Wilderness therapy


Wilderness therapy, also known as outdoor behavioral healthcare, is a treatment option for behavioral disorders, substance abuse, and mental health issues in adolescents. Patients spend time living outdoors with other peers. Reports of abuse, deaths, and lack of research into the method's efficacy have led to controversy, and there is no solid proof of its effectiveness in treating such behavioral disorders, substance abuse, and mental health issues in adolescents.
The term "wilderness therapy" is sometimes used interchangeably with "challenge courses, adventure-based therapy, wilderness experience programs, nature therapy, therapeutic camping, recreation therapy, outdoor therapy, open-air therapy and adventure camps." The lack of a consistent definition has created problems with comparing studies into the effectiveness of programs. To address this, an integrated definition of a wilderness therapy program is offered as one which "utilizes outdoor adventure activities, such as primitive skills and reflection, to enhance personal and interpersonal growth." Fernee et al. further distinguish wilderness therapy from adventure therapy by placing it within wilderness settings where the location and remoteness become a central part of the procedure, while also separating wilderness therapy from other forms of wilderness-based behavioural programs through the "clinical and therapeutic methods" that are applied. Media has often interconnected the term "boot camp" with wilderness therapy as a way to help people visualize and describe the physical and mental exercises adolescents are urged to do while a part of these programs. This idea may be misleading to the public because boot camp exercises are not effective treatments for substance abuse and behavioral disorders.
In part, the lack of a concise definition comes from the different environments in which these therapies have developed: for example, within the US wilderness therapy can be seen to have emerged from youth camps and experiential education; in Scandinavia the approach is connected to the outdoor life tradition; in Australia and Canada it is tied more to Indigenous practises.

Models

Natalie Beck and Jennifer Wong, in their 2020 paper "A Meta-Analysis of the Effects of Wilderness Therapy on Delinquent Behaviors Among Youth", offer three models of wilderness therapy: an expedition model, generally lasting for less than 8 weeks; a base camp model, where clients stay at a central location but engage in "short wilderness excursions"; and a long-term model, where clients engage in wilderness excursions but otherwise remain in a residential program. In the expedition model, clients undergo an extended hiking trip, setting up camps in various locations as they are taught survival skills. With the base camp approach the clients stay at a central facility, but undertake wilderness excursions from that location which can last for multiple days. Finally, when using the long term model, clients stay at a "rural camp" for an extended period – potentially up to 2 years – and "a wilderness component is introduced in daily activities or in the facility setting."
In the US a large number of these programs are located in the state of Utah. Incidents of alleged and confirmed abuse and deaths of youths have been widely reported across many of these programs.

History

The concept of wilderness therapy dates back to the 1940s, linked to progressive German educator Kurt Hahn, who founded the United Kingdom's "Outward Bound", an outdoor educational organization.
Many programs in the western United States started operating in the 1960s and 1970s. Some were started by former students of Brigham Young University such as the Aspen Achievement Academy, and the School for Urban and Wilderness Survival, which is located in the state of Idaho. In the 1960s, school officials at Brigham Young University developed a course called "Youth Leadership 480." This course, which was taught by an undergraduate, Larry Dean Olsen, aimed to help failing, "troubled" students rehabilitate and gain "readmission" through the camp. Through this camp, the "trouble youth" would learn outdoor survival skills on month-long backpacking trips in the Utah desert. This program caught the attention of Utah County officials, who then adopted the program's model to try to help juvenile delinquents. Seeing the potential of these programs to generate lucrative profit, some of Olsen's former peers decided to start their own private wilderness therapy camps. Over time, these wilderness camps targeting the troubled-teen sector have grown into a largely unregulated, multi-billion dollar industry. Over the years, Utah's scenic environment and relaxed oversight have made it a central location for wilderness therapy programs and facilities aimed at "troubled teens". These types of camps are also common in other parts of the U.S., especially throughout the West and Southwest. Another wilderness program in the Western United States is blueFire Wilderness, which primarily works with New Jersey teens. These programs aim to improve the mental health of their participants.

