“I will be the first person ever to have every single person in the world as my friend,” he said on a recent Zoom call, his sandy-brown hair hanging down to his shoulder blades. From Kai, this kind of proclamation doesn’t feel like bragging, more like exuberant kindness.

But when Kai’s school recently invited him back, he refused. That’s because his worry list is long, topped by his fear of getting covid-19 and giving it to his 2-year-old sister, Alaina. She was born with a heart condition, Down syndrome and a fragile immune system. To her, the disease poses a mortal threat, and he is her protector, the only one who can make her giggle breathlessly.

Kai also worries about being separated from his mom, Rashida Humphrey-Wall. His biological father died in 2014, and she remains his rock, his mama bear and occasional taekwondo partner. He sometimes visits her bedside, in the middle of the night, just to check on her.

This pandemic has been stressful for millions of children like Kai. Some have lost a loved one to covid, and many families have lost jobs, their homes and even reliable access to food. If that stress isn’t buffered by caring adults, it can have lifelong consequences.

“Kids have had extended exposure to chaos, crisis and uncertainty,” said Dr. Matt Biel, a child psychiatrist at MedStar Georgetown University Hospital.

But there’s some good news for kids like Kai: Educators across the country say their top priority right now isn’t doubling down on math or reading — it’s helping students manage pandemic-driven stress.

“If kids don’t return to school and get a lot of attention paid to security, safety, predictability and reestablishing of strong, secure relationships, [they] are not gonna be able to make up ground academically,” Biel said.

Promoting Mental Wellness in the Classroom

To reestablish relationships in the classroom — and help kids cope with the stress and trauma of the past year — mental health experts say educators can start by building in time every day, for every student, in every classroom to share their feelings and learn the basics of naming and managing their emotions. Think morning circle time or, for older students, homeroom.

At Irene C. Hernandez Middle School in Chicago, teacher Lilian Sackett starts off each day by checking in with students, then diving into a short lesson on mindfulness and other social-emotional skills.

The school is in a predominantly Latino area that was hit hard by the pandemic, Sackett said. She teaches English as a second language, and she learned that many of her students’ families were dealing with a lot of stress related to job losses and illness — that’s on top of any trauma that may haveÌýpredatedÌýthe pandemic.

“We need to allow the students to share their experiences with the pandemic and to give them that safe space [to] talk about it,” Sackett said.

What’s more, she said, children can benefit a lot from just a few minutes each day of classwideÌýcalm. When she found out her students love Bob Ross and hisÌýÌýfrom the 1980s and ’90s, Sackett decided to work him into their morning routine.

“We watch five minutes of Bob Ross, and we watch the whole painting session within one week,” she explained. “When they’re having fun, they’re so excited — they’ll learn anything you throw at them.”

Sackett said her approach was informed by aÌý, provided by Chicago’s Ann & Robert H. Lurie Children’s Hospital, that focused on the impacts of trauma on children.

“They mentioned a bad grade is never about a lazy kid,” she said. If a child is struggling academically, they may be dealing with really tough circumstances at home. Sackett learned that teachers can help by creating a supportive environment that fosters resilience.

Sheyla Ramirez, an eighth grader at Sackett’s school, has benefited a lot from daily check-ins with her teacher. Last fall, her family came down with covid, and her baby sister ended up hospitalized before she recovered. Sheyla’s uncle had died after testing positive for the virus months earlier. She said it was a really stressful time, especially for her sister in third grade.

“My sister was like, ‘Oh, I don’t want to die,'” Sheyla remembered. “I didn’t know what to tell her because I was in shock, too.”

School staff members routinely checked in to see if she or her family needed anything, and they offered to connect Sheyla with a school counselor. But Sheyla said the short daily lessons in mindfulness at the start of each school day — and being able to share her feelings and concerns with her teacher — were enough to help her get through.

“They’ve been doing an excellent job,” said Sheyla’s mom, Amparo Ramirez. “I’ve been telling them, ‘I’m thankful for you being here.'”

