There were two papers each from Australia and Norway, and the other four were from Sweden, Iran, the USA, and the UK. Five studies investigated the experiences of the parent who received psychiatric inpatient treatment [25, 35, 37, 38, 40]. One presented the recollections of adult children of when their parent was hospitalized . Three studies presented the experiences of children under 18 years of age [25, 38, 39] and one study presented the views of children aged 17–26 years . Three included the views of grandparents (parents of the individual who had been hospitalized) [25, 39, 41]. Four studies included multiple family members [25, 38, 39, 41]. Two papers exclusively focused on mothers receiving inpatient treatment [35, 37], and one focused specifically on fathers in forensic inpatient care . Four studies included families where a parent of any gender was admitted to a psychiatric unit [25, 36, 38, 41]. See Table 2 for further details. Please note that the final column in Table 2 presents the initial codes identified by the research team, during the early stages of the analytic process, not verbatim themes identified in the primary studies.
Four themes were identified: pressure and responsibility; a need for information and guidance; the emotional needs of children; and the parent–child bond during hospitalization.
Theme 1: pressure and responsibility
Six of the eight studies described pressures experienced by family members when a parent received inpatient treatment [25, 36, 38,39,40,41]. Seeking admission for the parent was challenging for families. According to Skundberg-Kletthagen et al. , “…they describe it as a battle to get help” (p. 119). One participant highlighted how difficult admission was even though the parent had previously engaged with the system: “It shouldn’t be so difficult to be admitted to a psychiatric ward. It’s the same old story every spring…” ( p. 119). Convincing the parent to seek help was difficult for some with one child saying, “I use thousands of tricks to take him to hospital” ( p. 99).
When parents were admitted, there were changes to children’s responsibilities. Knutsson-Medin et al.  found that adult children’s recollections from their childhood when they experienced “…feelings of relief when someone was responsible for their parent during his or her hospitalization” (p. 748). One participant in their study illustrated this by saying “I appreciated it when my mother was taken care of in hospital. I knew that she ate, took her medicine, slept well and felt better” (p. 748). Conversely, Skundberg-Kletthagen et al.  reported adult children’s concerns about the quality of care their parents were receiving: “…there were a number of temporary staff and many people to relate to, and the doctor was away for six weeks when dad was admitted” (p. 120). Simultaneously, the authors noted that children felt “more secure when they experience the health personnel are accessible and observe changes in the patient” (p. 120).
Other pressures and responsibilities were identified. Two studies [36, 38] found that some adolescent children did not have relatives or other adults to care for them and accordingly experienced financial difficulties and “were required to find their own accommodation” ( p. 5). O’Brien et al.  and Wells et al.  highlighted the inconvenient appointment times for families wishing to visit the parent. Relatives caring for children were burdened with making decisions about whether children should visit their parents, and felt caught between the respective needs of children and parents. Likewise, Wells et al.  found the responsibility fell to other family members (primarily the mother) to support and maintain the father-child relationship. Supervising young children on the ward was another responsibility that other family members found difficult, especially when expected to attending interviews with hospital staff. O’Brien et al.  reported: “Several parents and carers indicated that they had disagreements about children visiting, with the carer/parent not wanting to facilitate children visiting” (p. 140).
Despite the relief of seeing their parents, O’Brien et al.  found that children shouldered multiple responsibilities when visiting. Some children viewed these visits as a form of support directed to their parents rather than for their own benefit. One child (age not reported) commented, “seeing us would make him want to get better faster” (p. 140). This is a notion that was sometimes reinforced by other family members. “One child commented that his mother had said: ‘Don’t be too anxious about it... we are just there for Dad, so just be there for Dad’” (p. 140). One concern for children was that they would say or do something to upset their parents. One remembered thinking, “Maybe I shouldn’t have said that... maybe I have made her worse” ( p. 141).
