A worn teddy bear on the ground in the wild, symbolizing the harm done to children in unregulated wilderness therapy programs. Generated by Amalia Thompson using Gemini AI.
Amalia Thompson is a public health science and biology double major. She is a 2025-26 health care ethics intern at the Markkula Center for Applied Ethics at 鶹Ů. Views are her own.
In the middle of the night, was taken from her home, against her will, and sent to a wilderness therapy program in Utah after a history of suicidal and violent behaviors. At that camp, she was victim to both physical and sexual abuse, restricted food, and forced to endure grueling physical activity in the wild. What was supposed to be an alternative behavioral therapy program instead resulted in exacerbated mental health issues and a lifetime of PTSD, blurring the line between treatment and trauma due to coercive practices and a disregard for adolescent autonomy.
A Background on TTI and Wilderness Therapy
The troubled teen industry (TTI) is a system of youth rehabilitation facilities that are usually privately funded and primarily unregulated. They range from treatment centers, to boot camps, to boarding schools, to wilderness programs. These programs aim to treat substance use, mental health, and behavioral issues, but are widely criticized for their harsh treatments, histories of neglect and assault, and lack of oversight by any governmental body.
In terms of wilderness programs, Utah has turned into the with a reported 20,000 children sent there since 2015. Wilderness therapy gained traction in the 1960s and was later expanded into more “bootcamp” models by figures like , who founded one of the first modern programs, Challenger. These approaches emphasized harsh discipline—long hikes, food restriction, and physical punishment—to “break down” adolescents so that they can be rebuilt into “less troubled” teenagers. Cartisano was later charged with negligence and murder after a , highlighting the dangers of these practices, which nevertheless spread nationwide like wildfire.
In 2008, the released a report on these types of therapies that involved specific cases where children died or were heavily abused. These cases spanned from the 1990’s to the early 2000’s and took place in multiple states. They included reported deaths from suffocation of boys as young as 12 and as old as 16. This report demonstrated the clear evidence of abuse and neglect, the deceptive marketing used towards parents, and the lack of governmental oversight. What was supposed to be a call to action resulted in very little federal legislation or regulation passed to protect children from these types of programs. In fact, many of these organizations are privatized so as long as families are able to pay out of pocket, these practices will continue.
Ethical Concerns: Treatment without Consent
The idea of autonomy is one that is heavily emphasized by many ethical frameworks, including Kantian ethics, Rawlsian justice ethics, Principilism, and Care Ethics. Within healthcare, the principle of autonomy is a foundational ethical component that all healthcare providers abide by. The patient must consent to any treatment and have the ability to make their own healthcare decision for themselves, even if it goes against the beliefs of the providers. This recognizes each patient as a person who inherently has intrinsic value and self dignity. However, these very basic rights do not apply to those under the age of 18, leaving minors uniquely vulnerable.
Utah is considered a “parents right” state and lays out the specifics of how parents have the first say in all educational, healthcare, and management decisions for their children. This code specifically states that, “a parent has the right, obligation, responsibility, and authority to raise, manage … and reasonably discipline the parent’s child.” It even goes on to say that the state’s role is secondary to the role of the parent. This is the exact legal loophole that allows these private wilderness therapies to function. As long as the parent gives consent on behalf of their child, the decision-making power is shifted away from the adolescent and into the hands of the private institutions.
However, many of these parents might be oblivious to the harms occurring at these camps due to the fact that a good portion of the children sent to these camps are from completely different states. In fact, teens across state lines into Utah’s troubled teen facilities spanning from 2014-2019, highlighting the broad, interstate nature of this issue and the difficulty of quality oversight at a societal level. Due to the fact that many of the calls come from out of state and the children are often not informed in advance, wilderness programs might use a tactic called “escort services,” which are estimated to be used for up to . This usually consists of one or two grown men who work as security and are on any type of behavioral therapy. They come in the middle of the night and forcibly remove the child from their home and put them in a van or plane to take them across state lines to the program facility. If the child resists, they are known to use violence or restraints to get the child out of their home.
This type of treatment continues at the facility as youth are forced to engage in grueling wilderness activities, like long-distance hiking in extreme heat with limited food rations and disciplinary physical labor. If they refuse, they are met with the same violent and restraining measures, reinforcing the cycle of coercion and further limiting their autonomy. Due to the nature of these camps, many of the children and with a mistrust in medical or therapeutic providers, having experienced extreme exhaustion, emotional, psychological, and physical harm.
Beyond these acute harms, the systemic removal of choice in these therapies sends a bold ethical message: these teens are not treated as individuals with rights and agency, but as objects that are managed. This fundamental disregard for autonomy undermines their dignity and shows a profound moral failure in the structure of these camps.
Toward Safer, Effective, Ethical Alternatives
While some of the current wilderness programs that exist are inherently unethical and cause immense harm to children, there are many that are rooted in sound therapeutic practices. have recognized the emotional and cognitive benefits that nature and the outdoors can bring to children going through mental health or substance use issues, especially when the in their treatment. However, that child must opt into being in that environment in order to reap the benefits. Recognizing the autonomy of these teenagers and allowing them a choice instead of forced coercion is essential for positive outcomes. It is imperative that each state government aids in upholding this idea by creating strict regulations for physical punishment and laws that prioritize adolescent autonomy.
such as Functional Family Therapy and Multisystemic Therapy–both of which are “gold standards” for teens with “disruptive” behaviors–could be a better alternative. Many families may not be familiar with the resources available to them which is why it is important that communities, or even schools, have information on these evidence-based therapies. Furthermore, the costs of these might deter some which is why the state should step in to cover costs in extreme cases.
is treatment delivered involving family members and seeks to improve family communication, reduce familial conflicts, and reinforce positive behavior. This is an excellent alternative therapy as it not only includes the child’s voice in their treatment, but it is at the forefront. Additionally, is very effective for teens who may struggle with antisocial behaviors, substance use, or other behavioral issues. It focuses on all systems that may influence their behavior such as family, school, and community. This is effective as it does not forcibly remove a child from their home or blame them solely for their behavior, but works at meeting them halfway. This therapy has been associated with lower re-arrest rates, improved family relationships, and a reduction in substance abuse.
Overall, the question posed, “Wilderness Treatment or Wilderness Trauma?” is a deeply revealing one. The troubled teen industry, and specifically wilderness programs, represent a systemic failure at the intersection of healthcare, law, private institutions, and parental authority. While these programs claim to be a transformative solution for youth, the reality shows coercion, abuse, and long-term harm. By disregarding the autonomy and voice of adolescents and subjecting them to involuntary and harsh conditions, these programs violate fundamental ethical principles that are at the core of medical and therapeutic practice.