Issues in Mental Health Nursing, 31:242–247, 2010
Copyright © Informa Healthcare USA, Inc.
ISSN: 0161-2840 print / 1096-4673 online
Perceptions and Needs of Parents during a Young Adult’s
First Psychiatric Hospitalization: “We’re All on This Little
Island and We’re Going to Drown Real Soon”
Diana Clarke, PhD
University of Manitoba, Faculty of Nursing, Winnipeg, Manitoba, Canada
Joanne Winsor, MN
Interlake Regional Health Authority, Selkirk, Manitoba, Canada
A young person’s first psychiatric hospitalization can present
a crisis for the family. This initial contact with the mental health
has the potential to set the foundation for all future interactions.
The purpose of this study was to examine the impact of a young
the parents’ perspectives on their own emotional and practical
support needs. Ten parents (nine mothers and one father) of a
young person aged 18 to 25 were recruited through local support
of the event, coping methods they used, and support systems they
engaged while their adult child was hospitalized. Six themes were
identified: feeling relief about receiving a diagnosis; shock and
disbelief associated with the diagnosis of a mental illness; isolation
the discharge process; and grieving for the loss associated with
an altered future. The results revealed that participants received
their support from family, friends, and support groups and did not
find mental health care providers to be helpful or supportive. The
participants provided recommendations for those who work with
The first time a young person is hospitalized for a mental
illness can be a time of crisis for the individual and the family.
Not only is the individual acutely ill, but the stark realization
develops in the family that they may be facing a future with a
potentially chronic mental illness. This initial contact with the
mental health care system and mental health care providers has
the potential to set the foundation for all future interactions.
The first hospitalization can be an opportunity for health care
The authors acknowledge the contributions of Dr. Wanda Cher-
nomas of the University of Manitoba and the Early Psychosis Preven-
tion and Intervention Service (EPPIS), Winnipeg.
Address correspondence to Diana Clarke, University of Manitoba,
School of Nursing, 214 Helen Glass Centre, Winnipeg, Manitoba, R3T
2N2 Canada. E-mail: diana firstname.lastname@example.org
providers to engage with the family, within privacy allowances,
and collaborate for the individual’s recovery. If the family per-
ceives mental health care providers to be approachable and sup-
portive, a much more positive atmosphere is created than if the
health care professionals are perceived to be unapproachable or
adversarial. The purpose of this study was to examine the im-
pact of a young person’s first hospitalization for mental illness
on their parents and to determine the parents’ perspectives on
their own emotional and practical support needs.
Although the impact of caring for a family member with
mental illness and the place the family might have in facilitating
recovery has been well described (e.g., Huong & Slevin, 1999;
Karp & Tanarugsachock, 2000; Sin, Moone, & Harris, 2008;
Szmukler, Burgess, Herrman, Benson, Colusa, & Block, 1996;
Yamashita, 1998), few researchers have examined the experi-
ences of parents at the time of the initial psychiatric diagnosis
and hospitalization. Even though the first hospitalization has
been reported to have a tremendous impact on families and is
acknowledged by health care providers to be very stressful, it
has been rarely studied for exactly that reason—the event is
considered to be too stressful for the family to participate in re-
search at the time (Levine & Leginza, 2002; Rose, 1983, 1998).
Scharer (2000) studied the reactions of parents to the admission
process in general and strongly argued that this initial contact
point could set the stage for the relationship between the family
members and health care providers. Initial contact can provide
an opportunity to explore the expectations of the family, clarify
roles, and ultimately contribute to a more positive relationship.
Furthermore, parents’ expectations and prior experiences with
psychiatric treatment have been identified as important factors
influencing the nurse-parent relationship. Scharer’s study sam-
ple included first time parents as well as those who had been
through the admission process many times. Several differences
PERCEPTIONS AND NEEDS OF PARENTS
were noted in the expectations of the first timers. First time
parents often based their expectations on preconceived stereo-
types or media examples of health care professionals and the
hospital mental health setting. Those individuals who expressed
the strongest negative experience with the admission process
had no previous experience with health care and their perceived
expectations were not met.
In the literature, a strong theme is families’ assertion that
there is a need for more support from health care providers
(Letvak, 2002). To illustrate this point, Cradock, Young, and
Forquer (2002) asked family members to identify and rate what
they would like to see as outcomes of a mental health program.