Discharge was another stressful time and when children wanted to know “when are you coming home?” ( p. 17). Discharge was also challenging for families and children when they had to resume care for the parent before they were ready. Skundberg-Kletthagen et al. ( p. 120) reported, “the period of hospitalisation was too short … the treatment had not been completed and … the patient was not well enough to be discharged – all of which put a great burden on relatives: ‘We said she couldn’t just be discharged; she wasn’t capable of managing herself, but in fact that’s what they intended to do!’ ([adult] daughter).” When single parents were discharged, children felt pressured with one adult recalling a prior experience, “I had to take care of my mother myself” ( p. 748).
Theme 2: a need for information and guidance
Identified in seven studies were family members’ needs for information and guidance about how the experience of hospitalization [25, 35, 36, 38,39,40,41]. However, these needs were often unmet by hospital staff. Some family members believed that parent confidentiality was prioritized at the expense of them being involved in treatment planning or being informed about the parent’s progress . Children felt especially excluded from information about their parent’s treatment. One child (age unreported) said, “You shouldn’t be left in the dark because you’re a kid and maybe they don’t give us credit... you can handle it. It is much more scary not knowing” ( p. 141). According to Knutsson-Medin et al. , “some children claimed that they were not given any information even after their parent attempted suicide” (p. 748).
O’Brien et al.  found that parents, children, and other relatives were all disappointed at the lack of information or guidance about children visiting their parents in the hospital. When bringing children to the hospital, family members wanted advice on planning the visit and preparing children. They also wanted “assistance with the hellos and the goodbyes” (p. 141). Children wanted information about how to behave on the ward. However, “there was little assistance available when children visited or when the decision about visiting needed to be made. One carer noted: ‘No one took an interest in whether the child came in or not... I cannot say there was one staff member that counselled us’” ( p. 141). Fathers wanted professionals to help them build their bonds with children during hospital visits as they did not feel confident about doing this on their own . Drawing on a single case study, Kosman et al. ( p. 282) recommended that mothers with postpartum depression be provided with “frequent and extended supervised visitations with the newborn; offering lactation consultation and a private space to pump and store breastmilk”.
Parents who were inpatients wanted staff to provide their children and partners with psychoeducation about their mental illness . Children also said that they wanted this information [25, 36, 41]. O’Brien et al.  found that: “Children (particularly older children), who had been part of family interviews while their parent was hospitalized, appreciated being included and gaining some understanding of their parent’s illness” (p. 141). Finally, some children wanted guidance about how to interact with their parents after discharge: “We need to know how to deal with him and how to treat him… They should educate us about how to treat him to prevent conflicts” ( p. 99).
Theme 3: children’s emotional needs
Children experienced a range of emotions when their parents were hospitalized. Some children became lethargic, depressed and withdrawn [38, 41] while others described experiences of anxiety “that thought [that the parent is not going to get well] will stay with you... you don’t think logically... you think with your emotions” ( p. 141). Being in the hospital setting was emotionally difficult for some children. Recalling her childhood experiences of visiting a parent in hospital, one adult said, “The gloomy atmosphere and furnishings frightened me…” ( p. 749).
In four studies [25, 36, 38, 41], children of various ages described a need for connection and “someone to talk things through with” ( p. 5). An older child noted, “I need someone to sit and talk with me, throw me in another mood, and avoid remembering my past” ( pp. 98–99). Children sought this support from various sources. Parents who were inpatients and children both recognized that siblings often supported each other . Extended family members were also important. An adult child recalled, “…we go to my grandmother or uncle’s home to avoid being alone. Our morale is damaged seriously when we are alone. However, when somebody comes to our home, greets us, and consoles us, our morale is boosted considerably” ( p. 99). One child relied on his dog for comfort: “my dog is the closest thing I have to human contact for days when my mum is in hospital” ( p. 6).
