Letter to the Milwaukee Shepherd Express: March 8, 2001
Lack of care for Mentally ill
Doug Hissom's article ["A Question of Force," Feb. 15 Shepherd Express Metro] is a
disturbing illustration of the extent to which the mentally ill elicit hatred and fear in the
uninformed. It also underscores the need for more, and better, community mental health
care.
The reason Mr. Pagel stopped his medications so often was probably that he didn't like how
he felt while taking them. No antipsychotic medication, whether it is a "conventional" drug
like Haldol or an "unconventional" one like Zyprexa is without unpleasant side effects. Many
people taking antipsychotic medications complain that they feel sluggish a good deal of the
time. There is also associated weight gain, as well as the tremor that occurs when one has
been on moderate to high doses for a while. It is always tempting to discontinue these
medications and people like Mr. Pagel, without much social support, frequently do. This
always results in some sort of emergency hospitalization. Meds are restarted, the person is
stabilized, and the cycle starts all over.
The Oshkosh Police Department, to be blunt, blew it. The content of Mr. Pagel's paranoid
delusions involved imagined persecution by the police. To send uniformed officers to his
house while he was unmedicated was doomed to agitate him further. To send more
uniformed officers to manage the situation that ensued added fuel to the fire. Not knowing
Mr. Pagel, I do not know what would have been most effective instead, but care should
have been taken to make the initial police visit as non-threatening as possible. Once the
situation became hairier, the police should have backed off and summoned mental health
care workers. Milwaukee has an excellent Mobile Crisis Team that responds to such
situations. I don't know if Oshkosh has one.
There are also ways to increase the likelihood that Mr. Pagel would remain optimally
medicated. Long-acting injectable preparations of Prolixin and Haldol called depot
preparations are available. Depot Prolixin injections last two weeks. Depot Haldol lasts a
month. If a mentally ill person has had a run-in with the law and medication compliance is an
issue, the court can release the person from involuntary hospitalization on the stipulation that
they see their doctor regularly and continue to take their medications. If they fail this, they
are rehospitalized. Did this ever occur in Mr. Pagel's case? Had he ever been "on stips?"
What is saddest about this case, apart from the behavior of the OPD, which is at best
mean-spirited and at worst sadistic, is that it can happen again. And it will as long as the
state, county and local governments continue to turn their backs on chronically mentally ill
people like Mr. Pagel. These illnesses prevent people who suffer from them from being fully
functional and so many of them live in relative poverty. There is no incentive for the private
sector to pick up the ball, so the responsibility for their care falls to the community. If Mr.
Pagel had a consistent relationship with a treatment team (doctor, social worker, counselor),
he would be more likely to have remained compliant with his medications. If Oshkosh or
Winnebago County had a mobile crisis team of trained mental health professionals who can
intervene in situations like this, Walter Pagel may be alive today.
These services require the participation of an agency. Either an existing one needs to step up
and take on the task or one needs to be created that is dedicated to the care of the mentally
ill in the community. This agency needs to have staff, facilities and access to a full range of
medications. It also needs a relationship with a hospital that has a secure psychiatric unit, so
that people in crisis-like Mr. Pagel-can be hospitalized. This all requires funding-either from
the private sector or taxpayer funds or both-and a government that is dedicated to the care
of these unfortunate people. It sounds expensive, but how much more expensive is it to
contend with the problems that arise when people like Walter Pagel go untreated. Mr. Pagel
and his family, of course, paid the ultimate price.
Ray Bender, MD