Effectiveness

Critics say that the effectiveness of wilderness therapy is unclear, and that further scientific studies are needed. Many of the studies that have been conducted have led to ambiguous conclusions. One meta review of the outcomes of private pay clients over 36 different studies found that roughly half of the participants reported positive growth in qualities like self-esteem, locus of control, behavioral observations, personal effectiveness, clinical measures, and interpersonal measures, while the other half reported no change at all.
One meta review concluded that wilderness therapy may reduce delinquent behaviors among young participants. Another review has suggested that for childhood cancer survivors, wilderness therapy programs could increase social involvement, self-esteem, self-confidence, self-efficacy, social support, and physical activity, and may decrease their discomfort and psychological distress. However, the majority of the articles included in the review did not assess possible safety issues for participants in wilderness programs, and the authors recommended that possible side effects be investigated further.
Katharine Reynolds conducted a survey on 59 parents and 36 adolescents who had experience at the Anasazi Foundation's Wilderness Therapy Program with correlation to positive parent-adolescent relationships after completing the program. She found that there is a positive correlation between positive parent-adolescent relationships and having completed treatment, in addition positive physical health, mental clarity, and continued association with the Anasazi Foundation after discharge from the program.
While proponents claim involuntary transport to wilderness therapy programs is necessary to ensure "uncooperative" youth receive treatment, most participants do not return home after the programs are complete, instead remaining institutionalized in other treatment programs.

Clients

Many wilderness therapy programs are part of the troubled teen industry much like therapeutic boarding school and residential treatment centers. A study of adolescents sent to wilderness therapy and residential treatment programs in the United States found that clients tended to have "greater than average intelligence and academic achievement" in spite of often having issues with schooling. Behaviors leading to a placement in these programs included defiance, substance abuse, school problems and running away, with clients often showing violent and criminal behaviors, and "approximately a third" of those sent to the centers reported self-harm including suicide attempts. Other programs, though, have focused on different groups such as cancer survivors, people with diabetes and clients with disabilities.

Consent

One study found that, among 17 surveyed "outdoor behavioral healthcare programs" in the US, about half of the therapy participants attended involuntarily and were transported by a teen escort company. A "remarkably low" proportion of these participants return home after taking part in the programs, with most youths continuing in some form of therapeutic program after the outdoor behavioral healthcare program is complete. The study also found that participants are less likely to return home after treatment if they were involuntarily transported to the program than if they enrolled voluntarily.

Costs

Costs can vary, but in the US wilderness therapy programs "can cost upwards of $50,000 per stay". In 2016 the American Hospital Association recognized wilderness therapy as a viable treatment model and provided an insurance billing code. This, along with the increasing use of national accreditation programs, has allowed some US providers to work with insurance companies to increase coverage for their programs. Blue Ridge Wilderness Therapy is an example of an organization that works to accept insurance plans and provide financial aid, among many others. However, insurance companies sometimes reject these claims "because there is not enough data to justify that the treatment is effective and that the cost is necessary for said treatment."

Regulation

Aiming to combat widespread negative opinions about wilderness therapy and form an industry oversight body, five U.S. based wilderness therapy programs banded together to create the in 1996. The OBH Council's main objective was to bring more recognition to wilderness therapy programs and their correlation to post-positive behavioral health in adolescents. The council was also interested in exploring and investigating the best forms of practice and treatment plans to integrate into their programs. They merged with the National Association of Therapeutic Schools and Programs in December 2024.
In 2021, the state of Oregon implemented regulations on transportation, banning the use of blindfolds, hoods, and handcuffs. Other states have considered similar legislation, though implementation has varied widely. These states include Utah, California, Montana, and Missouri, which have all implemented laws and regulations.

