AMNA NAWAZ: Turning now to another major issue facing young people in America, the COVID-19 pandemic revealed the enormous strain on the mental health care system.

And, as Christopher Booker reports, parents whose children have complex mental and behavioral health needs have had to take desperate measures to get their kids treatment.

It's part of our series Early Warnings: America's Youth Mental Health crisis.

And a note: This report includes discussions of suicide and depression.

CHRISTOPHER BOOKER: Every night, 14.5-year-old Hannah Norris calls her mom, Lisa, at their home in Hilliard, Ohio.

LISA NORRIS, Mother of Hannah Norris: Did you eat today?

HANNAH NORRIS: I ate a little bit, yes.

We had (INAUDIBLE) balls for lunch.

LISA NORRIS: That's a good lunch.

CHRISTOPHER BOOKER: Hannah has been a patient at a residential psychiatric hospital in Central Oklahoma since January.

When did you start to notice that she may have had some struggles with her mental health?

LISA NORRIS: Almost immediately.

CHRISTOPHER BOOKER: After Lisa adopted Hannah out of the foster care system as a toddler, Hannah was diagnosed with PTSD, anxiety, depression, and ADHD.

LISA NORRIS: Looks like every other kid in the yearbook.

CHRISTOPHER BOOKER: Those conditions were manageable, Lisa says, but got worse when puberty hit.

LISA NORRIS: The end of fifth grade over the summer was when she fell apart, and we have not had any school pictures since.

CHRISTOPHER BOOKER: In recent years, Hannah has made multiple suicide attempts and experienced psychotic breaks.

LISA NORRIS: The older she's gotten, the bigger she's gotten, the stronger she's gotten, the harder that is for us to mitigate in the house and to keep everybody safe.

CHRISTOPHER BOOKER: So her behaviors became violent?

LISA NORRIS: Very much so.

The most heartbreaking thing is, 20 minutes afterwards, an hour afterwards, once you get her back calm and regulated, like, she's horrified that she did that to people that she loves.

CHRISTOPHER BOOKER: Lisa says Hannah is, for now, safe.

LISA NORRIS: She can't access really anything to hurt herself.

It's staffed 24/7.

All the sharps are removed.

CHRISTOPHER BOOKER: The goal of inpatient residential programs is to provide intensive treatment so that kids can return home.

A 2007 study found the average length of stay varies by program, from less than two months to more than two years.

Lisa says Hannah has made progress with daily therapy and new medications.

LISA NORRIS: I'm hearing light in her voice for the first time in a long time.

CHRISTOPHER BOOKER: But it's been an extraordinarily difficult journey to get the specialized treatment her daughter needs.

Like many kids with severe mental health needs, Hannah cycled in and out of emergency rooms and psychiatric units, meant to stabilize kids in crisis.

DR. PURVA GROVER, Cleveland Clinic: Children are children.

They are developmentally, physiologically, psychologically very different.

CHRISTOPHER BOOKER: Dr. Purva Grover chairs pediatric emergency medicine at Cleveland Clinic.

She says more families are showing up in E.R.s because the supply of specialized mental health services has not kept up with demand.

DR. PURVA GROVER: We are not psychiatrists.

We are not the specialists of mental health and the long-term consequences treatment diagnoses.

We are simply what we call crisis management.

CHRISTOPHER BOOKER: Last year, 42 states had a severe shortage of child and adolescent psychiatrists.

Nationwide, the number of residential treatment facilities for children fell 30 percent from 2012 to 2020.

CELESTE FERGUSON, Mother of Shabbo: She definitely overstayed her welcome in an acute facility.

They're not designed for long-term care.

CHRISTOPHER BOOKER: Celeste Ferguson's 17-year-old daughter, Shabbo, known as Shabbi (ph), has been diagnosed with depression, anxiety, and a mild intellectual disability.

She's struggled with self-destructive behavior for years.

CELESTE FERGUSON: She would find things to wrap her on her neck to get that, like, sensation and feeling.

She would eat things that aren't food items.

And this sort of thing was happening any moment.

CHRISTOPHER BOOKER: Shabbi has been in a holding pattern at a Columbus children's hospital for more than 60 days as her mom and care team search for long-term treatment.

CELESTE FERGUSON: So we're hopeful that soon a bed will open at -- there's a couple spots that I think they might be willing to accept her.

And, hopefully, she will be stable and ready to make that transition.

CHRISTOPHER BOOKER: On top of limited services, parents also have to reckon with high costs.

CELESTE FERGUSON: We're still paying off the debt from when we couldn't get a diagnosis and we were just private paying everything.

LISA NORRIS: The insurance costs, I don't even want to try to estimate, other than it's probably in the millions at this point.

CHRISTOPHER BOOKER: In 2020, when doctors recommended residential treatment for Hannah, the Medicaid funding she received as an adoptee covered medical care, but not the facility's room and board.

They had used up her state funding for treatment.

And Lisa, a public school special ed coordinator, couldn't afford the $40,000 she says was required up front.

