Regulation was scant, however, and programs operated in remote places far from public view. Some were run by sincere, well-trained staff, but others were little more than moneymaking schemes that preyed on parents' fears. Desperate parents had little way to know which was which. Aaron Bacon's death tarnished all the programs.
In 1997, hoping to revive their battered industry, a handful of companies formed the Outdoor Behavioral Healthcare Council. "Our intent was to shout from the rooftops: 'Wilderness therapy works!' " says Hallows. But their conviction wasn't enough; the council needed research to back its claims, and programs needed a more robust clinical component to be considered legitimate interventions.
Most early programs were expedition-style, sending groups of kids deep into the wilderness for seven to 10 weeks and relying on nature – not therapists – as the primary catalyst for growth. Today, nature is just one tool among many. Between shorter trips in the backcountry, students meet with licensed therapists and follow individual treatment plans. At Wisconsin and Oregon's New Vision Wilderness, yoga teachers, art therapists and psychologists work alongside outdoor guides. At the Anasazi Foundation in Arizona, families play an active role, joining students for a three-day retreat. Summit Achievement in Maine mixes wilderness trips with rigorous academics, and Hawaii's Pacific Quest has nearly forsaken backcountry expeditions altogether for a curriculum based on an organic farm.
Some fear the changes have caused the industry to lose its soul. "It's not wilderness therapy," says Tim Murphy, a veteran of the field who now installs solar panels in Durango. "It's clinical therapy done in an outdoor setting. It's got a need and a purpose, but for someone like me whose heart is in the wilderness element, it doesn't work." Norman Elizondo, co-founder of Durango's Open Sky, agrees that the pendulum may have swung too far in the clinical direction. But striking a balance is hard. "We're trying to provide the rawness of the wilderness experience," he says, but "people are more risk-averse than ever."
At the root of wilderness therapy's struggle for mainstream legitimacy is its cost. Without insurance or public funding, most of today's 88 programs require parents to pay $400 a day or more out-of-pocket for a stay of up to 10 weeks. Some families can get 25 percent covered by insurance if they fight for it, and there are a few scholarships and Medicaid-funded programs. But mostly, the industry caters to the affluent.
Expanded insurance coverage could give more teens access, as well as help companies stay viable. Yet though new federal healthcare regulations afford mental and behavioral health treatment the same status as other types of medical care, insurance providers still dismiss wilderness therapy as experimental.
"It is not experimental," insists Mary Covington, president of Denials Management, a Salt Lake City-based company that resolves health insurance disputes. Covington is fighting some 60 denied wilderness therapy claims and says lawyers are considering a class-action lawsuit. "There have been adequate studies, and (companies) have been licensed for years. How can they possibly still be called experimental?"
To convince insurance agents – and others – that wilderness therapy is legitimate, a group of researchers connected with the industry began seeking solid data on its effectiveness. Relying heavily on exit surveys filled out by parents and participants and information collected from the field, the Outdoor Behavioral Healthcare Research Cooperative has today published more than 300 studies supporting the idea that therapeutic wilderness interventions can indeed foster long-term coping skills and improve mental health.
Many in the industry believe that before long, major providers will be compelled to insure licensed providers. "We've got the outcome data," says Frazer. "The next piece is (national, third-party) accreditation, then cost-benefit analysis. In the next three to five years we'll have everything in place to be able to go to insurance companies, and they'll have a much more difficult time refusing us."
Insurance may be wilderness therapy's last major hurdle, but it also threatens to create more upheaval in an industry still getting back on its feet. If more families are able to send their children to wilderness therapy, companies used to working with the privileged and well-educated may have to adapt to a different demographic: Teens born to drug-addicted mothers and raised in foster care, for example. That could affect the industry's success rate: 92 percent of participants currently complete treatment, compared to 42 percent of residential patients, and many go on to college.
That's not to say that wilderness therapy works for everyone or solves all problems. "Having a mental illness is like having cancer or diabetes," says Elizondo. "(Many) kids who go to wilderness therapy are going to need long-term care." Nor is it risk-free. Though there hasn't been a death in eight years, suicides and accidental deaths have occurred in even the most well-regarded programs. The decision to send one's child to an unforgiving, unfamiliar environment is not made lightly.
Elizabeth Douglas* spent her 14-year-old son's college fund on a stay at Summit Achievement after he began drinking and smoking pot, experimenting with harder drugs and getting in trouble with the law. Tom was a big kid, and after he took out the walls with a golf club, Douglas became afraid to live in her own home. College, she thought, was a fantasy; she'd be lucky if her son survived high school. Today, Tom is captain of the football team and sending out college applications.
"There's risk in everything," she says. "But there's greater risk in not doing anything. These kids take pills (without knowing) what's in them. They drink until they black out. They're not ever where they say they're going to be. My kid was doing things more dangerous every day than Summit would ever try. Ever."
*name has been changed.
Disclaimer: HCN editorial fellow Krista Langlois has worked for two wilderness therapy programs, Alaska Crossings and Pacific Quest.