Transient man falls through cracks of fractured mental health system.
By Kate Ready
Jackson Hole News & Guide
The last time Rachel Cappucci saw her brother was in August 2019, in a Massachusetts courtroom at a commitment hearing. She and her mother were fighting, with the help of a psychiatrist, to have him held for treatment that he refused.
The next time she learned of her brother's whereabouts was from Teton County law enforcement officers, who recovered the skeletal remains of Brad Cappucci, 33, on Dec. 14. A hiker discovered them while out hiking with his dog. Officers believe he had been living since mid-September in Darby Canyon, on the west side of the Tetons close to the Wyoming-Idaho border.
“We suspect the remains were there for about two months,” said Dave Hodges, a detective who investigated.
The death was caused by hypothermia and exposure, Deputy Coroner Russ Nelson said.
A photo of the scene shows a sleeping bag, backpack, electric razor, clothing and a few other items.
“We didn’t see any evidence of violence, suicide or abuse,” Nelson said. “It was an unfortunate situation where this man was living off the land, and two and a half months later he turned up as a partial skeleton.”
Cappucci was last seen by Driggs, Idaho, police officers, who had minor involvements with him, Hodges said. “He was a transient, he had been offered a ride out to the Darby Canyon area before, back in September,” Hodges said.
For Rachel Cappucci, her brother’s death had been a constant fear. She and her mother had struggled for seven years to get him adequate medical care for his schizophrenia, a formal diagnosis he received in 2019.
“I've read that a unique characteristic of schizophrenia is the ability to turn it off and on, and he often was able to hide his symptoms from doctors, police, jobs and others,” Cappucci said.
Schizophrenia affects about 1% of the world’s population — more than 3 million Americans — and is classified by the National Institutes for Mental Health as one of the top 10 causes of disability in the developed world. A disorder of the brain, the illness causes psychotic episodes of varying duration and severity. Symptoms of a psychotic episode range from unusual thoughts or perceptions and inability to form coherent thoughts to delusions and hallucinations.
She and her mother tried repeatedly to get him committed so he could be helped, she said.
“He just refused, and it’s near impossible to have an adult held against their will,” she said.
A report by the Treatment Advocacy Center, a leading mental health nonprofit dedicated to eliminating barriers to the timely and effective treatment of severe mental illness, found that this imminent danger “box on a form” is a needless barrier to treatment. To remedy this, the report advises that the threshold for danger to one’s self and others should not require imminent harm.
State psychiatric commitment laws “make it insurmountably difficult for families to commit their loved ones with severe mental illness who desperately need treatment,” said Geoffrey Melada, director of communications for the center.
“A widespread phenomenon that we see are states that have that imminent danger requirement are making people with severe mental illness wait until their illness has deteriorated to the point that they are on the brink of suicide or homicide until they can get treatment,” Melada said.
The report, published in September 2020, found that all state laws are different, meaning adequate care depends on where a person happens to be.
“We do not have a ‘mental health care system,’ we have a loose patchwork of laws,” Melada said. “We are running 50 different state experiments with wildly different results.”
The report assigned scores out of 100 and grades to all states by evaluating their laws for providing involuntary treatment for psychiatric illness. Wyoming was near the top with an A-minus; but Massachusetts received an F.
Wyoming ranked higher than states such as Massachusetts for its broader definition under law of what constitutes being a “danger” to oneself and others. The Advocacy Center is working to reform how other states nationwide define danger.
“We’re working with states to drop the imminence adjective and define danger as the inability to care for one’s basic survival needs and include psychiatric deterioration,” Melada said. “Wyoming has that more progressive, enlightened statute where ‘danger’ includes psychiatric deterioration and the inability to meet basic survival needs.”
A ‘time bomb’
Brad Cappucci’s symptoms began in 2014, five years before his formal diagnosis. At the time he was working as the lead economist for the Boston Public Works department.
“He went from being the most successful, having the brightest possible future, to a ticking time bomb," Rachel Cappucci said, "refusing treatment. We watched him disappear into his illness on the heels of my father passing away. I'm grateful my dad didn't have to see this. For my dad, Brad stayed that brilliant and talented athlete. But it wrecked us."
Her family became accustomed to her brother taking off for a few months at a time, but he would eventually return home.
“The last time I heard from him," she said, "his email said he was in Idaho on the border, the mountains were beautiful, and that he was working for a cement company. So he wasn’t a missing person, this was his pattern, and he was always welcome home.”
The last time she saw her brother was in August 2019, in that courtroom.
“At the commitment hearing, the judge deemed there was no hard evidence that he was violent,” she said. “It seemed like that’s the key. We couldn’t prove he was a harm to himself or others, so the [judge] released him.”
Although Brad was never violent, for Cappucci her brother’s ability to turn his schizophrenia off and on seemed to be the barrier standing in the way of getting him the help he needed. Cappucci and her mother filed between five and 10 Section 12 forms over the years, an application that authorizes temporary involuntary hospitalization.
A uniformed officer would respond to the Section 12, transport Brad to the emergency room and deposit him into the psych ward, where he was routinely dismissed after 30 minutes of evaluation.
When they were finally able to get Brad a commitment hearing in front of a judge, it was because of one major change.
