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Family work – the evidence

There is a robust evidence base supporting the effectiveness of family work in improving the quality of life for both the people living with mental health difficulties and their families. The evidence has existed for more than 30 years. Research has demonstrated that family work reduces stress in the family and relapse and rehospitalisation rates for the individual for a number of different mental health problems. There are extensive research reviews of this area.

References: Recovery for Carers / Family Members (143.0 KiB)

The approaches that are effective focus on day-to-day issues with the whole family. Information sharing, knowing how to spot signs of relapse, increasing problem-solving and coping skills, and looking at new ways for family members to communicate, are the key components. Behavioural Family Therapy (BFT) is an example of these evidence-based approaches. Find out more information and a description of BFT here.

Working with families in this way is also cheaper for services in the longer term because relapse and rehospitalisation is reduced. For an analysis of the costs and benefits of family work in this context read the report – Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis.

Investing In Recovery: making the business case for effective interventions for people with schizophrenia and psychosis (912.5 KiB)

The evidence base has been used in the development of several key policies and guidelines that focus on the delivery of mental health interventions for a range of mental health issues.

Using England as an example of how the evidence has been translated into policy, this page identifies some key documents that have been developed recommending interventions for people living with mental health problems. These have all recommended engaging with the family, and offering family work. 

The National Institute for Clinical Excellence England has produced guidance on four diagnoses with a recommendation for family interventions.

This guidance recommends that family intervention is offered to people with bipolar disorder who are living, or in close contact, with their family.

This guidance states that Adults with a first episode of psychosis should start treatment in early intervention in psychosis services within two weeks of referral.

This document includes the following guidance:

“Consider anorexia-nervosa-focused family therapy for children and young people (FT-AN), delivered as single-family therapy or a combination of single- and multi-family therapy.

Some key points from the document:

  • need to emphasise the role of the family in helping the person to recover
  • should not blame the person or their family members or carers
  • include psychoeducation about nutrition and the effects of malnutrition
  • early in treatment, support the parents or carers to take a central role in helping the person manage their eating, and emphasise that this is a temporary role
  • in the first phase, aim to establish a good therapeutic alliance with the person, their parents or carers and other family members

This guidance states that services should offer family intervention with individual CBT, along with oral antipsychotic medication, as treatment for first episode psychosis in children and young people. Family intervention should include the child or young person with psychosis or schizophrenia if practical, be carried out for between three months and one year, include at least ten planned sessions, take account of the whole family’s preference for either single-family intervention or multi-family intervention, take account of the relationship between the parent or carer and the child or young person with psychosis or schizophrenia, have a specific supportative, educational or treatment function and include negotiated problem solving or crisis management work.

All of the NICE guidance can be accessed on their website


This report provides the most up-to-date economic evidence to support the business case for investment in effective, recovery-focused services. Drawing on a wide range of data, evidence for the cost-effectiveness of recovery-focused interventions is set out and contains a section focussing on family work.

Knapp, M., Andrew, A., McDaid, D., Iemmi, V., McCrone, P., Park, A., Parsonage, M., Boardman, J., & Shepherd, G. (2014) Investing in recovery: making the business case for effective interventions for people with schizophrenia and psychosis. Centre for Mental Health, The London School of Economics and Political Science, Rethink Mental Illness, London, UK.


Similarly, other countries such as the US have developed similar guidelines. In the US, the PORT guidelines (Schizophrenia Patient Outcomes Research Team) apply:

Dixon, L.B., Dickerson, F., Bellack, A.S., Bennett, M., Dickinson, D., Goldberg, R.W., Lehman, A., Tenhula, W.N., Calmes, C., Pasillas, R.M., Peer, J. & Kreyenbuhl, J. (2010) The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements. Schizophrenia Bulletin, 36 (1), 48-70.

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