Mothers’ Perceptions of System-Related Burden Following Their Youth’s Psychiatric Hospitalization: A Longitudinal Qualitative Study

The period following youth psychiatric hospitalization is characterized by considerable caregiver burden. Through research suggests that mental health system involvement, socioeconomic status, and change over time may influence caregiver experiences, these areas remain underexplored. Using qualitative methods, this study examined aspects of the mental health system that contribute to parental burden in the year following youth psychiatric hospitalization and compared burden between mothers with high and low household incomes. Drawing from a longitudinal dataset of 252 mothers with an adolescent recently discharged from psychiatric hospitalization, we randomly selected 20 mothers with high (>$100,000) and low (<$25,000) household incomes. Mothers completed semi-structured interviews one (M1), six (M6), and twelve (M12) months following their adolescent's hospital discharge. Interviews were analyzed using basic qualitative inductive and deductive coding approach and multi-cycle coding process; recurrent cross-sectional analysis explored longitudinal change. Four themes were found that generally persisted over time: (1) Difficulty accessing mental health services; (2) Dissatisfaction with mental health services; (3) Frustration with medications; and (4) Gaps in support from auxiliary systems. Exploratory analyses identified nuanced differences between income groups regarding dissatisfaction with services and gaps in support from auxiliary systems. Findings contribute to knowledge of service use following youth psychiatric hospitalization, a critical period for youth safety. Findings also highlight implications for clinical practice and systems reform, including the importance of collaborative and family-centered care, shared decision making, flexible and responsive provider-caregiver relationships, improved cross-system care coordination, and structural supports that reduce the burden on families navigating fragmented services.