When More Serious Help Is Needed

For many kids, a little morning circle time with a caring teacher, or an occasional chat with a school counselor is all they need. And the more schools invest in promoting mental health and equipping children with social-emotional skills, the fewer children will go on to develop more serious problems, said child psychiatrist Biel.

But there will always be children who need more intensive interventions, which could involve school social workers and psychologists, when available, or a referral to a mental health professional beyond the school.

Kai has been talking regularly with a therapist through his elementary school. And he said she has helped him come up with strategies to manage his stress at home.

“I would go in my room, lay on my bed, and either watch TV or play with my toys or do something like that,” Kai said. “And then I’ll come back out when I’m more calm and happy.”

As a solo parent, Kai’s mom, Humphrey-Wall, has also had a tough year. She admitted that looking after two kids, in addition to taking on a new job, during a pandemic has been stressful. “In the beginning, I think I had depression, anxiety … anything you can think of, I probably had it.”

Biel said that kind of stress can trickle down to children.

“All of the best evidence-based practices in the world are not going to have the desired effect if that child is living in a family that’s overwhelmed by stress,” he explained.

One of the best ways to address that is to also help caregivers, like Humphrey-Wall. And that’s exactly what Kai’s school has done. Through a partnership withÌý, Kai’s school arranged for Humphrey-Wall to meet with a clinical psychologist once a week for what they call “parent wellbeing sessions.”

Without it, she said, “I don’t know what I would have done, really.”

Partnerships between schools and mental health care providers can be expensive for districts and may not be an option in rural or under-resourced areas where there simply aren’t enough child-focused services.

Biel said he’s hopeful the rise in telehealth will help. But whatever the solution, he said, schools need support as they explore their options.

“Schools can’t beg, borrow and steal from what they already have to do this,” Biel said. “We need to support schools and school systems with more resources to make this possible.”

Federal Help for Schools

For districts that want to do more,ÌýÌýcould be a big help. The American Rescue Plan contains roughly $122 billion for K-12 schools, some of which can be used to hire more counselors, social workers and psychologists. And one U.S. senator has been pushing the Biden administration to emphasize mental health as it guides districts on how to spend that money.

“Not all schools and districts are equipped to work on these complex mental and behavioral health issues and meet the unique needs of today’s students,” Sen. Catherine Cortez MastoÌýÌýto the secretaries of the U.S. Departments of Education and Health and Human Services. “Many suffer from drastic shortages of counselors, social workers, and psychologists to work with students even under normal circumstances. They will need robust assistance from community-based service providers and the health care community.”

Cortez Masto said a recent spate ofÌý, Nevada, underscores just how urgent the needs are.

“This is a unique situation we’re in, hopefully a once-in-a-lifetime pandemic,” she said. “We don’t know the impact it’s going to have long term [on] our kids. But we know the short term. I’ve seen it here in southern Nevada and its devastating consequence here. So we’ve got to change that dynamic.”

In the U.S., where access to health care — especially for children’s mental health — is inequitable and inconsistent, the difficult work of identifying and tending to the mental and emotional health of this pandemic generation will fall largely on the shoulders of educators.

Programs like the one at Kai’s school, in Washington, D.C., could play a critical role in helping change that dynamic. Cortez Masto hopes the flood of federal relief dollars will help other districts create similar partnerships with child mental health providers, or find other solutions.

In the meantime, Kai and his mom are trying to figure out when Kai will return to in-person school. Humphrey-Wall said it would be good for her son to get out of the house, but Kai still fears bringing covid home. He’s talking it through with his school-based therapist, doing his best to give those worries a roundhouse kick:

“We all need to be free from this quarantine. I’m going crazy. I want to be free!” Kai shouted. He’s eager to get back to the business of making friends with the entire world.

If you or someone you know may be considering suicide, contact theÌýÌýat 1-800-273-8255 (en español: 1-888-628-9454; deaf and hard of hearing: dial 711, then 1-800-273-8255) or theÌýÌýby texting HOME to 741741.

