with mental illness. Screening, appraisal, and analysis were conducted independently by two researchers to minimize interpretive bias and ensure data reliability and validity through careful review.

The methodological discussion on participatory health research in manuscript 1 focused on dialogue between supporters and family members, and between family members themselves. Family members discussed among themselves their thoughts and feelings on participating in the program, in which safety was assured. This not only clarified participants’ needs for the program through free dialogue, but also revealed new methods of coping with the behavior of the person with mental illness. In manuscript 3, the person with mental illness and their family participated in Family-Centered Support Conversations together. By reflecting on their daily lifestyle, mutual understanding was deepened among the person with mental illness, their family, and specialists. In manuscript 4, families were included in the construction process of a new intervention format. Family members’ opinions and needs were investigated, and the results were then given as feedback to family members. A new format was constructed through this process, which appeared to contribute to acceptance of intervention and high satisfaction.

Manuscripts 1 and 2 indicated the importance of continuous connection with supporters, and family members being able to utilize such support at any time. The results of manuscript 2 indicated that differences in care content did not impact effects. Manuscript 3 stated that when family members who had nobody to consult with were able to come into contact with a specialist, this was a good experience. Manuscript 4 revealed that family members exhibited high satisfaction when sessions were held flexibly in line with their needs, and they could easily access online sessions. In addition, offering long-term, continuous support for family members forms the basis for new challenges and appears to contribute to continuous experiences for families and supporters.

Manuscript 1 revealed that some family members were unable to participate in the research process continuously due to the state of their family member’s mental illness. Manuscript 2 described how family caregivers coped with the problematic behavior of the person with a mental illness and revealed that their health and lifestyle were greatly impacted by the state of their family member’s mental illness. Manuscript 1 discussed methods of response to the person with a mental illness. Manuscript 3 revealed that the person with a mental illness was able to talk about things that they had not discussed with their family members, but only with a specialist at the sessions, indicating that these sessions aided their self-disclosure. This gave family members an opportunity to more deeply understand how the person with a mental illness experienced their illness and symptoms, resulting in changes to family dynamics. Results indicated the need for caregiving family members to receive support in order to help family members themselves maintain social activities, including mental and physical health as well as family relationships, while remembering that these elements will be affected by the recovery of the person with a mental illness.

Manuscript 1 revealed a completely different process from that which was first conceived by specialists as a result of program revisions based on discussions with family members. Action research encouraged specialists to focus on taking a stance of not forcing their values as specialists. Manuscript 3 emphasized a non-hierarchical treatment relationship as the basis for dialogue sessions.

There are relatively few manuscripts available on support for family members of people with mental illnesses compared to reports related to other mental healthcare fields. This also appears to be greatly affected by major differences observed in support systems offered by various countries worldwide. The targeted manuscripts revealed that in countries where care for families is widespread, efforts were being made to further improve implementation rates, various intervention programs were being implemented, and more effective implementation methods were being investigated. Depending on regional characteristics, the dissemination of online care for families was being investigated. In countries where care for families was not sufficiently widespread, in addition to introducing intervention programs, there is a need to make adjustments in accordance with mental health systems, environment, and culture so that such care can become widely used, and to increase practical implementation. The applicability of the practical elements identified in this study may vary depending on national systems and cultural backgrounds. For example, in countries such as the UK and Norway, where community-based mental health care and family involvement are institutionally established, opportunities for dialogue and participatory approaches can be implemented relatively easily. In contrast, in countries like Japan, where psychiatric care remains hospital-centered, structural and policy-level changes are required to realize continuous connections with supporters and non-specialist-led support. However, even in contexts where institutional systems are underdeveloped, these practical elements may still be flexibly integrated. For instance, by utilizing existing primary care resources and incorporating brief consultations, it is possible to build support systems that prevent caregiver isolation and ensure access to assistance.

Therefore, when applying these practical elements, it is essential to appropriately adapt them to the local mental health system, available resources, and cultural background.

The results of our investigation of the literature revealed that dialogue between supporters and family members, and amongst family members themselves, as well as support for families that emphasized dialogue within families, was useful. The family caregivers of people with mental illnesses often put their own lifestyle and health needs last, as they earnestly hope that their family member will recover. This is because, in addition to being family, they are now a caregiver who has to shoulder the burden of a diverse range of physical, psychological, and social roles [11] [12] . Furthermore, social prejudice regarding people with mental illnesses is targeted not only at the person themselves, but also at their families, causing them to repeatedly experience hurt feelings. As situations such as these continue over the long term, these family members experience increased exhaustion and isolation [13] . In this context, it is only natural that such family members would hesitate to talk about their experiences, and it is likely that they would have very few opportunities to engage in such dialogue. In medical and welfare settings, family caregivers also need to act as a cooperator for treatment of their family member who has a mental illness. They have limited opportunities to talk about their challenges and conflicts and have to take on a supporter’s role in the treatment of their ill family member. More interest needs to be shown toward situations that make it difficult for family caregivers to engage in dialogue. Opportunities need to be created to enable family caregivers to engage in dialogue soon after treatment is started and to make connections with each other.

The seriousness of the disease of the person with a mental illness and their problematic behavior can greatly affect the lifestyle of family caregivers. There is a major impact on family caregivers’ social life, which can make it difficult for them to continuously participate in support programs. When treating and responding to people with mental illness, it is essential to understand that family members play a role as caregivers, and to consider how to support the family caregivers of people with mental illnesses. Focusing on supporting family recovery, aiming to improve family members’ health and quality of life, is also an essential element of family support.

The process by which family members discuss their own experiences and feelings is also a very important experience for specialists, as it altered their mutual relationships and care practices. Supporters deepened their understanding by listening to the opinions and dialogues of family members, which enabled them to provide more comprehensive and flexible care. The quality of support was improved by shifting from a conventional unidirectional care stance to a cooperative relationship with deepened mutual understanding. To do that, partnerships should be built on an equal basis among the person with mental illness, family members, and specialists. When implementing support for the family members of people with mental illnesses, specialists need to take a stance of discussing and collaborating with the parties involved in order to construct support strategies.