DRUG ABUSERS, MENTALL ILL FINISHING LAST

Here's an exercise in difficult choices. • Tony, a cocaine addict, has been
suspended from work and told he can't return until he completes rehab.

But he hasn't completed his six-month probation and has no health benefits
to pay for rehab.

He is about to become homeless. • Sherry is a battered wife whose husband
has just blackened her eye and cracked one of her ribs - again.

She flees with her three children but finds there is no room at the
shelters in her community.

She is totally dependent on her husband's income. • James is a law student
who has just tested positive for HIV. He works part time, with no benefits
to pay for the very expensive medicines he needs to keep him healthy.

Does he quit law school?

No one will give him benefits with his condition. • Shannon, 13, has been
sexually abused by her stepfather. She tells a school counselor, who tells
the police, who arrest the stepfather, who confesses. The mother, who
hasn't worked outside the home for eight years, is angry and frustrated.
Shannon, feeling responsible, wonders if life is worth living. • Raul, 18,
is a top student and his high school's student-body president. He applies
for college financial aid and someone tips the Immigration and
Naturalization Service. He is undocumented. His parents brought him from
Colombia at age 2. The INS will deport him after he graduates. • Laura, 32,
is schizophrenic, out of work and desperately in need of treatment. She
comes from an affluent family, which refuses to help. She is alone and
about to become homeless, too. • Mabel, 76, has never worked outside the
home. She and her husband, a railroad pensioner, exhausted their savings to
care for him during a lengthy illness.

He died last year and her income is now $465 a month. They had no children.

She is ill, but Medicare doesn't cover her prescriptions and she can't
afford supplemental insurance. OK, you get to help only five of these people.

Which two don't you help? If you picked the substance abuser and the woman
suffering from mental illness, you have a lot of company - as in everyone
in the 50 states, apparently. Brian Spicker, executive director of Phoenix
Body Positive, created the exercise - which I changed slightly for impact
and brevity.

He has been giving it to groups for the past five years and says that the
druggie and the mentally ill person consistently get tossed from the
lifeboat, which is how one person who did the exercise recently phrased it.
Our individual choices here might have something to do with the
circumstances as presented.

They did for me. But it's probably no accident that drugs and mental
illness consistently rank last in priority. Some might feel that Laura's
family should help. OK, but there is no law to compel them. Tony, the coke
addict, is simply going to be sleeping in a bed of his own making, right?

OK, so he becomes homeless and a drain on society in other unintended, yet
costly, ways. In a perfect world, we'd help all seven.

But it's not a perfect world. There are a lot of problems and finite funds
to address them. But would it surprise anyone to discover that we probably
spend more money dealing with mental illness and drugs than the other maladies?

The problem: Our preferred treatment for both appears to be jail and
prison. Jailing and imprisoning the mentally ill and non-violent drug
offenders have made jails and prisons growth industries. It's an old story
and has to do with historic notions of the deserving and the undeserving
poor, says Spicker, who runs a non-profit group that helps people living
with HIV. In the old days, there was no question of our perception -- the
disadvantaged deserved their lot. Circumstances and environment were not
considered factors. We've evolved since then. Well, maybe.

Or maybe we've just replaced the poorhouses and asylums of old, with modern
jails and prisons.

We apparently still prefer punishment over treatment.

They deserve it, right?