The main outcomes included “a supportive and understanding
clinician” (p. 259) as well as “an excellent relationship with
family” (p. 259). This has not always been realized, however,
as Solomon and Marcenko (1992) reported “high levels of dis-
satisfaction with the hospital in terms of teaching them about
medication, teaching them to motivate their relative, providing
practical advice on how to cope with their situation, provid-
ing assistance in crisis, and giving them emotional support”
(para, 32). Similarly, Ferriter and Huband (2003), in a study
examining how families rated health care professionals when
providing support to the family, found that health care providers
were perceived as being the least helpful while support groups
and other family members were perceived as being the most
helpful. Doornbos (2002) further found that 34% of caregivers
in her sample found nothing at all supportive about the mental
health care system.
Research suggests, that while health care providers are not
perceived to be particularly supportive, they are in an advan-
tageous position to assess the needs, coping mechanisms, and
supports used by family members and to offer interventions
(Ferriter & Huband, 2003). Saunders (1999) recommended that
“since families in crisis are disorganized and frequently unable
to restore stability to the family system, nurses must learn to ob-
jectively assess a multitude of family processes such as coping,
psychological distress, patient behavioural problems, and fam-
ily social support” (p. 108). Hill, Shepherd, and Hardy (1998)
also identified the need for coping strategies and concluded
that caregivers caring for people with bipolar affective disorder
wanted to know more about personal coping strategies. As a
consequence, in this study, we chose to examine the crisis of
initial hospital admission and how health care providers might
Since little is known about the needs of family members
at the time individuals are first admitted for a mental illness,
a descriptive, exploratory study was designed within a qual-
itative paradigm. Crisis theory was chosen as the theoretical
framework because it maintains the focus on the limited time of
hospitalization and because a first hospital admission has the
potential to become a crisis event.
Crisis theory maintains that a crisis event can be viewed as
either an opportunity or a threat. Aquilera and Messick (1986)
explain that the main danger of a crisis event is that the family
and/or the individual in question may be affected negatively
in terms of mental health. On the other hand, the crisis event
may present the opportunity for families to grow and learn in a
personal sense so they can be more amenable to other available
therapeutic interventions leading to recovery. In either case,
a state of disequilibrium can occur after the event when the
individual and family must either adapt to the event and resolve
subsequent problems, or adjust to a non-solution. Ultimately a
new state of equilibrium must somehow be established.
This theoretical framework is sufficiently generic to serve
a variety of different situations. It begins with stressors that
threaten the equilibrium of the individual and family. When the
stresses produce a state of disequilibrium, equilibrium must be
an influence on the ability of an individual to re-establish equi-
librium and include the perception of the event, situational sup-
ports, and coping mechanisms. These factors may be distorted
ity to establish a new equilibrium. If a new equilibrium is not
established, the crisis continues.
The first participants were recruited in the winter of 2004
from a local support group for families of young people with
psychotic illnesses. A snowball sample was further obtained
from these individuals. Nine mothers and one father of young
to major depression were recruited into the study. Half of the
parents were between 50 and 59 and the other half were be-
tween 40 and 49 years of age. They were well educated with
seven of the ten having university degrees. Seven were working
full time and seven were married. All parents had close contact
with their child with the mental illness and most of them had
eas: perception of the hospitalization; situational supports used
during the hospitalization; and coping mechanisms used during
the hospitalization. The perception of the hospitalization was
simply defined as how the parents appraised and reported their
feelings and experiences within the context of the hospitaliza-
tion. The one- to two-hour interviews were semi-structured.
Interviews were transcribed verbatim and analysis was com-
pleted using Morse and Field’s (1995) four processes: compre-
hending; synthesizing; theorizing; and recontextualizing. The
data collection and analysis occurred concurrently so that, as
the similarities emerged, they could be further explored in sub-
sequent interviews. The transcripts were then read and reread
D. CLARKE AND J. WINSOR
understood and the next level of examination could begin (com-
prehending). Colour highlighters were then used to code simi-
larities and the transcripts were read to ensure that the meaning
Similarities were identified as themes which were combined or
renamed (theorizing). Finally, the data were analyzed for pat-
terns and relationships between categories and for the extent to
which the data fit with the conceptual framework (recontextu-
alizing). This involved many discussions with a key informant
and a secondary discussion with eight of the participants.
Perception of the Event
agnosis; shock and disbelief associated with the diagnosis of a
ness; feeling excluded during discharge; and grieving the losses
associated with an altered future. Most of the informants also
provided remarkably consistent recommendations for mental
health care providers regarding interactions with family mem-
bers during the individual’s first hospitalization.