Despite families wanting hospital staff to provide support for children, they reported “…a lack of support from, and almost no contact from the staff” ( p. 750). Parents and children both indicated that children should be debriefed by staff after parents were admitted . Similarly, one child said that “someone should see that the child is okay before they leave” the hospital after visiting parents ( p. 141). Likewise, some children wanted their own professional support with one adult participant reflecting, “I wished that I could have seen a social worker or a psychologist, someone who could have asked me about my reactions…” ( p. 749). Another suggested, “our school welfare officer should have been informed” ( p. 749) so that they could receive support through their school.
Theme 4: the parent–child bond during hospitalization
Four papers [25, 35, 37, 40] presented findings related to experiences of the parent–child bond when the parent received inpatient treatment. Some parents felt ambivalent about psychiatric hospitalization, and where as one mother described, she benefited from hospitalization for her mental health  but at the same time, reported that bonding with her child and being involved in childcare and parenting was a challenge, an experience also reported by fathers admitted in forensic inpatient care .
Two studies found that some parents experienced a sense of disconnection from their children when hospitalized [35, 40]. Even though they remained in contact with their children through telephone calls or visitation, two papers, one study with mothers ( p. 280) and the other with fathers ( p. 14) described “missing out on” their children’s development, and subsequently felt guilty and remorseful. Some fathers felt they were no longer able to voice their opinion on childcare issues . However, for other fathers, physical absence from their children did not necessarily lead to psychological disconnection, as one father reported, “my kids will always be around me …if not physically, spiritually they will always be around me” ( p. 11). This psychological connection can be maintained by “cognitively holding their child(ren) in mind” ( p. 15) or through child contact, which “takes away the... severity of having to serve a sentence as such in a mental hospital… I can pick up the phone any time and phone the children ( p. 19).
The parent–child bond was also impacted by the practicalities involved in organising visits from children, which were not easy to organise with issues around transport and cost [25, 40]. The social support network, particularly the child/ren’s other parent and grandparents, were other factors impacting children’s ability to visit. One mother admitted to inpatient treatment was able to maintain her bond with her baby as her partner and mother took turns taking the child to the hospital and bringing her photos of the baby . Likewise, one father attempted to keep a harmonious relationship with their child/ren’s mother “so I can speak to them [children] when I need to” ( p. 13). Conversely, other fathers indicated that their ex-partners kept their children away from them when in hospital and where “it’s down to your other half and whether they want to bring them” ( p. 19).
Some parents were unsure whether their children should visit them. Some parents recognized the benefits of seeing their children, e.g., “having family come to see (me) is one of the best cures” ( p. 139) and where seeing children was “the only positive that’s going on in my life” ( p. 11). Family members also recognized the benefit of visits for the parent as they may “not have seen their kids for many weeks... and it’s quite distressing for them to be separated and not to be able to reassure their kids that they are okay” ( p. 140). However, some parents indicated: “I don’t want anyone to let her know that I go to this sort of hospital”, which the authors reported was due to the “fear that her child would tell people where her mother was, and thus attract stigmatizing responses herself” ( p. 140).
Many parents were concerned about their children visiting them in hospital and where some mothers “feared that the diagnosis would come to define them as mothers. They felt they were at risk of losing their children” ( p. 6). Consequently, they minimized their mental health difficulties when talking to clinicians even though they knew it undermined their own recovery; “I’m probably afraid of being labelled a lunatic and then they will take my children away…” ( p. 7). Likewise, one father, concerned about child protection procedures indicated that “I don’t feel pleased... they [staff] are taking the moment from the visit” ( p. 21). Conversely, some inpatient professionals facilitated parents’ bond with their children by prompting visits and asking, “‘when is your daughter picking you up?’... they [staff] always want to know what else she [daughter] is doing... my boys come in and they tease them a little bit… it’s good like... very supportive and very important to me” ( p. 14).
Although challenging, some parents attempted to fulfil their parenting responsibilities in the confines of the hospital. One mother with postpartum depression pumped breast milk so that her partner could feed their baby  while some fathers in forensic inpatient care “enact[ed] paternal parenting practices” including providing emotional support, guidance, and money to their children ( p. 18).