Controversy

Allegations of abuse, deaths, and lawsuits

There are well-documented cases of death, abuse, and other potentially traumatic situations associated with or caused by wilderness programs, including the following cases:
  • February 1990 – Three teens drown at Convict Lake whilst enrolled at Camp O'Neal. Camp director Bobbi Trott, who was in charge during the teenagers' death, would go on to found Crater Lake School and be a founding member of NATSAP.
  • May 9, 1990 – Michelle Lynn Sutton from California dies from dehydration whilst enrolled at the Summit Quest program.
  • 1990 – Kristen Chase dies three days into the Challenger Wilderness Program.
  • January 15, 1995 – Aaron Bacon dies from acute peritonitis whilst attending the North Star Wilderness Program.
  • 2001: The New York Times reports that there have been 31 deaths at outdoor camps for troubled youths in 11 states since 1980.
  • May 27, 2002 – Erica Harvey dies from heat stroke and dehydration.
  • July 15, 2002 – Ian August dies during a hike whilst attending the Skyline Journey Wilderness therapy program.
  • August 2002 – 11 teens are found in distress at a wilderness therapy program camp and taken into protective custody by Montana Department of Public Health and Human Services child and family services division.
  • September 18, 2002 - William Edward Lee suffers damage to his vertebral artery after being restrained.
  • October 14, 2003 - Charles "Chase" Moody asphyxiates and dies after staff improperly restrain him at the On Track wilderness program in Texas.
  • March 23, 2003 – Cory Baines dies after a tree limb falls on his tent during the Catherine Freer Wilderness Therapy program.
  • August 28, 2009 – Sergey Blashchishen dies from dehydration and hyperthermia whilst at Sagewalk Wilderness Therapy Program.
  • November 23, 2014 – Alec Lansing dies from hypothermia and a broken femur whilst trying to run away from the Trails Carolina program.
  • December 2015 – Six students are evacuated from Open Sky Wilderness Program and flown to Denver, Colorado with frostbite; Open Sky Wilderness Program is accredited by Outdoor Behavioral Healthcare Council, Association for Experiential Education, and the Department of Human Services for Colorado and Utah.
  • February 2024– A 12-year-old boy is found dead at a camp located in Lake Toxaway, North Carolina. He had arrived at the camp less than 24 hours before he was found dead by camp staff. Days later, a woman files a lawsuit alleging she was sexually assaulted by a fellow camper at age 12 at the same camp.
Maia Szalavitz, author of the 2006 book Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids, has concluded that many tactics employed by wilderness-therapy programs are no different than those used at Guantanamo Bay. Szalavitz has documented cases of emotional and physical abuse, and the withholding of food, water, and sleep.
Kayla Muzquiz, who spent much of her childhood in "troubled-teen" institutions, said of her experiences in the SUWS of the Carolinas, a wilderness therapy program in rural North Carolina, "We would wake up every day and hike 10 miles with almost a 60-pound pack on our backs. It was excruciating because I had an undiagnosed autoimmune disorder throughout my time in the troubled-teen industry. So while I was hiking, I was constantly in pain. And it wasn't just regular pain that ibuprofen or Tylenol could take care of; it was just my body attacking itself constantly. So, if you complained, you couldn't move up in levels or ranks in wilderness, so it was more like you just had to bite your tongue and kind of just roll with the punches."
In October 2007 and April 2008, the United States Government Accountability Office convened hearings to address reports of widespread and systemic abuse in adolescent treatment facilities. In connection to the hearing, they issued a report about the wilderness therapy industry, in which thousands of allegations of abuse were examined. The Federal Trade Commission has published a list of questions for parents to ask when considering a wilderness program.
Due to the trauma and alleged harm reported by former wilderness program residents who have been forcibly escorted into placement, psychologists have heavily criticized this approach as inappropriate, and grossly inconsistent with establishing the necessary trust required for building a therapeutic relationship between youth and providers. Some former participants have testified that they have suffered lifelong trauma from their experiences at these programs.

Staff qualifications

In some programs, licensed mental health personnel are not employed to work directly with participants,⁣ with programs instead hiring licensed mental health personnel as consultants or in other roles.
To be licensed in the counseling field, one must possess at least a master's degree in counseling, but much of the time these counselors are individuals without even a bachelor's degree. Some programs report having no licensed mental health professionals on staff. Some have argued that it is unethical for programs serving "high-risk" youth to deliver therapeutic services using less than professionally trained and credentialed mental health staff.
Some researchers have argued that national standards should be created with respect to the training, formal education, and licensure in therapeutic wilderness programs. Wilderness programs are not required to employ licensed workers, and so the counselors may be unqualified to help adolescents in the programs to create therapeutic change.

After the program

After a wilderness therapy program, clients may return home or may be transferred to a therapeutic boarding school, young adult program, or intensive residential treatment center.

Notable former clients