This story is part of a reporting partnership that includes NPR, Illinois Public Media and Kaiser Health News.

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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Her mom calls her Princess, but her real name is Lindsey. She’s 17 and lives with her mom, Sandra, a nurse, outside Atlanta. On May 17, 2020, a Sunday, Lindsey decided she didn’t want breakfast; she wanted Doritos. So she left home and walked to Family Dollar, taking her pants off on the way, while her mom followed on foot, talking to the police on her phone as they went.

Lindsey has autism. It can be hard for her to communicate and navigate social situations. She thrives on routine and gets special help at school. OrÌýgotÌýhelp, before the coronavirus pandemic closed schools and forced tens of millions of children to stay home. Sandra said that’s when their living hell started.

“It’s like her brain was wired,” she said. “She’d just put on her jacket, and she’s out the door. And I’m chasing her.”

On May 17, Sandra chased her all the way to Family Dollar. Hours later, Lindsey was in jail, charged with assaulting her mom. (KHN and NPR are not using the family’s last name.)

Lindsey is one of almostÌýÌýin the U.S. who have a serious emotional or behavioral health condition. When the pandemic forced schools and doctors’ offices to close last spring, it also cut children off from the trained teachers and therapists who understand their needs.

As a result, many, like Lindsey, spiraled into emergency rooms and even police custody. Federal data showsÌýÌýof kids in mental health crisis during the pandemic — a surge that’s further taxing an already overstretched safety net.

‘Take Her’

Even after schools closed, Lindsey continued to wake up early, get dressed and wait for the bus. When she realized it had stopped coming, Sandra said, 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 report 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. But they often put Sandra on hold.

“This is ridiculous,” she said of the wait. “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, [the crisis] is done!”

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

That’s why, on May 17, when Lindsey walked to Family Dollar in just a red T-shirt and underwear to get that bag of Doritos, Sandra called the last option on her list: the police.

Sandra arrived at the store before the police and paid for the chips. According to Sandra and police records, when an officer approached, Lindsey grew agitated and hit her mom on the back, hard.

Sandra said she explained to the officer: “‘She’s autistic. You know, I’m OK. I’m a nurse. I just need to take her home and give her her medication.'”

Lindsey takes a mood stabilizer, but because she left home before breakfast, she hadn’t taken it that morning. The officer asked if Sandra wanted to take her to the nearest hospital.

The hospital wouldn’t be able to help Lindsey, Sandra said. It hadn’t before. “They already told me, ‘Ma’am, there’s nothing we can do.’ They just check her labs, it’s fine, and they ship her back home. There’s nothing [the hospital] can do,” she recalled telling the officer.

Sandra asked if the police could drive her daughter home so the teen could take her medication, but the officer said no, they couldn’t. The only other thing they could do, the officer said, was take Lindsey to jail for hitting her mom.

“I’ve tried everything,” Sandra said, exasperated. She paced the parking lot, feeling hopeless, sad and out of options. Finally, in tears, she told the officers, “Take her.”

Lindsey does not like to be touched and fought back when authorities tried to handcuff her. Several officers wrestled her to the ground. At that point, Sandra protested and said an officer threatened to arrest her, too, if she didn’t back away. Lindsey was taken to jail, where she spent much of the night until Sandra was able to post bail.

Clayton County Solicitor-General Charles Brooks denied that Sandra was threatened with arrest and said that while Lindsey’s case is still pending, his office “is working to ensure that the resolution in this matter involves a plan for medication compliance and not punitive action.”

Sandra isn’t alone in her experience. Multiple families interviewed for this story reported similar experiences of calling in the police when a child was in crisis because caretakers didn’t feel they had any other option.

‘The Whole System Is Really Grinding to a Halt’

RoughlyÌý 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.

Many of these children depend on schools for access to vital therapies. When schools and doctors’ offices stopped providing in-person services last spring, kids were untethered from the people and supports they rely on.

