By Tim Bonfield
The Cincinnati Enquirer

Three years ago, the awesome burden faced by the Maiorano family opened some eyes about the state of mental health and substance abuse services available to Greater Cincinnati teens.

Within a single family, one teenage boy - Chris - was facing cancer. At the same time, his older brother - Daniel - was battling severe mental illness and substance abuse.

Their father - Nick - went public with the story because he was outraged that so many services were available for Chris yet Dan had to be sent out of town for care.

Now, both boys are gone.

Despite treatment, cancer claimed Chris a year ago at age 19. Despite continuing care, Dan committed suicide about a week ago. He was 21. His body was found in his supervised-living apartment Tuesday. Cincinnati police told the family that Dan probably shot himself during the weekend.

"When Chris passed, I was kind of prepared. But this knocked my socks off," Nick Maiorano said. "He took it hard when Chris passed and kind of backslid. But he seemed to be putting things back together over the summer. He had a girlfriend he'd been seeing for several months. He had a part-time job."

The Maioranos' story was central to several Enquirer stories about childhood mental illness and substance abuse in 2000 and 2001.

Experts said then Dan's struggles were more common than many people realized. And the way he died is more common than many people realize now.

Suicide is the ninth-leading cause of death in Ohio, claiming more than 1,200 lives a year, according to Ohio Coalition for Suicide Prevention.

Despite his grief, Nick Maiorano wanted to talk about Dan.

"I'm not ashamed of my kids," Nick said. "If telling our story helps someone else down the road, then that helps us deal with it, too."

Nick doesn't blame "the system" for Dan's death.

If there is an explanation, part of it was the sheer difficulty of the problems Dan faced. Part of the problem was Dan himself.

Through his teen years, Dan struggled with a wide array of problems.

He was diagnosed with severe depression, bipolar disorder and borderline personality disorder, the inability to control extremely self-destructive behavior.

His substance abuse progressed from sneaking beers to smoking pot every day to experimenting with LSD, opium, peyote, heroin and crack.

He ran away from home. He crashed a family car. He attempted suicide at least four times.

As an adult, Dan was able to get services here. But as a minor, the family had to send Dan to Athens, Columbus and Indianapolis for services that weren't available here.

Since 2000, several changes have occurred in childhood mental health care:

In January, Cincinnati Children's Hospital Medical Center opened a $9 million mental health treatment center in College Hill that sharply expanded the availability of inpatient care.

In September 2002, the Junior League of Cincinnati launched its MindPeace program and stated that raising awareness about childhood mental illness would be the group's top project for the next five years.

Meanwhile, several agencies are working on combined ways to treat mental illness and substance abuse, rather than treating them as unrelated problems.

But Nick Maiorano said a clear gap still exists between mental health care and the rest of medicine.

"The way health care is divided up really isn't fair. Mental health is kind of the red-headed stepchild of the system. People need to pay more attention," he said.

E-mail tbonfield@enquirer.com