Relief was the first emotion that the participants identified
at the time of the hospital admission. The family members pro-
vided lengthy, detailed, and often emotionally overwhelming
stories about the behaviours and events that led up to the hos-
pitalization. They often described days, weeks, even months of
bizarre behaviour and of knowing that something was wrong
with their son or daughter but being unsure about how to deal
event that led to the hospitalization. Another parent described
room prior to bringing him to emergency.
the hospital, acknowledging that something was indeed wrong,
they felt a sense of relief with the hope that things were going
to be fixed or that, at least, help was available. One parent said:
Oh, God! Did I want to leave him there? Yes, in some ways ...
it’s like you know he’s not safe at home. And something had to be
Disbelief and Shock
Relief did not last long before disbelief and shock set in. The
sense of disbelief and shock was described by family members
who had not been aware of their son’s or daughter’s diagnosis
before the admission. Informants described themselves as be-
ing in a “fog,” where their lives were a blur interspersed with
moments of crystal clarity. One parent said: “And we went to
walk out the door and I’ll never forget the sound of that door
shutting. Very gentle touch and this little click indicating he’s
locked, he’s locked in. My baby!”
During this time parents often expressed their concern that
their child did not “belong” on a psychiatric unit. In most sit-
uations, the hospital setting was a locked unit where patients
of various ages and in diverse mental states appeared to be
wandering around. Parents who were experiencing this type of
environment for the first time were clearly uncomfortable with
it. Their expectations may have been based either on television
or movie portrayals, their imaginations, or the situation seen in
other general areas of the hospital. One mother described her
experience of leaving her son behind in a locked unit: “... it’s
... it’s like, this is not happening. This is NOT happening. You
open the door and you get out of the elevator and you get into
that locked unit...”
Feeling Alone and Stigmatized
A “feeling of being alone” was a theme clearly identified by
every participant. At some point in the hospitalization they felt
that no one had ever experienced this type of situation before
and that hope was lost. The fact that inpatient staff seldom, if
ever, acknowledged their presence on the unit when visiting
their child further exacerbated their feelings of invisibility and
Contributing to this sense of isolation was the stigma of
mental illness. The parents often felt they could not share what
was happening to their son or daughter with their friends or
co-workers because of a fear of being judged, appearing to be
Do you read stuff about this in the paper? No, it’s almost like oh,
hush, hush, don’t talk about this.”
“And most of our friends didn’t understand it. Lord knows we
know what to say. Yeah, so it’s like, OK, here we are on this little
island and we’re all floating and we’re going to drown real soon.”
Some parents described a need to hide the experience from
other family members or to keep their son or daughter’s mental
illness a secret. One parent was asked to keep the secret from
his other siblings at the request of her hospitalized son.
For my son, there was so much stigma attached to [the hospital]
and being in [the hospital], when we took him there, that first night,
and he said, I do not want you to tell anyone that I am here.
Feeling Excluded During the Discharge
Every interviewed parent told a discharge story that ex-
pressed the feeling of being excluded from the process in many
ways. They felt excluded even when they had been invited to
the discharge meetings. Parents wanted to be heard when they
wanted to know what and what not to do to do next. Receiving
an invitation to a discharge meeting on the day of discharge did
PERCEPTIONS AND NEEDS OF PARENTS
not allow sufficient time for the family to adjust to the idea of
discharge or to prepare for the care of their family member that
might be required once they were home. Parents reported that
discharge meetings were intimidating and that they did not feel
they were heard nor that their input was deemed to be of any
is to discharge him and, you know, like it wasn’t, it wasn’t a joint
decision. It was like, he’s going to get discharged. What do we need
it wasn’t a place that decisions were going to be changed or anything
you know. I was, at that point I was relatively happy to have him in
the hospital ... relatively concerned about him coming home.”
Grieving for the Loss of Expectations and an Altered Future
Loss and grief was the last theme identified from the inter-
views. Often this part of the interview was the most emotional.
Coming to the realization of and understanding the reality of
the diagnosis was similar to a grief reaction for the parents as it
represented the loss of expectations and dreams for their child.
One of the participants tried to explain the intricacies of the
process during the interview:
You’ve lost the person, the expectations, the athletic guy, the
pretty good marks, you know, he’s got a future ... You’re losing
your dreams of where he will be, of having a normal life and having
a family and of grandchildren ... and you’re grieving for yourself
but also grieving for them because you know that they realize, or
they will realize that, that they, that their lives will be different.
