There is strong evidence for family support for those with schizophrenia from studies on expressed emotion and family psycho-education. These studies demonstrated that family support is essential for those with schizophrenia in clinical practice; however, many family members do not receive sufficient support from mental health services in Japan. For example, the National Federation of Mental Health and Welfare Party in Japan (Minna Net) criticized the lack of family support in the mental health system in Japan after the results of a large-scale survey in 2010.
 Insufficient time with their psychiatrists and the subjective feelings of family members that the patients do not sufficiently interact or dialogue with their psychiatrists were suggested as issues in the shortage of family support.
 Therefore, we advocate the importance of the implementation of an interactive dialogical process in which mental health care is provided together with family members. As an example of the training of the dialogical process, we introduced a training model of "Manju-theory (Steamed bread-theory)" conducted by the Japanese Network of Psycho-education and Family Support Program. In addition, we introduced some principles of family support that we share in assertive community treatment clinical practice as concrete examples of family support in outreach services.
 According to the NICE clinical guidelines (CG178), support for caregivers (family members) should be respected in the care of schizophrenia patients across all phases in conjunction with (1) service user experience, (2) race, culture and ethnicity, (3) physical health, (4) comprehensive service provision, and (5) peer support and self-management.
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