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Mars Is Homeless

Notes from an emergency room doctor: The woman saw the man lying in a culvert behind her home. She thought he was dead and called the police. When they arrived, they too thought he was dead. But when they shook him, he groaned, and flailed his arms to swat them away. He reeked from the odor of alcohol, vomit, and months of going unwashed. Unsure whether he was just drunk or dying, the police called the paramedics and they brought him to the emergency room.

"What's your name?" we asked him.

"Mars," he answered. "I'm a *@#*! Martian."

He rambled on with foul epithets and spat at anyone that approached him. Though the day was hot, he wore layer upon layer of foul smelling clothes. His entire wardrobe was on his back.

The medics knew him. He was homeless, mentally ill, and an abuser of drugs and alcohol. They had often transported him to one hospital or another over the years, after someone discovered him lying drunk and unconscious in a gutter, or found him injured after a fall. He had seizures, diabetes, and hypertension. Each of his visits had ended with him being given prescriptions and referrals for help. He never took the medicines and refused to go to any havens for the homeless or rehabilitation facilities. And all we ever knew about him was that he called himself "Mars" and wanted to be left alone.

Each of his visits to an emergency room warranted an extensive and expensive work-up. Our system and our ethics don't allow us to just assume "Mars is drunk again," and leave him lying in a gutter. But when sober enough to walk out, he does.

It is interesting that our morality requires us to forcibly hospitalize anyone who commits the irrational act of attempting suicide. These people are treated "against their will." Afterall, you have to be crazy to try to kill yourself. But if you are really "crazy" and in the process of killing yourself slowly by succumbing to the diseases of alcohol, drugs, or the gutter, you are not high on society's list of priorities.

There are a lot of homeless on the streets today. Many are down on their luck and in need of food, shelter, and the resources necessary to get them back on their feet again. But there are resources out there and though seeking them out may be difficult, time-consuming, and for some demeaning, it is possible to get help. But there are also tens of thousands of homeless mentally ill. Their illness may range from severe depression to severe schizophrenia. Many are unwilling or unable to accommodate to the conventions of society's social service systems. They usually can't keep appointments. And even if they do get to one, they often can't comply with treatment recommendations. The skills they need to survive on the streets - a distrust of strangers and a defensive hostility - are the exact opposite characteristics necessary to utilize shelters and seek out help.

Rather than wasting society's money on the repetitive emergency room visits of people like Mars, we should change the "involuntary commitment laws." The homeless mentally ill should be treated - even if they refuse care. If we won't allow someone to kill themselves quickly, why should we allow them to do it slowly?

But if involuntary commitment laws are liberalized, we have to be willing to provide increased resources to care for these people. And that unfortunately is unlikely to happen. So, for now, Mars will remain a Martian. And people will continue to find bodies in their back yards.