“The lack of in-person services is really detrimental,” saidÌý, a pediatrician and professor of emergency medicine at Brown University.

Marjorie, a mother in Florida, said her 15-year-old son has suffered during these disruptions. He has attention deficit hyperactivity disorder and oppositional defiant disorder, a condition marked by frequent and persistent hostility. Little things — like being asked to do schoolwork — can send him into a rage, leading to holes punched in walls, broken doors and violent threats. (Marjorie asked that we not use the family’s last name or her son’s first name to protect her son’s privacy and future prospects.)

The pandemic has shifted both school and her son’s therapy sessions online. But Marjorie said virtual therapy isn’t working because her son doesn’t focus well during sessions and tries to watch TV instead. Lately, she has simply been canceling them.

“I was paying for appointments and there was no therapeutic value,” Marjorie said.

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 low-income people and those with disabilities.

In the first few months of the pandemic, between March and May, children on Medicaid receivedÌýÌýfewer 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. That’s even after accounting for increased telehealth appointments.

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 with 2019.

The Centers for Disease Control and Prevention found that, from April to October last year, hospitals across the U.S. saw aÌýÌýin 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,” said Duffy. “Not only are we seeing more children, more children are being admitted” to inpatient care.

That’s because there are fewer outpatient services now available to children, she said, and because the conditions of the children showing up at ERs “are more serious.”

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

Child and adolescent psychiatrists working in hospitals around the country said children are increasingly “boarding” in emergency departments for days, waiting for inpatient admission to a regular hospital or psychiatric hospital.

Before the pandemic, there was already aÌýÌýfor children, saidÌý, a child psychiatrist at Judge Baker Children’s Center in Boston. That shortage has only gotten worse as hospitals cut capacity to allow for more physical distancing within psychiatric units.

“The whole system is really grinding to a halt at a time when we have unprecedented need,” Bellonci said.

‘A Signal That the Rest of Your System Doesn’t Work’

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

Part of the problem is there have never been enough psychiatrists and therapists trained to work with children, intervening in the early stages of their illness, saidÌý, a child psychiatrist at New York University.

“Tons of people showing up in emergency rooms in bad shape is a signal that the rest of your system doesn’t work,” she said.

Too often, Havens said, services aren’t available until children are older — and in crisis. “Often for people who don’t have access to services, we wait until they’re too big to be managed.”

While the pandemic has made life harder for Marjorie and her son in Florida, she said it has always been difficult to find the support and care he needs. Last fall, he needed a psychiatric evaluation, but the nearest specialist who would accept her commercial insurance was 100 miles away, in Alabama.

“Even when you have the money or you have the insurance, it is still a travesty,” Marjorie said. “You cannot get help for these kids.”

Parents are frustrated, and so are psychiatrists on the front lines.Ìý, who leads the psychiatric crisis department at Nationwide Children’s Hospital in Columbus, Ohio, said that once a child is stabilized after a crisis it can be hard to explain to parents that they may not be able to find follow-up care anywhere near their home.

“Especially when I can clearly tell you I know exactly what you need, I just can’t give it to you,” Glawe said. “It’s demoralizing.”

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. At that point, Glawe said, the cost and level of care required will be even higher, whether that’s hospitalization or long stays in residential treatment facilities.

That’s exactly the scenario Sandra, Lindsey’s mom, is hoping to avoid for her Princess.

“For me, as a nurse and as a provider, that will be the last thing for my daughter,” she said. “It’s like [state and local leaders] leave it to the school and the parent to deal with, and they don’t care. And that’s the problem. It’s sad because, if I’m not here …”

Her voice trailed off as tears welled.

“She didn’t ask to have autism.”

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

But given that many states have seen theirÌýÌýdue to the pandemic, there’s a concern services will instead be cut — at a time when the need has never been greater.

This story is part of a reporting partnership that includes , and .

Ñî¹óåú´«Ã½Ò•îl Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).