If only somebody had heard the cries of Coder Vance.

"I'd still have him," said his mother, Tamara O'Brien of Tahlequah.

She wishes she had known. And that others who noticed signs had told her. She regrets she allowed him to stay in a relative's home where drugs were readily available.

But she says she didn't know about the drugs.

"I had no idea," O'Brien said. He was staying with the relative because he wanted to go to school in Sand Springs, she says.

Of her seven children, Coder had always been her happy-go-lucky, spunky kid. She called him Pepe Le Pew after the Warner Brothers' French skunk character.

But the 15-year-old boy died Sept. 7, 2007, after taking a mixture of methadone, hydrocodone, Xanax and Lor- tab. Osage County authorities ruled his death a suicide.

"All I know is what it's done to me and my kids. We'll never be the same," O'Brien said. "I want to tell his story to help others. Love your children. Listen to them."

Coder is one of many Oklahoma children over decades who have slipped through the cracks of a fragmented mental health system. On Thursday, the Oklahoma Department of Mental Health and Substance Abuse released a report on the status of mental health services for the state's children.

The conclusion: Oklahoma has neglected its children who have substance abuse or mental health challenges.

"It's abominable," said State Mental Health Commissioner Terri White.

One in every five Oklahoma children are struggling with a mental illness or substance abuse, the report said. Yet more than 40 percent of the state's youths who need mental health services and 80 percent who need substance abuse services are not receiving them, it said.

"We need to integrate physical health and mental health. It's a fact that we silo the two off from each other so that we separate the health of the brain from the rest of the body. That needs to change," she said. "Mental illness and addiction are diseases of the brain, much like asthma is a disease of the lungs."

Untreated mental illness and substance abuse costs Oklahoma taxpayers $3.2 billion in direct expenditures and $4.4 billion in indirect costs attributed to premature death and lost productivity, the report said.

"If this was happening with asthma, there would be a public outcry. Every policy-maker would be incensed," White said.

In the last 10 years, Oklahoma has seen a dramatic increase in suicides among children. In Oklahoma, the suicide rate is higher than the national average and the second-leading cause of death for youths ages 10 to 19, the report said.

In addition, more than 85 percent of children in foster care meet the criteria for a mental health disorder, it said.

Mike Brose, executive director of the Mental Health Association of Tulsa, said Oklahoma long ago made a conscious decision to "backload our intervention."

That means, early intervention is virtually nonexistent and the state waits until children are placed in the juvenile justice or adult correctional systems before dealing with them, he said.

About 66 percent of boys and almost 75 percent of girls in juvenile detention have at least one mental health disorder, the report said.

"Now we are reaping the harvest," Brose said. "It's very difficult, but it takes political will. Backloading is more expensive, not only in dollar costs but in human costs."

It also takes community will.

"We had a big controversy recently with trying to find a site here in Tulsa for an alternative school for kids with substance abuse problems," Brose said. "These are our kids and we as a community thumbed our noses at them and said 'We don't want you in our community because you will lower our property values.' "

Oklahoma also has fewer than 20 child and adolescent psychiatrists, with an inadequate number of workers throughout the continuum of care, the report said. Most providers are located in metropolitan areas, leaving rural Oklahomans to drive hundreds of miles for services, it said.

"About a year ago, a report ranked Oklahoma 50th in the nation in terms of mental health overall. We are about 46th in per capita spending," White said. "When we don't invest in early intervention for mental health, we can't expect better outcomes."

The state must start training pediatricians and family care physicians to detect mental health or substance abuse problems. In addition, the state must reach out to schools to provide access to resources and health care in the community, she said.

"Kids are our most valued resource," White said. "It seems to me the most valued resource of a child is their brain. If we invest in children, we invest in the future of our state."