When schools closed last spring, children with severe mental illnesses were cut off from the services they'd come to rely on. Many have since spiraled into emergency rooms and even police custody.



This pandemic has been very hard on kids. Millions of American children have diagnosed developmental or behavioral or emotional disorders, and they rely on treatment. But the pandemic has stopped many of them from getting it. Public health experts warn that this is turning into a mental health crisis. Here are Cory Turner from NPR and Christine Herman from WILL. And just a quick warning - this story has some disturbing details.

CORY TURNER, BYLINE: Shortly after the pandemic forced schools and doctors' offices closed last spring, emergency rooms began seeing a surge of kids in mental health crisis.

JENNIFER HAVENS: Tons of people showing up in emergency rooms in bad shape is a signal that the rest of your system doesn't work.

CHRISTINE HERMAN, BYLINE: NYU child psychiatrist Doctor Jennifer Havens says without schools and in-person therapies, kids have been cut off from many of the trained adults they depend on.

TURNER: But this crisis did not start with the pandemic. For years, Havens says, the nation's mental health system was already failing kids.

HAVENS: We wait until the kids get big, and often we wait until they're too big to be managed.

HERMAN: Part of the problem, she says, is there have never been enough doctors and therapists trained to work with kids.

TURNER: That's not news to Marjorie, a mother in Florida who asked that we not use her last name to protect her family's privacy. Getting help for her 15-year-old son has always been hard. He has ADHD and oppositional defiant disorder.

HERMAN: That means little things, like asking him to do his schoolwork, can send him into a rage, leading to holes punched in the wall, broken doors and violent threats.

MARJORIE: Last night, he said he was going to kill me (laughter). And I'm not laughing because it's funny. It's like, I'm laughing because I can't believe this is my life.

TURNER: Marjorie has been frustrated by online therapy because her son will watch TV instead and not participate. Last fall, he needed a psychiatric evaluation, but the nearest in-network doctor was 100 miles away.

MARJORIE: I mean, even when you have the money or you have the insurance, it is still a travesty you cannot get help for these kids. And even beyond the telehealth, just the isolation of the kids not being in school, the lack of social interaction, that further isolates them, and then that anger is taken out on the immediate people within the household. So just that in and of itself exacerbates the situation.

TURNER: Parents are frustrated, and so are psychiatrists on the front lines. Dr. C.J. Glawe leads the psychiatric crisis department at Nationwide Children's Hospital in Columbus, Ohio.

C J GLAWE: Essentially, we are a emergency service for children who are having acute mental health needs.

TURNER: Once a child is stabilized after a crisis, he says it's hard sometimes explaining to parents that they may not be able to find follow-up care anywhere near their home.

GLAWE: Especially when I can clearly tell you, I know exactly what you need; I just can't give it to you - I mean, it's, you know, in some cases, you know, demoralizing.

HERMAN: When states and communities fail to provide children the mental health services they need, kids can deteriorate and even wind up behind bars.

TURNER: Kids like Lindsey, who is 17 and lives with her mom outside Atlanta. We're not using last names to protect her privacy. Lindsey has autism. She thrives on routine and gets special help at school.

HERMAN: So when the pandemic hit and schools closed, her mom Sandra, who's a nurse, says their living hell started. Lindsey began hitting her mom. Also, she would still wake up early for school. But when the bus never came, Sandra says she'd often grow agitated and just walk out.

SANDRA: It's like her brain was wired. And she's out the door, and I'm chasing her.

TURNER: That's when Sandra would race through the short list of places she could call for help. There was her state's mental health crisis hotline, but she'd often have to wait.

SANDRA: This is ridiculous. It's supposed to be a crisis team, but I'm on hold for 40, 50 minutes. And by the time you get on the phone, it's done.

HERMAN: There was the local hospital, but she'd already been there with Lindsey a few times and been told there's really nothing they can do.

TURNER: So on May 17, when her daughter ran out before breakfast, Sandra followed in her car and called the last option on her list - the police.

SANDRA: She's turning this way. She's turning this way. And they say, ma'am, stay in one spot. But I can't because if I stay in one spot, she's gone; I don't know where my daughter is.

HERMAN: Turns out Lindsey wanted a bag of Doritos and walked to the store. On the way, she took off her pants. So when she got there, she was wearing a red shirt and gray underwear.

TURNER: According to Sandra and police records, at the store, in front of a female officer, Lindsey hit her mom hard on the back.

SANDRA: And she hit me, and the lady saw, and I say, she's autistic, you know. I'm OK. I'm a nurse. I just need to take her home and give her her medication.

TURNER: But the police said they couldn't drive Lindsey home and asked if Sandra wanted to take her to the nearest hospital. Sandra said no because...

SANDRA: They already told me, ma'am, there's nothing we can do. They just check her labs. If it's fine, they ship her back home.

HERMAN: So the officer said the only other thing the police could do was take Lindsey to jail for hitting her mom.

TURNER: At that point, Sandra says, she felt helpless and out of options. I don't know, she said. I've tried everything. Finally, in tears, she told the police, take her.

HERMAN: When Lindsey resisted, several officers wrestled her to the ground and handcuffed her. The teenager, still in her underwear, was taken to jail, where she spent much of the night until her mom was able to post bail.

TURNER: Lindsey's case is still pending. The Clayton County solicitor general, Charles Brooks, told NPR his office is working to ensure that the resolution in this matter involves a plan for medication compliance and not punitive action.

HERMAN: Millions of kids are grappling with similar challenges. Many cycle through police custody and emergency rooms or face long, costly stays in residential treatment facilities.

TURNER: That's exactly what Sandra is hoping to avoid for Lindsey.

SANDRA: For me, as a nurse and as a provider, that'll be the last thing for my daughter. It's like, they leave it to the school and to the parent to deal with, and they don't care, and that's the problem. It's sad because if I'm not here, you know - she didn't ask to be - she didn't ask to have autism, you know.

HERMAN: To help families like Sandra's and Marjorie's, advocates say governments need to invest more to create a mental health system that's accessible to anyone who needs it.

TURNER: But given that many states are right now seeing revenues drop, there's a concern that services will instead get cut at a time when the need has never been greater.

For NPR News, I'm Cory Turner.

HERMAN: And I'm Christine Herman.


KING: That story comes from a reporting partnership among NPR, Illinois Public Media and Kaiser Health News.