Episode 44: Healing Hands of Nature

Wilderness Therapy is a form of treatment that uses the natural world and wilderness settings to address behavioral and mental health issues in teens. With a history dating back to the nation’s earliest summer camps, the idea of nature as healer has deep roots. But with a tattered history of institutional abuse, patchwork oversight, and absent legislation, is this treatment option too wild to be trusted?

When Jake Duggan was fourteen, his parents sent him to sleep away camp. The camp included days-long camping trips which lasted from Thursday through Sunday. On one particular trip it rained non-stop from Thursday through Saturday. Jake remembers being soaked to the point there was no escaping it. Then, just as he and his fellow rain-soaked campers were setting up for Saturday’s dinner things started to clear.

That’s when it happened.

“I looked and I saw the sun setting and the clouds clearing, and this sounds like I’m making it up but I’m not, I turn around and there’s this giant, giant rainbow, the biggest rainbow I’ve ever seen,” Jake says. “And then a huge bald eagle flies right through the rainbow. I grabbed one of the guides and I was like, ‘This is the first time I’m feeling happy, in years.’”

For Jake, being happy was a big deal because this wasn’t an ordinary summer camp, and Jake wasn’t an ordinary camper.

We tried different medications, which only made things worse. Whatever anyone would tell us to do, we would do.
— Erin Duggan

Jake’s mom, Erin Duggan, says when Jake was growing up he would spend a lot of time outside with his dad, Tim. They started hiking the 4,000 footers in New Hampshire and in the winter months would spend their weekends skiing together.

“To this day he is the best skier I’ve ever skied with,” says Tim. “He’s a natural, incredibly gifted skier.”

As Jake got older, he started skiing more with his friends and less with his dad. Then, the winter of his eighth-grade year, Jake didn’t want to ski with his dad or his friends anymore. A few months later he was spending all his time alone, locked in his room.

pHOTO: jIMMY gUTIERREZ

pHOTO: jIMMY gUTIERREZ

“For like one whole summer, the summer after eighth grade that’s all I did,” Jake says. “It would be days that I wouldn’t go outside because it was very tough.”

“We tried different medications, which only made things worse,” says Erin. “Whatever anyone would tell us to do, we would do.”

In February of 2013, everything came to a head when Jake was hospitalized after a skiing trip. A therapist told the Duggans, “You’re not a hospital. You can’t keep him safe.”

“As parents, you’re in the middle of it,” says Tim. “It’s not the kind of research activity you wish you could do as a parent because you don’t have the bandwidth to do that.”

A consultant offed a solution the family hadn’t tried yet: Wilderness Therapy. They were pointed to a program a few hours away in Maine called Summit Achievement.

 

The Natural World’s Potential for Treatment

On the northern end of the White Mountain National Forest, Summit Achievement owns fifty acres dedicated to help struggling teens get out into wild spaces.

“I’ve lived up here in the White Mountains of New Hampshire since the 80s,” says Will White, co-founder of Summit Achievement. “People are starving for more time outdoors.”

Summit Achievement got its start twenty years ago in the mid-nineties and is considered a Wilderness Therapy camp, which means it’s more like counseling in nature than a summer camp with bonfires and s’mores.

Teens spend Monday through Wednesday on Summit’s campus attending classes and the rest of the week is spent in the backcountry camping, with lots of therapy along the way. There’s a variety of backgrounds at Summit including teachers, therapists, licensed social workers, and a labradoodle named Baxter.

I don’t think I’d be here if it wasn’t for Summit Achievement.
— Jake Duggan
 
pHOTO: jIMMY gUTIERREZ

pHOTO: jIMMY gUTIERREZ

“Many of the people who started these programs were working in traditional environments,” says Will. “I’ve worked at mental health centers, I’ve worked at boarding schools, I’ve worked at public schools, and those environments were not as powerful as the one here.”

With a childhood full of summer camps and the boy scouts, it’s no wonder Will was drawn to the natural world’s potential for treatment.