LISA NORRIS: There's no way, and there's no way that most people could do that.

CHRISTOPHER BOOKER: Out of options, she says she had to accept an unthinkable alternative, surrender Hannah to the state, which, by law, would be obligated to cover the costs.

LISA NORRIS: I had to try to sell to her that we're doing this because you have to get help.

We're doing this because mom's trying to keep you alive.

Kellijo Jeffries has seen other parents make this bargain.

A licensed social worker, she is the head of job and family services in Portage County, east of Akron.

KELLIJO JEFFRIES, Portage County, Ohio, Job and Family Services: I have not seen in nine years that I have been here the frequency that I'm seeing now, where those type of tough choices are having to be made from parents.

CHRISTOPHER BOOKER: In 2021, 12 percent of children who came into Ohio state custody entered primarily because of behavioral health needs.

Is what you are currently doing what you were set up to do?

KELLIJO JEFFRIES: Absolutely not.

We are supposed to investigate child abuse and neglect, not be the ones to try to foster and create placement opportunities.

We're not the right professionals to work in that space.

CHRISTOPHER BOOKER: Even with funding, she says child protection agencies are struggling to find appropriate treatment for kids in need.

KELLIJO JEFFRIES: We're failing children.

And so that's the most heartbreaking part of this behavioral health and placement crisis issue.

CHRISTOPHER BOOKER: Back in Hilliard, Hannah received six months of residential treatment when she was in the custody of Franklin County Child Services.

But Lisa says her mental health quickly regressed when she was discharged and placed in foster care and then a group home.

LISA NORRIS: My naive thought was, by turning her over to the system, they were going to help me put her behind a locked facility, where she couldn't get ahold of things to hurt herself, hopefully help her at the same time.

It didn't go that way.

CHRISTOPHER BOOKER: With help from an attorney, Lisa regained custody of Hannah, but she says was back to square one.

With the shortage of mental health care workers, coupled with high costs, families often face a series of difficult and complicated decisions when seeking care.

In response, states like Ohio have begun to restructure their state services, hoping they can reach more kids and spare families some of the anguish.

GOV.

MIKE DEWINE (R-OH): We know that serving this group well not only results in better lives for the tens of thousands of these children and adults with multiple challenges, but also improves the lives of their families.

CHRISTOPHER BOOKER: Last July, Republican Governor Mike DeWine launched a new program known as OhioRISE.

HABEEBAH RASHEED GRIMES, Positive Education Program: This program is focused on young people with complex developmental and mental health needs, helping them find resources and receive coordination of care that allows them to stay in their home, in the community, in the schools where they live.

CHRISTOPHER BOOKER: Habeebah Rasheed Grimes heads Positive Education Program, a Cleveland nonprofit that has served inner-city youth for decades, and now runs OhioRISE in Central Cuyahoga County.

WOMAN: Do you guys have school stuff set up yet?

CHRISTOPHER BOOKER: If a child's needs can't be met through in-community support like this, the program funds inpatient treatment.

Youth under the age of 21 who are eligible for Medicaid and require significant behavioral health treatment qualify for the program.

Children whose families earn more than the Medicaid threshold are eligible too through a federal waiver if they have acute needs.

What is the reality on the ground from a staffing perspective?

We hear again and again that there's not enough therapists.

There's not enough infrastructure out there to support these kids.

HABEEBAH RASHEED GRIMES: This is true.

There is not a big enough work force to address all of the clinical needs that exist on the continuum of care.

And that's going to take time to get folks into that work force pipeline.

It is indeed a crisis.

CHRISTOPHER BOOKER: For now, families like Celeste Ferguson's continue to grapple with that shortage.

OhioRISE is working with her county's disability family and children's agencies to cover Shabbi's cost once they find long-term treatment.

Where does the funding come into the conversation as we sit right now?

Do you have to think about that as you're trying to find these facilities?

CELESTE FERGUSON: I don't.

I was talking with someone the other day, and I don't even think twice about it now, which is a godsend.

CHRISTOPHER BOOKER: And this financial relief means she hasn't had to consider giving up custody of Shabbi.

CELESTE FERGUSON: It's also opened us up to a team of people who are incredibly supportive that we just didn't have before.

CHRISTOPHER BOOKER: The new support has provided tremendous relief for Hannah Norris' family.

Last year, a care coordinator helped Lisa apply to more than 100 treatment facilities.

When a fully funded spot in Oklahoma opened up, she didn't hesitate to drive Hannah the more than 900 miles.

LISA NORRIS: We stopped for fast food.

I had the first normal meal with my daughter in months.

And then I had to drop her off 14.5 hours away from home.

So I left Oklahoma with her being carted behind the scenes to a place I had never seen, trusting those staff to take care of her and keep her safe.

And God bless them, they did.

CHRISTOPHER BOOKER: Now that Hannah is safe and getting treatment, Lisa can focus on what comes next, finding care closer to home.

For the "PBS NewsHour," I'm Christopher Booker in Hilliard, Ohio.