Environmental supports were identified by the family mem-
bers based on what they received and what they wanted. Parents
port but also mentioned different support groups or places such
as local self-help organizations, where information was readily
available. Interestingly, the families clearly did not perceive the
hospital staff as being supportive. Participants stated they were
seldom, if ever, acknowledged when they visited their child and
prior to discharge. When asked outright if they found the health
care providers to be supportive, they answered resoundingly,
The final part of the interview included questions about cop-
ing where participants were simply asked “What did you do
to cope with the experience of the first hospitalization?” Par-
ents reported using a variety of coping mechanisms, which
worked to varying degrees. According to Lazarus and Folk-
man (1984), conceptualized coping functions can be either
emotion-focused or problem-focused. Emotion-focused meth-
ods are used when the perception is that nothing can be
done to change or control the situation. Problem-focused cop-
ing occurs when the situation is appraised as being change-
able and problem-solving techniques are used to address the
Problem-focused methods of coping that were identified by
parents included seeking information or learning about the ill-
ness, becoming physically active (e.g., aerobics or walking),
and going to work where no one knew about their son’s or
daughter’s situation so they could feel “normal” for a short
time. Emotion-focused methods of coping included escaping,
substance use, and expressing emotions. The most frequently
mentioned method described was expressing emotions by cry-
ing. For example, one parent said, “After visiting him in the
hospital, I’d drive up to the cottage, go for a walk on the beach,
and just cry.”
Surprisingly, the parents readily volunteered information
about their use of alcohol, cigarettes, and prescription medi-
cations to cope with their situation.
Towards the end of the interview, the participants were asked
if they had any suggestions for health care providers that would
have helped them cope with the crisis of the diagnosis and
hospitalization. They had many, which included:
• Acknowledge the family and make a connection: The
family is entering into an unknown experience that is
not “just another routine admission” for them. Hospi-
talization is a last resort and the parents have already
played a huge role in the story leading up to the hospi-
tal admission. This needs to be validated as does their
contribution. Simply say “Hello” and ask “How are
strate understanding of their situation and can offer
some support. Trustworthy and accurate, evidence-
based information is necessary to decrease family
and decrease the feelings of helplessness. Recommend
a support group. These groups are essential so that par-
ents can pool resources and address their feelings of
• Provide comprehensive involvement at discharge: The
reality is that most families take their children home
need to be a part of the overall plan for continuity and
consistency of care and ultimately, an important part
of the clients’ recovery.
• Instil hope: Hope in a time of crisis depends on others.
However, health care providers need to consider the
recovery when discussing prognosis with the family.
dations is of any use if health care providers do not interact with
the family. Several parents stated that the health care providers
D. CLARKE AND J. WINSOR
would not or could not interact with them because their son or
daughter had not consented to having information shared with
the family. Some parents went so far as to suggest that the hos-
pital staff were hiding behind the Personal Health Information
Act. In any case, the lack of consent for sharing of personal
health information does not prohibit health care providers from
intervening with any of the aforementioned suggestions. The
privacy rights of the client can be maintained while still attend-
ing to the emotional and informational needs of the family.
The diagnosis of mental illness in a young adult child was
indeed a crisis event in the lives of the families who partici-
pated in this study. In their perceptions of the event, they related
experiencing emotions ranging from relief to shock to grief.
Accordingly, in this study, the family members wanted valida-
tion that their experiences were difficult and devastating. They
also wanted recognition that their efforts to help their child in
the time leading up to the hospitalization weren’t in vain and
they wanted to know that they were not deemed to be fail-
ures as parents. This recognition was generally not forthcoming
from the mental health care professionals they encountered in
the inpatient system. As a result, they felt that they were ex-
pected to relinquish their roles as parents while their child was
hospitalized. Milliken and Northcott (2003) described similar
experiences at a stage where parents became disenfranchised
as they realized the situation they were in was one where their
parents believe they know their child better than anyone else,
psychiatrists and other professionals seldom consulted or even
listened to them. Yet, paradoxically, the young person was often
discharged to the parents’ home and care. The majority of these
parents discovered that “their ability to take responsibility for
their child was effectively blocked by the law, by mental health
professionals, and often by their own children” (p. 104).
Parents described these feelings of isolation and marginal-
ization progressing throughout the hospitalization through to
discharge. Chambers, Ryan, and Connor (2001) recommended
feel they have to take the initiative to seek professional help”
(p. 104). Although their study was not specific to mental health,
their conclusions and research findings were surprisingly simi-
lar to those presented here. They also recommended that health
care professionals be more aware of the experiences of care-
givers, provide referrals to support groups, and address the need
for coping strategies to include “problem solving, as well as
[institute] treatment aimed at emotional catharsis” (Chambers
et al., 2001, p. 104).