“You interview parents who send their kids to summer camp and most of them will say, ‘Wow, he or she really grew up from that experience,’” says Will. “This is the same idea but it’s much more intense and much more therapeutically focused.”

And that’s where Jake Duggan went back in 2013: depressed, suicidal, out of options.

“When you’re out in the woods, whether it’s alone or with a group of people and you’re on a backpacking trip, you have such a purpose and you’re needed for everything that happens,” says Jake. “I don’t think I’d be here if it wasn’t for Summit Achievement.”

So what exactly was it that helped Jake get better? Was it teamwork? Top-of-the line counseling? Eagles soaring through rainbows? When it comes to the field of Wilderness Therapy, the science is still out on exactly how and why some kids get better in nature. There’s even a name for it. Experts call it the black box. And while Jake emerged from that black box seemingly healed, not all Wilderness Therapy camps are created equal.

Wilderness Therapy Gone Wrong

Cynthia Clark-Harvey’s story read a lot like the Duggans – in 2001 she was the parent of a teen in distress, searching for answers, who was eventually pointed towards a Wilderness Therapy camp.

“Erica was just very bright, very talented,” Cynthia says. “We were all just kind of awed by her a lot of the time.”

Erica, the Harvey’s oldest, was an award-winning artist, competitive springboard diver, and weekly volunteer at the local animal shelter for years. Cynthia says things turned on a dime in the eighth grade.

The first sign of distress came when Cynthia and her husband, Michael, found out that Erica had begun cutting herself. Within a week they were in front of a psychologist.

“She was hospitalized just before her 15th birthday for suicidal ideations, suicidal thoughts, and suicidal behavior,” says Cynthia.

Over the next few months, Cynthia and Michael tried everything. They brought her to family therapy, a psychiatrist, entered her in a drug treatment program. Erica began to show signs of mild improvement. Then, a consultant nudged them to consider Wilderness Therapy. Cynthia dove into any published materials she could find.

We got to the parking lot and told her she was going to a Wilderness Therapy program and she was distraught, hysterical.
— Cynthia Clark-Harvey

“We culled it down to three or four places, I think I at least talked to two of them,” says Cynthia, “and then we decided to send her to Catherine Freer.”

The Catherine Freer program was based in Nevada, a short plane ride from the family’s home in Phoenix. The staff advised Cynthia and Michael not to tell Erica about the camp, with fears she’d run away–something she’d never done before. So they told her they were taking a family trip to Lake Tahoe.

“We got to the parking lot and told her she was going to a Wilderness Therapy program and she was distraught, hysterical,” says Cynthia.   

In 2007, then-California state Rep. George Miller called for a federal investigation into abusive youth programs at residential treatment facilities, which included a number of Wilderness Therapy camps.

At a hearing before the House Committee on Education and Labor, legislators, advocates for and against the industry, and parents testified. Cynthia Clark-Harvey was among those who shared their stories.  

“On May 27, 2002, the first full day of Erica’s Nevada wilderness trek,” Cynthia says, “Freer’s trusted team mistook a dire medical emergency for teenage belligerence and Erica died that afternoon from heat stroke and dehydration.”  

The day after the Harvey’s dropped off Erica at Freer’s she collapsed multiple times during the camp’s daily hike. On her last fall, she collapsed face first off the trail into rocks and scrub brush. She laid there for almost an hour as staff idly looked on. By the time Erica received advanced life support, it was too late.

Besides lacking a centralized database, the government found four widespread and specific issues from their case studies on the industry: untrained staff, misleading marketing practices, abuse before death, and negligent operating practices.

“Our story is a personal tragedy but please remember, for each family that has suffered the ultimate damage, the death of a beloved child,” says Cynthia, “there are perhaps thousands of others who have suffered physical or psychological damage and abuse.”

The government’s investigation went on to unearth thousands of cases of abuse. For Erica, she was one of three teenagers who died that year at Catherine Freer camps.

“During 2005 alone, 33 states reported 1,619 staff members involved in incidents of abuse in residential programs,” Greg Kutz, Managing Director of the Government Accountability office, said at the hearing. “[We] could not identify a more concrete number of allegations because [we] could not locate a single web site, federal agency, or other entity that collects comprehensive nationwide data.”

