If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing “988,” or the Crisis Text Line by texting “HOME” to 741741.

A national shortage of mental health care providers, and the search for affordable care, has exacerbated strain on parents, often the primary caregivers who maintain the health and well-being of their children. Their day-to-day struggle has led to its own health crisis, say psychologists, researchers, and advocates for families.

As parents navigate the mental health care system’s shortcomings, stress can start to take a physical and mental health toll that disrupts their ability to continue providing care, said Christine Crawford, the associate medical director at the National Alliance on Mental Illness. Parents pour their energy into helping their kids, often at the expense of their own health, Crawford said.

“When you are worrying about whether or not your child is going to survive the day, you are constantly living on edge,” she said. “Your fight-or-flight is constantly activated.”

And the number of parents in crisis is greater than it seems.

Recent reports from the Centers for Disease Control and Prevention, the surgeon general’s office, and medical providers all show an alarming number of kids in the U.S. are experiencing severe mental health challenges. About 40% of U.S. parents with children younger than 18 say they are extremely or very worried their children might struggle with anxiety or depression at some point, according to a study.

Evidence-based therapies to address a child’s mental health should include the parents, say researchers and pediatric mental health specialists. But the focus on the adult caregivers and their anxiety and stress too often falls short. For example, parent-child interaction therapy coaches parents to manage their young child’s behavior to prevent more severe problems in the child later on. While this may help the child, it doesn’t directly support the parent’s health.

“I have so many parents sit across from me on the couch and cry,” said Danielle Martinez, a behavioral health specialist.

“They felt so alone, felt like bad parents, felt like giving up and then felt guilty for wanting to give up.”

When the parent’s mental and physical health deteriorates, it complicates their ability to prevent the child’s condition from getting worse, said Mary Ann McCabe, a member of the board of directors at the American Psychological Association. Parents are a kid’s most important resource and need to be a concern, she said.

Some parents also said they are feeling the strain on their mental and physical health.

“The children are in crisis. But the families are also in crisis,” said Robin Gurwitch, a professor in psychiatry and behavioral sciences at Duke University. “They are struggling to figure out how best to help their children in a system that doesn’t come with a manual.”