It was lunchtime on Monday when counsellor Rebecca Henderson answered a crisis call from a distraught girl with thoughts about ending her own life.

The teenager was locked in the bathroom at home, agitated, and scratching at her arms. She knew that she needed help, but was scared about contracting coronavirus if she went to the hospital.

“A young woman with existing problems, isolated in a stressful home situation without support with thoughts of taking her own life … that’s a high-risk perfect storm,” said Henderson, who works at the Crisis Center in Birmingham, Alabama, part of the national suicide prevention lifeline network.

She’s not the only one. Every aspect of normal life has been turned upside down by the strict physical distancing measures to mitigate the pandemic, which has already claimed almost 50,000 lives and 26m jobs in the US. With no end in sight, the mental health consequences of Covid-19 are starting to manifest – fuelled by the devastating mix of uncertainty, isolation, grief and economic despair.

Nationwide, crisis services are trying to deal with the immediate aftermath. But the country’s weak mental health system may not be able to meet rising demand.

Counsellors on the crisis text line, a global SMS helpline typically utilized by teens with relationship issues, said they were dealing with a 40% increase in messages in the US. The demographics have changed radically: now, over-35-year-olds are the most frequent users, with those on low incomes accounting for 31% of traffic – compared with 19% before the pandemic.

“In the first wave people were anxious, but now in the second wave people are feeling depressed and isolated, especially very poor people and those in violent situations,” said Nancy Lublin, the CEO and co-founder.

In Alabama, calls to the hotline are up 50% since the start of the pandemic, with a big rise in isolated young people and rural dwellers worried about finances. “We’ve seen an increase in suicidal ideation among people who’ve lost their jobs, worrying about how they’re going to feed their families,” said Meg McGlamery, executive director of the Crisis Center.

In California, calls to a disaster distress line more than tripled between February and March, and are on track to rise another 50% this month, according to Didi Hirsch Mental Health Services. Unsurprisingly, the vast majority of callers to this national hotline are anxious about Covid-19 .

As the economic fallout deepens, mental health advocates warn about the potentially devastating impact on millions of Americans. “We fully expect a jump in calls to the suicide prevention lifeline in the next couple of months as people remain unemployed, lose their homes and can’t pay the bills,” said Lyn Morris, the senior vice-president of clinical operations at Didi Hirsch.

There’s precedent for that dire outlook. In the aftermath of the 2007 recession in North America and Europe, about 10,000 more people, mostly middle-aged and older men, committed suicide than expected in a two-year span.

But it’s not just about isolation or financial dire straits – the pandemic has its own specific victims. The number of Asian Americans using the national crisis text line has doubled, counsellors say, amid a wave of harassment and bullying probably linked to the racist rhetoric spouted by Trump and some of his supporters who blame China for the spread of the virus.

Requests for help from domestic violence victims are also up by a third at the crisis text line. The world over, home is the most dangerous place for women and children – a grim reality exacerbated by physical distancing and travel restrictions.

Facebook Twitter Pinterest A woman leans out of her window to smoke in New York earlier this month. Photograph: Justin Lane/EPA

In Alabama, Henderson recalled a call from a woman desperate to flee a violent partner but who was scared of being arrested if she crossed state lines. In another case, the center struggled to find emergency shelter for a rape survivor.

Children are often the most vulnerable during public health crises. There is particular concern for those with pre-existing psychological issues, and those cooped up with an abuser or an adult with substance misuse problems, mental health experts said.

In order to mitigate the risks, one school counselor in New Jersey told Lisa Athan, a grief specialist, that she holds up a paper sign with “can you speak freely?” to which the child responds with a nod or shake of the head.

Athan said children are struggling to process grief as normal rituals associated with death such as saying goodbye and funerals are almost impossible.

“Without these rituals, deaths don’t feel real, and children feel helpless, anxious, angry and too upset to concentrate on school work,” said Athan, who is trying to teach mindfulness and yoga virtually. “Now they see protesters [on TV] who want businesses reopened while their teachers and grandparents are still dying … it makes them feel angry, that these people don’t care.”

The unresolved grief and trauma from the pandemic, meanwhile, can increase the risk of complex problems such as depression, substance misuse, physical complaints and violence.

Crisis services and clinicians have scrambled to adapt by rolling out virtual therapy and telehealth consultations. But the country’s inadequate mental health infrastructure, means this is unlikely to be enough.

“The US mental health system is patchy at best and faces being overwhelmed by the likely substantial increases in anxiety and depression, substance use, domestic violence and child abuse,” said Sandro Galea, the dean of Boston University’s school of public health.

In 2018, there were 27.9 million people without health insurance, and record-high unemployment will increase that figure.

Recruitment and training of mental heath professionals has also fallen way behind: the Department of Health and Human Services predicts widespread staffing shortfalls by 2025 including up to 57,000 psychologists, 14,000 psychiatrists and 48,000 mental health and substance abuse social workers.

Even before the pandemic, half of adults with mental illness did not receive treatment, according to the National Association of Mental Illness (Nami) which has seen calls to its helpline rise by 40% during the pandemic.

As the need for mental health services rises, access to adequate and timely help will probably decline – unless drastic steps are taken now to expand digital outreach, improve surveillance to detect abuse, and fund services, according to Galea.

Even then, the repercussions are likely to be felt well after the peak of the pandemic.

“The mental health curve is going to have a long tail,” said Dr Ken Duckworth, the chief medical officer for Nami. “When life finally returns to normal, the following year will not be a good one for mental health.”

• If you need mental health support you can find help 24 hours a day:

Text HOME to 741741 to connect with a crisis text line counsellor

Call the national suicide prevention lifeline on 1-800-273-8255

Call 1-800-985-5990 for the national disaster distress helpline