“The only way we were able to get a commitment hearing was because a mental health clinician showed up at the door, not an officer,” Cappucci said. “But even she told us that the only way to get him help was to fabricate a form to say that he was a harm to himself and others. We had to become the mental health care system for my brother, advocating and fighting at every turn.
"We knew he could be a harm to himself," she said. "We feared this outcome, so it wasn't a shock, but that doesn't make it any easier to reconcile."
Another factor the Treatment Advocacy Center takes into account when grading the states is the number of psychiatric beds available in hospitals statewide. Wyoming ranked in the top nationally for having 21 beds available statewide as of 2016, the second-highest bed count per capita. However, that’s still below the requirement suggested by the Treatment Advocacy Center, which advocates for a bare minimum of 50 psychiatric beds per 100,000 people.
“Not a single state in the union meets the minimum threshold that my treatment center has identified for meeting the mental health needs of the population,” Melada said.
That lack of resources to meet the demand puts pressure on hospitals to release patients as soon as they’re stabile.
Another barrier to treatment is what Melada calls anosognosia, a neuropsychiatric condition that affects roughly 50% of people with schizophrenia.
“It’s a symptom of their illness that prevents them from perceiving the extent of their illness. They do not understand that they are sick and in need of treatment,” Melada said. “So it’s less likely that they will seek treatment voluntarily or otherwise consent to treatment.”
Long recognized in stroke, Alzheimer’s disease and other neurological conditions, studies of anosognosia in psychiatric disorders is producing a growing body of evidence of anatomical damage in the part of the brain involved with self-reflection. Brain scans with people experiencing anosognosia show significantly poor activation in several key brain areas when people are asked to think about themselves.
“There’s a much broader range of folks who are in danger; people who stay day after day in a state of untreated psychosis experience brain damage,” said Brian Stettin, policy director for the Treatment Advocacy Center. “That’s a form of being dangerous to yourself. You’re not volunteering for treatment if you don’t think you’re sick.”
Wyoming also ranked highly in the report due to its adoption of “assisted outpatient treatment” laws. Assisted Outpatient Treatment is the practice of providing a court-ordered personal treatment system in place to motivate an adult who struggles with adhering to voluntary treatment. The program engages a community of social workers, psychiatric professionals and court officials to keep the individual engaged and hold them accountable.
Three states have yet to adopt these laws: Connecticut, Maryland and Massachusetts, where the Cappucci family struggled.
“A big benefit of the AOT program is that we take that possibility of being held in contempt of court out of the equation, because we’re trying to break the cycle of these individuals winding up in jail,” said Stettin, who wrote the nation’s first AOT law in 1999.
It was one of the first major pieces of legislation that required individuals with serious mental illnesses to accept treatment: “The court order is effective in that it gets the person’s attention, then we use principles of recovery to engage them, so we figure out what their life goals are, what kind of treatment can we put into this plan that’s going to work for you, and then the court’s involvement is meant to be there as a champion and friend for that person, to be following up on that case. The court is there to ensure that the treatment community is upholding their commitment.”
Laws might save lives
Stettin believes AOT laws can end the revolving door of hospitalization, incarceration and homelessness that many individuals with mental illness experience.
“There are dysfunctions in the system that allow those in need of supervision and monitoring to be roaming around,” Stettin said.
It was one such individual, Andrew Goldstein, whose actions led to Stettin writing and ultimately passing the nation’s first Assisted Outpatient Treatment law in New York City.
Goldstein, who had schizophrenia, threw a woman onto the path of an oncoming subway train. Kendra Webdale died, leading New York state to call the AOT policy “Kendra’s law.”
“There had been so many opportunities to get [Goldstein] help,” said Stettin, who was New York’s assistant attorney general at the time he wrote the law. “But the system was only equipped to stabilize him in a hospital in a moment of crisis and then had an obligation to release him under law. I started developing AOT to ensure that when people are released from hospitals, that we have support for them to ensure they stay engaged with treatment.”
Before his diagnosis of schizophrenia in 2019, Rachel Cappucci describes her brother as an “absolute model older brother.”
“He was a brilliant, almost perfect pinnacle of a human,” she said. “He was handsome, funny, a terrific athlete, successful … being Brad's sister was an honor, but watching him vanish into his illness was absolute hell.”
The narrative of schizophrenic people disappearing and then popping up again is common, Melada confirms. But there is an answer.
“We’re seeing that people with untreated severe mental illnesses like schizophrenia and bipolar disorder, very often their lives are a revolving door of repeated hospitalization and discharge, homelessness and incarceration,” Melada said. “This is why AOT is so important. We have the qualitative and quantitative data to know that AOT works and breaks that cycle.”
In the wake of her brother’s death, Rachel Cappucci feels peace in knowing that she did everything she could to help him, that he spent his final days in nature and that in her final memory of him they said, "I love you."
She’s also received an outpouring of similar stories from friends and loved ones of people affected by schizophrenia or other mental illness.
“It’s unbelievable how many people reach out privately with similar situations. It blew me away. When I dig further online, there’s story after story of [family members with schizophrenia] retreating into the wilderness, going off grid, showing up and then going back and seeing an end like this,” Cappucci said. “This is the story, this is what happens. It’s happening everywhere and no one’s talking about it.”
People can donate directly in Brad’s memory to the National Alliance on Mental Illness (NAMI) at Donate.NAMI.org/Brad.
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