Background: The focus of research on families of the severely and persistently mentally ill is on unidirectional caregiving from family members to the ill individual (consumer). It seldom addresses whether the consumer also gives something to the family. Thus the concept of reciprocity was investigated in this context.Objective: The objectives of this study were to identify differences in families who reported reciprocity from consumers with those who did not and to describe the kinds of reciprocity perceived by these families.Design: The objectives were met with the use of responses from a mailed questionnaire to family members.Results: Reciprocity was reported more by women than men, by respondents who lived with the consumer, and by families who reported giving more assistance to the consumer and who perceived the consumer as higher functioning. Neither age of family member or consumer nor type of family relationship was related to reciprocity. The kinds of reciprocity families perceived were categorized into instrumental tasks, caring, family solidarity, self-caring, peace of mind, family sensitization, and financial.Conclusion: The findings support the importance of planning nursing interventions that recognize that the severely and persistently mentally ill may give to their families as well as receive from them.