Alethea Zavitz holds her son, Jacob, 10, who is bipolar. The in-patient residential psychiatric treatment that her son needs for his mental illness is not available in Clark County. Photo by Jane Kalinowsky.

Tragic stories about the mentally ill make Alethea Zavitz weep.

The suicides, the fatal confrontations with police, the acts of public violence are all frightening indicators of what might happen to her 10-year-old son, Jacob. Although he's been diagnosed as bipolar and received more than one doctor's recommendation for long-term residential psychiatric care, it's a prescription that can't be filled in Clark County for children under the age of 12.

"I read those kinds of stories, and I cry because that can't be my son," said Zavitz, a claims adjustor for an insurance company. "But the possibility is there, especially if he doesn't get the kind of treatment he needs."

Jacob was first diagnosed as bipolar when he was 5 years old. The mood disorder caused by a chemical imbalance in the brain means that he's prone to rages that can last until he passes out and bouts of extreme sadness that can make him suicidal.

"I have bad days at school and bad dreams," is the way Jacob explains his condition.

Jacob's bipolar condition grew worse between the ages of 5 and 8. In 2004, Zavitz made the wrenching decision to send her son out of state so that he could receive in-patient treatment at the University of Utah's Neuropsychiatric Institute in Salt Lake City.

There was no other choice, Zavitz said, because local facilities like Desert Willow and Montevista won't admit young children except in emergency cases.

"He was there from April 30 to May 26," Zavitz said. "It was the first time he was away from home. I went there every single weekend to see him for 30 minutes a day. Thank God I had a credit card and some savings."

Zavitz's situation isn't an uncommon one. Earlier this month, Judge William Voy called attention to the state's lack of in-patient psychiatric treatment programs for 9- to 11-year-old juvenile offenders. Voy said it has become common practice to send children to either Texas or Florida, a situation he called unacceptable.

Dr. Johanna Fricke, a behavioral developmental pediatrician who is also an associate professor for the University of Nevada School of Medicine, is regularly placed in a similar position.

Fricke treats patients whose conditions, such as autism or retardation, are compounded by mental illnesses. The kind of residential care those illnesses can require doesn't exist in Nevada, she said.

It's something Fricke has had to explain to parents before referring their children to programs in other states.

"Parents nowadays will do anything to keep their kids at home," Fricke said. "I think that's a good thing. But when it becomes absolutely necessary for parents to do this, there's literally nothing for them here."

The lack of services has come about for several reasons, Fricke said. Mental health services for adults and children historically have not been a funding priority in Nevada. There's also a shortage of behavioral developmental physicians, child psychiatrists and psychologists in Clark County. And providing pediatric in-patient psychiatric programs is expensive because younger children require higher levels of staffing.

"Montevista (Hospital) does have a pediatric program for acute care," said Ingrid Whipple, chief executive officer of the psychiatric treatment facility. "But we don't have long-term care services in our facilities."

Whipple said that Montevista also refers children out-of-state for residential treatment programs that are unavailable in Nevada.

In 2005, the Nevada Division of Child and Family Services published a document for legislators that emphasized the need for improving mental health services.

One stated goal in the paper was to reduce the wait lists for children who require immediate treatment.

In most states, Fricke said, families wait for three to six months to see a doctor in her specialty. But because she's the only behavioral developmental pediatrician in Clark County, Fricke's wait list dates back to 2004.

Zavitz has firsthand experience in how difficult it is to get to see a child psychiatrist. Either you're turned away or put on a wait list, she said.

Her son Jacob sees a psychotherapist every two weeks and a psychiatrist every month.

At times when an emergency has come up or the doctor is unavailable to come to the phone, Zavitz said she's resorted to waiting in the parking lot outside the doctor's office so that she can have a few minutes to discuss her son's condition.

"You do what you have to do," Zavitz said.

Keith Schwer, director for UNLV's Center for Business and Economic Research, produces the annual Nevada Kids Count in partnership with the Casey Foundation.

The report tracks state indicators related to the well-being of children, but doesn't include information on children's mental health because there isn't a good source for empirical data on the issue. But Schwer said it is an issue that concerns many people.

One of those individuals is Cheryl Murphy, co-founder of the Depression and Bipolar Support Alliance of Southern Nevada. The lack of mental health services available to children here is a personal issue for her.

Her daughter is bipolar, and at one point, Murphy said she was advised by a psychiatrist to give her daughter's care up to the state because that was the only way the child would get the treatment she needed.

"My comment to the doctor was ... 'I adopted her when she was 2. Why would I give her up now? What kind of message would that send to her?'" Murphy said. "And it happens to other people as well. It's a typical story."

The lack of treatment at an early age has a tremendous impact on those who are bipolar, Murphy said. The mental illness often leads to suicide in teenagers or acts that land them in the juvenile justice system.

"These aren't bad kids, they're sick kids," Murphy said. "And half of them wouldn't be juvenile offenders if they'd been able to get treatment when they needed it."

Voy has encouraged people to make children's mental health needs a priority when they speak with lawmakers. Murphy certainly plans to do so.

In the meantime, Zavitz said she'll continue to help Jacob make do with a patchwork of services that doesn't really meet his needs or prepare him to manage his condition.

"The majority of our life is day to day," Zavitz said. "We deal with things as they happen."