Besides lacking a centralized database, the government found four widespread and specific issues from their case studies on the industry: untrained staff, misleading marketing practices, abuse before death, and negligent operating practices.

Another issue the investigation focused in on was the prices of these camps. Catherine Freer’s total cost was over $11,000 for 21 days back in 2002, or $523 per day. Even Summit Achievement, Jake’s camp, runs north of $500 per day - which brings his four months of treatment to approximately $60,000.

The explosion of Wilderness Therapy camps in the late 80s and early 90s were two-fold. First, was the increased demand for teen treatment after the closure of many inpatient psych hospitals and substance abuse treatment centers aimed at adolescents. Second was  the draw of an industry with incredible profit margins, low overhead cost, and little barrier-to-entry.

Those inside the field like to delineate between two types of camps, therapeutic camps and harsher, boot-camp models, which often fall under court-ordered or adjudicated camps. While a core group of the industry only considers the therapeutic camps true Wilderness Therapy camps, there is no governing body.

So along with financial inequality in access to treatment, there’s also a wide racial gap when it comes to who attends the therapeutic camps versus adjudicated camps. In the higher-end, private Wilderness programs, like Summit Achievement, three quarters of clients are white males. At the harsher adjudicated programs, that same demographic makes up less than half the population.

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“Troubled Teens”

These camps and programs hold appeal to parents of kids in desperate situations, with some branding themselves as camps or schools for “troubled teens.” This was an attractive option for Dynesha Lax, who, back in 2012 found herself in a position similar to the Duggans and the Harveys.

After making her 14-year old son Alonta wear a sign detailing his bad behavior, local news stations quickly picked up the story. Not long after that, multiple daily talk shows called the family to book Dynesha and her son on their shows. She decided to go on Dr. Drew Pinsky’s brief daytime show called Lifechangers with the hope he would have advice for how to corral her young teen.

That day on the show, another guest of Pinsky's was Ephraim Hanks, Clinical Director at Diamond Ranch Academy. That’s a boarding school in Utah that sells itself as: “The Top School for Troubled Teens.” And he was there to offer Alonta free tuition for a year at the school.

“I didn’t think sending him with two complete strangers who don’t know anything about him was helping him,” she says.

Dynesha didn’t send Alonta away and she said felt bamboozled. After the show, Diamond Ranch upped their offer, saying they’d take Alonta for up to two years. So when she got back to her hotel, she did what any curious person would do, she Googled the school.

I didn’t think sending him with two complete strangers who don’t know anything about him was helping him.
— Dynesha Lax

“I started reading how one kid had died there and one kid wrote how his shoes and his clothes were taken from him,” Dynesha recalls, “and how they were ridiculed by the staff and couldn’t have outside function with their family or anything.”

The year after Dynesha refused their offer, a camper committed suicide while attending Diamond Ranch. This past February, a staffer was charged and sentenced to twenty-two and a half years in federal prison for producing child pornography.

Diamond Ranch didn’t return our calls requesting comment, but a court of law has never found them guilty of abuses, and their website is filled with positive testimonials. But in that moment, none of that mattered to Dynesha. She read the negative reviews and was confident she had made the right decision.

The term “troubled teen” is usually a catch-all for kids dealing with behavioral issues, mental health issues, and/or substance-misuse issues. It should also be a warning sign. One common problem found with programs using this term is a catch-all approach to services provided, instead of an individualized approach, which is crucial to long-term improvement.

“The thing I always recommend when parents contact me,” says Maia Szalvita, author of Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids, "is, start with a complete psychiatric evaluation by somebody who is not affiliated with any program or anything like that.”

She says the term “troubled teen” reveals a lot about how the industry is structured, but it tells us nothing about the issues these kids are dealing with.