In the current study, the participants did not identify hope as
being present in great abundance. They did, however, identify
helplessness, which is inversely linked with hope. As long as
people believe that the situation is hopeless and describe them-
selves as being alone, they see little chance of hope. Therefore
it is largely dependent on others to take the early initiative. To
quote Miller (2000): “When significant others believe in the
possibility of a positive outcome and convey a willingness to
facilitate positive coping mechanisms.
The coping method that was most often described by par-
ents in the current study was crying, a type of emotion-focused
coping, suggesting that family members may have viewed their
situation as one over which they had little or no control. The
family members also identified a need to learn more coping
skills (Hill, Shepherd, & Hardy, 1998). Some researchers have
specifically focused their research on coping. Huong and Slevin
(1999) identified many methods of coping used by caregivers
of individuals with schizophrenia, many of which were also
identified by the participants in the current study. The methods
of coping were categorized into psychological coping, physical
coping, and social coping and included such activities such as
keeping busy, seeking information, using alcohol or smoking,
and getting physical exercise.
By recognizing this and discussing these aspects with family
members and informing them about what they might expect to
experience during this difficult time, health care workers can
aid them in coping with the situation. Offers of support to the
family, and the recognition of the reality of the situation can be
beneficial. Health care professionals can be helpful by suggest-
ing family members avoid more problematic coping techniques
that would be of little overall benefit, such as increased alcohol
consumption or drug use. At the very least, health care profes-
sionals should ask family members about what they have done
in the past to cope with stressful situations. This discussion may
prompt families to use coping mechanisms that were successful
in the past.
However, in this study, since support was not forthcoming
from mental health care professionals, parents needed to look
elsewhere for knowledgeable, credible support, and informa-
tion. Family members not only identified the need to have ac-
cess to information about support groups but also recognized
the benefits of support groups. Mannion, Meisel, Draine, and
Draine (1996) compared family members who attended a sup-
port group with those who did not and concluded “that partici-
pation in a support group positively affects key variables in the
participant’s adaptation to mental illness in a relative ... mem-
bers report more extensive adaptive coping and less subjective
burden than do non-members” (para. 30).
inpatient mental health care sites were equally represented. A
replica study that accessed a larger group of individuals would
strengthen the conclusions.
The current sample included nine mothers and only one
father. As has been noted by other authors in mental health
PERCEPTIONS AND NEEDS OF PARENTS
research (e.g., Nystrom & Svensson, 2004) recruiting male par-
ticipants is typically a difficult task. Since several of the female
participants in the current study suggested the needs and ex-
periences of fathers were different than their own as mothers,
exploration and comparison of the experiences of fathers is
needed. It was interesting to note, however, the striking similar-
ities between the findings in this study and Nystrom and Svens-
son’s (2004) work with the experiences of fathers in caregiving
In the current study, a variety of mental illnesses were repre-
sented. Little is known about how the needs of parents might be
different for a son or daughter who may suffer with depression,
bipolar affective disorder, or schizophrenia.
group which has several implications. For example, they may
have been unduly influenced by the discussions that had taken
place in previous support group meetings. Nevertheless, since
ents, it is less likely that their descriptions of their experiences
changed as a result of having attended a support group meet-
ing. Further research involving a more diverse group of partici-
pants would help to elucidate possible influences and biases of
white, middle-class sample. Further research with other socioe-
conomic and ethnic groups will be needed to gain a broader
understanding of the central issues.
The experience of an initial psychiatric hospitalization was
indeed a crisis in the life of the parents interviewed. They
reported emotions ranging from temporary relief to profound
shock to longer lasting grief. To make the situation worse, emo-
tional and educational support was often hard to come by. The
stigma of mental illness made their dilemma a difficult one
to discuss with friends and even with other family members.
They further felt ignored by and invisible to the profession-
als caring for their children. Because parents need to be active
members of the caregiving “team” as their child heads out on
the road to recovery, early engagement between parents and
mental health professionals is crucial. Furthermore, health care
isaprofound life-changing crisisforthepatient and theirfamily
and, as such, represents the classic opportunity accorded to a
crisis—the potential for disaster versus the potential for life-
Declaration of interest: The authors report no conflicts of
interest. The authors alone are responsible for the content and
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