Sandra's 17-year-old daughter, Lindsey, has autism.

Lindsey thrives on routine, and got special help at school until the coronavirus pandemic cut her off from the trained teachers and therapists she'd come to rely on.

Sandra's 17-year-old daughter, Lindsey, has autism.

Lindsey thrives on routine, and got special help at school until the coronavirus pandemic cut her off from the trained teachers and therapists she'd come to rely on.

Or got help, before the coronavirus pandemic closed schools and forced tens of millions of children home.

When the pandemic forced schools and doctors' offices closed last spring, it also cut children off from the trained teachers and therapists who understand their needs.

Federal data show a nationwide surge of kids in mental health crisis during the pandemic — a surge that's further taxing an already overstretched safety net.

Even after schools closed, Lindsey would continue to wake up early, get dressed and wait for the bus.

When it stopped coming, Sandra says, her daughter just started walking out of the house, wandering, a few times a week.

In those situations, Sandra did what many families in crisis tell NPR they've had to do since the pandemic began: race through the short list of places she could call for help.

First, her state's mental health crisis hotline.

Then there's the local hospital's emergency room, but Sandra says she had taken Lindsey there for previous crises and been told there isn't much they can do.

According to Sandra and police records, when an officer approached, Lindsey grew agitated and hit her mom on the back, hard.

After Lindsey's school closed, Sandra says her daughter continued to wake up early, get dressed and wait for the bus.

After Lindsey's school closed, Sandra says her daughter continued to wake up early, get dressed and wait for the bus.

The hospital wouldn't be able to help Lindsey, Sandra said.

children, ages 6 through 17, are living with serious emotional or behavioral difficulties, including children with autism, severe anxiety, depression and trauma-related mental health conditions.

The issues cut across socioeconomic lines — affecting families with private insurance, like Marjorie, as well as those who receive coverage through Medicaid, a federal-state program that provides health insurance to lower-income people and those with disabilities.

In the first few months of the pandemic, between March and May 2020, children on Medicaid received 44% fewer outpatient mental health services — including therapy and in-home support — compared to the same time period in 2019, according to the Centers for Medicare & Medicaid Services.

And while the nation's ERs have seen a decline in overall visits, there was a relative increase in mental health visits for kids in 2020 compared to 2019.

saw a 24% increase in the proportion of mental health emergency visits for children ages 5 to 11, and a 31% increase for children ages 12 to 17.

"Proportionally, the number of mental health visits is far more significant than it has been in the past," says Duffy.

That's because there are fewer outpatient services now available to children, she says, and because the children showing up at ERs "are more serious.".

This crisis is not only making life harder for these kids and their families, it's stressing the entire health care system.

Psychiatrists on the front lines share the frustrations of parents struggling to find help for their children

Havens says too often, services aren't available until children are older — and in crisis

When states and communities fail to provide children the services they need to live at home, kids can deteriorate and even wind up in jail, like Lindsey

To help families like Sandra's and Marjorie's, advocates say all levels of government need to invest in creating a mental health system that's accessible to anyone who needs it