Built-in disparities in Utah's health-care system — from the thousands of poor and minorities who are continually underserved to a teenager who committed suicide last month because he couldn't get the help he needed — dominated Wednesday's discussion of the Legislature's Health and Human Services Interim Committee.

Experts, state agency administrators and a distraught aunt of the boy who killed himself urged lawmakers to do something to address gaps in the system that have reached a crisis stage, particularly in mental health services.

Department of Human Services executives told lawmakers that centralizing care or hospitalization of those most in need runs counter to a more community-based approach that would allow families with mentally ill children to have continuing involvement in care. That countered a previous proposal from the department to remodel the state hospital for about 100 mentally ill children.

Mark Payne, who directs the department's capital facilities, said the agency isn't asking for more beds but just replacement capacity to handle children whose emotional problems require constant oversight available only in a closed setting.

The model for treatment to those who have varying degrees of substance-abuse problems, ranging from intensive, resident care to more outpatient to community-based daytime treatment options "has dealt with that pretty well."

Sherri Wittwer, executive director of the Utah chapter of the National Alliance for the Mentally Ill, said discussions have been under way for years to address an inpatient versus outpatient approach. But even if a new program is proposed, "the funding never materializes," which makes everyone hesitant, even those who support new programs and want to suggest cuts to current funding.

"People are reluctant to even have the conversation because they don't want to lose what we have," she said.

Treatment options in recent years have focused on doing whatever is possible to provide services that would keep people with mental illnesses near families and in their home communities.

"If we have centralized locations and you have a family in St. George, how do you stay involved in your child's care?" Wittwer said. "If you put them away, often there is increased depression and other problems that aren't in the best interest of the well-being of the child."

Committee member Rep. David Litvak, D-Salt Lake, said the notion of hospitalization is "scary" to any family and suggested that fellow lawmakers at least begin a dialogue that would address both the realities and scope of mental illness treatment.