Teen, Interrupted

Ryan Lewis had been exhibiting signs of clinical depression for months. Concerned about their son, his parents decided to send him to a residential treatment center to get him help. They consulted an educational expert, who referred them to the Alldredge Academy in West Virginia, a therapeutic wilderness program in the Appalachian wilderness that promised a combination of schooling and therapy to treat Ryan. The colorful brochures and promises of healing in the outdoors appealed to both Ryan and his parents, and with some hesitation coupled with mostly hope, they sent their son away. Less than a week later, he was found dead, having hanged himself on campus property.

Tragically, Ryan’s story is one of many. More than a decade after Ryan’s death, residential teen treatment centers like Alldredge Academy (later rebranded as Alldredge Wilderness Journey) are still dangerously under-regulated and can be woefully under-equipped to handle the teenagers placed in their care. In a similarly horrific case, Diamond Ranch Academy, a treatment center notorious for its deplorable conditions, charged one girl’s family $60,000 for ten months of care, over the course of which she was exposed to beatings, unsanitary medical facilities, and a rigid environment where she was not even allowed to sit down without permission. Like many other facilities, Diamond Ranch also makes use of so-called “transport” groups, organizations that forcibly remove children from their homes and place them in these treatment facilities. Since this is done with parental approval, a child is often helplessly placed into a facility where her complaints or allegations of mistreatment are discounted and ignored. Ryan Lewis, for example, was accused of trying to manipulate his counselors into letting him leave the day he killed himself. But many parents who send their children to a dangerous facility often do so unknowingly, rather than out of a lack of concern for their child. This was the case for Ryan’s parents, who hired an independent educational consultant and thought long and hard about their decision before sending their son away.

In fact, treatment academies like Alldredge and Diamond Ranch often prey on the parents of children suffering from severe depression, substance abuse, or other psychological ailments, luring them in with what many describe as a highly effective and occasionally manipulative marketing campaign that promises a variety of benefits for teens. But these benefits are often difficult to evaluate, especially since independent inspections are rare and usually not state-mandated. While many of these academies were created out of a genuine desire to provide mental rehabilitation for those who were dealing with serious psychological issues, the system in place for regulating and accrediting these centers remains nearly nonexistent and incapable of dealing with the onslaught of cases involving negligence and misconduct.

Yet the abuse is far from unknown. A Government Accountability Office (GAO) report noted over 1,500 cases of abuse across 34 states pertaining to facilities like Alldredge. The report also provided a disturbing reminder that while some of these facilities do close after reports of abuse or even deaths, many simply rebrand themselves without making any meaningful changes, like Alldredge did before ultimately closing in 2008.

In terms of federal oversight, there are no specific regulations for these centers beyond general rules regarding child safety. States, theoretically, fill in this gap themselves, providing the appropriate regulation and protection for teens in residential treatment. But state laws are, to say the least, lacking. Riddled with loopholes and often vague, they do little to prevent abuse simply because hundreds of cases of mistreatment slip through the system. For example, a Texas law would allow a residential treatment center to rebrand itself as simply a “boarding school” to avoid having to obtain a license. And in some cases, the private accreditors of these centers do not notify the state if an accreditation is suspended or denied.The GAO report even noted that many state agencies simply remain unaware that these programs exist at all, with a full 45 states reporting that they did not have enough information about these facilities to confirm whether a teen under their care had died.

In addition to the lack of oversight, limited funding often prevents state agencies from carrying out any meaningful enforcement, including conducting inspections. For instance, Utah undertook a massive overhaul of its laws regarding such centers in 2005 following numerous reports of abuse. Yet by 2012, reports of abuse were already cropping up again, involving programs that were specifically targeted by the regulatory reforms. The problem wasn’t that the rules weren’t stringent enough or that teens were crying wolf — the issue was funding. The state can only do so much with even the best rules if it doesn’t have the manpower or the resources to enforce them.

In turn, many have called on the federal government to intervene and help regulate these centers effectively. Congressman George Miller (D-CA) originally held hearings on the state of residential teen treatment centers and their shortcomings in 2007, which produced the GAO report confirming deaths and abuse due to a combination of negligence, inadequate training, and, of course, a significant lack of government oversight. Following the revelations from the report, Congressman Miller introduced the the Stop Child Abuse in Residential Programs for Teens Act of 2008, but it failed to pass. The legislation contained many hopeful provisions, including prohibiting the abuse of minors in rehabilitation programs and punishment by withholding food and water. Congressman Miller has since reintroduced it in subsequent congressional sessions even after the Democrats lost their majority, most recently in 2013. Yet time after time, the bill is scuttled without so much as a vote, typically due to complaints by the industry that the bill unfairly targets them, in addition to a lack of Republican support. But even as Congressman Miller’s bill slowly moves through the legislature, there is still a pressing need for immediate action. Many students are still in programs like Alldredge Wilderness Journey or Diamond Ranch Academy, and even more parents are considering whether their troubled teen should be sent to one of these institutions.

While many of these academies were created out of a genuine desire to provide mental rehabilitation for those who were dealing with serious psychological issues, the system in place for regulating and accrediting these centers remains nearly nonexistent and incapable of dealing with the onslaught of cases involving negligence and misconduct.

The Federal Trade Commission’s (FTC) main tactic to prevent abuse is encouraging parents to research individual institutions and judge their merits before they make a decision. But even this can be highly confusing, given the number of accreditation agencies that a family is supposed to consult just to find out if a school is properly licensed. The FTC also advises parents to ask about background checks, noting that if the organization in question does not perform them on their employees, parents should “consider it a red flag.” Yet background checks for employees are not required in every state, and there is no uniform standard for how thorough they must be.

The core of the problem, however, may be just how lucrative treating teenagers has become. Residential treatment centers now comprise a billion dollar industry, and that figure is expected to grow, with institutions collectively adding around 10,000 to 20,000 teenagers each year. Thus, it seems inevitable that some facilities may become more careless by using less qualified counselors or doing minimal training and upkeep to save a few dollars.

But for an industry focused on helping some of society’s most vulnerable members at an extravagant price, this is simply unacceptable. Parents need a means of oversight to protect their children, and teenagers dealing with what can be life-threatening mental health problems deserve legitimate care and better conditions. A manager for one treatment center, Deb Hatland, reportedly said, “We are not a perfect organization, and…we all make mistakes.” While Ms. Hatland is certainly right that everyone makes mistakes, the margin of error is simply too large when treating troubled teens for anything below the very best.

Art by Alyssa Schulman