We know that if you isolate vulnerable people, people with disabilities, children, away from society you will end up with institutional abuse. And so the only reason to use a residential facility is when you have no alternative.
— Maia Szalvita

“If your child has a specific problem, you want to get help for that specific problem,” says Szalavitz. “Basically, if you are going to work with troubled teens that genuinely need residential care, there is absolutely no way to make a profit if you hire professionals that are appropriately qualified.”

She argues that nature in and of itself is not meant to be used as a primary treatment option since there’s no science proving its efficacy. She also says that the proliferation of these camps and schools leads to more serious systemic issues.

“We know that if you isolate vulnerable people, people with disabilities, children, away from society you will end up with institutional abuse,” says Szalvitz. “And so the only reason to use a residential facility is when you have no alternative.”

While she concedes that there is science behind the restorative properties of green space and time spent in nature, she says the industry of Wilderness Therapy is still too wild to trust.

“In the current unregulated environment where you can’t have unannounced inspections, and where there isn’t enough people to even do that oversight in the states that do have some regulations,” says Szalvitz, “you’re going to end up with the same problems repeating themselves.”

But what is a parent to do when they’re out of options and are trying to save their child?

“A lot of times parents feel like when someone offers them some place to go, that’s the right way to go,” says Dynesha. “But I can’t really say that, because even after the show, Alonta did go into placement for a total of 14 months and it actually made his life worse.”

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What Role Does Nature Play in Mental Health Care?

When it comes to the field of Wilderness Therapy, people inside the industry believe there’s been honest change since the government’s investigation a decade ago.

“I do think that report was a kindling to say, wow, we need to do better,” says Dr. Anita Tucker. “We’re not perfect, we know we still have such a ways to go, we’re just in such a holistically different place than we were ten years ago.”

Doctors Mike Gass and , the Association of Experiential Education’s 2016 Distinguished Researchers, are professors at the University of New Hampshire. They’re also the leadership behind the Outdoor Behavioral Healthcare Center (OBHC), which was established in 2015 to improve the field through best practices and evidence-based research.

Last year the center published 20 scientific articles in peer-reviewed journals–even in some journals that wouldn’t have touched the industry a decade ago. They’ve also put together an 85-page analysis of what a healthy wilderness program looks like. It’s the most comprehensive benchmark in the industry today. The OBHC includes twenty-two wilderness programs that have met that standard.

We’re not perfect, we know we still have such a ways to go, we’re just in such a holistically different place than we were ten years ago.
— Dr. Anita Tucker

Today, one of the most pressing issues for the OBHC and its programs is cost. They envision Wilderness Therapy as a primary care option with broad acceptance and for that to happen, more people need access to treatment.

“It’s heartbreaking to see families spend their [child’s] college tuition to pay for these programs or mortgage their house,” says Gass. “It would be great if we could turn this around and it could earn the type of reimbursement that I believe should happen for third party payments.”

Starting this July, OBHC’s billing code officially kicks in, which will allow for third party reimbursements for selective camps. And unlike the industry’s fly-by-night history of the past, Gass says this process took ten years of highly-detailed documentation.

While major inroads to credibility are being made, the center still has to contend with unpacking the black box and answering the question: What role does nature play in mental healthcare?

“We’ve got a good idea that it’s got a lot to do with the group work that’s done and a lot of work that the adventure brings and using that as a change function,” says Gass. “But, then we kind of go, is it nature, is it exercise, is it good food, is it mindfulness? We don’t really know what concepts are responsible for the types of changes were seeing.”

And until that happens, it may be a hard-sell towards legitimizing the field against a backdrop of abuse, absent legislation, and patch-work oversight.


Outside/In was produced this week by:

Outside/In was produced this week by Jimmy Gutierrez with help from: Sam Evans-Brown, Maureen McMurray, Taylor Quimby, Molly Donahue, Hannah McCarthy, and Logan Shannon

Special thanks to Dr. Nicki Bush of ASTART, Alpinist Grant Stathem, and outdoor risk management expert, Ross Clouthier.

Music from this week’s episode came from Sometimes Why, Montplaisir, Blue Dot Sessions, Podington Bear, and Uncanny Valleys.

Our theme music is by Breakmaster Cylinder.

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