What helps people with mental illness to function in daily life? Findings from a Delphi study

Functional impairment remains a central yet insufficiently addressed challenge in mental health care, as many systems continue to prioritise symptom containment over sustained participation in daily life. This study aimed to identify and prioritise strategies that support optimal functioning among individuals living with mental illness by integrating psychosocial, community-based, and digital approaches within recovery-oriented and biopsychosocial frameworks.

A modified Delphi design was employed with 18 experts from clinical, counselling, and academic settings. In Round 1, participants generated strategy statements that were synthesised through thematic analysis, supported by AI-assisted coding and subsequent human review, into eight dimensions of functional support. In Round 2, 16 experts ranked these dimensions by perceived importance, and Kendall's coefficient of concordance was used to assess consensus.

The final framework comprised: Medical and Professional Support; Social and Family Support; Physical Health and Wellness; Emotional and Cognitive Coping; Mindfulness and Spiritual Practice; Structured Daily Living; Self-Directed Support and Autonomy; and Functional Adaptation and Masking. Experts prioritised formal clinical care, relational support, and physical health as foundational, with everyday self-regulation and structured routines occupying mid-level importance, and masking-based or high-effort compensatory strategies ranked lowest. Kendall's W indicated statistically significant but modest agreement, consistent with the expert's heterogeneity.

The findings recast functional recovery as an emergent property of treatment access, social ecology, lifestyle stability, and self-regulation, while highlighting the ethical limits of placing responsibility for functioning primarily on individuals. The framework offers a practice-oriented scaffold for clinicians, service planners, and policymakers seeking to reorient mental health systems toward cultivating meaningful, sustainable everyday living.

Not applicable.