What if our Fear Of Treatment is The Real Risk

The loudest stories about teen treatment often skip the most important question: what does high-quality care look like right now, and how do you tell the difference? Todd Weatherly sits down with Dr. Stephen DeMille, Executive Director of Redcliff Ascent and Three Peaks Ascent, to give families a clearer map of modern adolescent mental health treatment, including wilderness therapy and other higher levels of care.

We talk candidly about why parents hesitate to “press go” when their child is struggling, and why waiting for rock bottom is a gamble that can shrink options fast. Stephen explains how licensing, accreditation, and stronger state oversight have raised the bar across the behavioral health field. We also dig into level-of-care matching, because placing a teen too low can create a painful loop of treatment failures that makes later recovery harder.

Then we get specific about outdoor behavioral healthcare. Stephen breaks down why nature-based therapy can be so effective for adolescents: a novel environment that disrupts old patterns, a tight peer community where feedback lands differently, and therapeutic approaches like narrative therapy that fit naturally around a campfire. We also address safety head-on, including perceived risk versus actual risk and what published wilderness therapy risk data suggests when compared with common teen activities.

If you’re weighing residential treatment for teens, wilderness therapy, or other intensive mental health options, this conversation is built to replace fear with clearer thinking and better questions. Subscribe for more conversations like this, share the episode with a parent who needs it, and leave a review with the question you still want answered.

Transcript

Welcome And Guest Introduction

SPEAKER_02 0:00

Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country sharing their thoughts and insights on the world behavioral health care. Broadcasting on WPVM 1037, the voice of Asheville, independent commercial free radio. I'm Todd Weatherly, your host, therapeutic consultant and behavioral health expert. With me today is Dr. Stephen DeMille, otherwise known as DeMille, executive director of Redcliffe and Three Peaks Ascent Wilderness Therapy Programs, part of the larger Ascent Behavioral Health Programs family, providing residential and nature-based programs for adolescents in the heart of Utah, where we just were able to be together for a conference out there. Very beautiful. Stephen's connection to the outdoors goes back to his childhood in Las Vegas, where trips into the wilderness of southern Utah, hiking Zion, climbing Veo, shaped his belief that nature is one of the most powerful settings for healing. That belief has guided his career spanning more than two decades. Starting in 2000 as a field guide at Three Peaks Ascent and growing through roles as senior field instructor, field support manager, assistant medical director, primary therapist, and research director before stepping into his current role as the executive director. He got a doctorate somewhere in the somewhere in there. Stephen is a licensed mental health counselor with clinical training and experiential therapies, narrative family therapy, and cognitive behavioral therapy, and has worked with adolescents and families across residential treatment, community mental health, and foster care settings. He holds his MA in mental health counseling and a PhD in counselor education and supervision with research focused on nature-based short-term residential treatment, adolescent development, and counseling ethics, where he presents and publishes at conferences around the world. Outside of his work, he's still outside. Even though he works outside, he's still outside. Dr. Stephen lives just outside Zion National Park with his wife, a former Few Three Peaks field staffer herself and their four children, where family time in nature is a constant. Dr. Stephen. Welcome to the

A Life Shaped By The Outdoors

SPEAKER_02 2:08

show.

SPEAKER_01 2:08

Thank you, Todd.

SPEAKER_02 2:09

I'm glad to be here and looking forward to our conversation. Excellent. Well, um, you know, the we we share a lot of background. I started in this field as a field instructor as well, uh, in a wilderness program, uh way back in the day. I'm only slightly older than you are. And and, you know, combining nature with what I felt to be something that's like, how do people heal from the conditions that they suffer from? They find meaning in things. They reconstruct their life around something that means something different, you know. And nature is one of those places that uh has always carried great meaning for me. It's a place that I just love to spend my time in. And it, you know, in becoming in coming into this field in the in the wilderness uh approach to you know, wilderness therapy and healing in wilderness settings and experiential therapies and adventure-based settings. Taking that to kids, taking it to adults, even, and helping them kind of recraft meaning so they can find something in life that feels like it's really worth living for, that they have some agency in the way that their life is directed, has been like paramount to everything I've ever done and continues to be. So what where did you and it sounds like you grew up in the woods or well in the desert in your case? Yeah. What what kicked you off? Like where did you start? Where did you where was your entry point into this field?

SPEAKER_01 3:40

Yeah. So um growing up, I had very little um exposure experience with the helping or the human services field. Um, so my entry point actually came through the outdoors. And so growing up, I um growing up in Vegas, we don't have we don't have wonderful access to the outdoors. So I grew up traveling, we would go to Utah and California and some places that had um, you know, places where we go camping and such as a family. We me and a few of my friends started an adventure club in in high school, and it was partially an excuse to miss class to go camping, and we also still liked camping, and so it was like a double benefit. And then um, after I graduated from high school, um, I in a backpacking magazine there was an advertisement that says get paid to camp and hike. And I was like, I, you know, I'm used to paying for these activities. I would sure like to, yeah, I would sure like to get paid to do these things that have cost me money for so long. Um, and it happened to be at a wilderness therapy program. And so shortly after I graduated high school, when I traveled to Utah um and took my first guiding job working in the human service field. Um and when I started in wilderness therapy, um, my attraction there was because I was working in the outdoors, right? So I was doing these one to three week long treks where we would take these groups of at the time we would call them at-risk populations into the backcountry, and we would provide for them these kind of small community-living um environments where um these the struggling teens could get and receive feedback in real time, um, have these um impactful experiences, and um, you know, it's a place for healing and change. Um, and I uh early, it was actually fairly quickly in

The Bow Drill Moment That Changed Him

SPEAKER_01 5:33

my career, my motivation for the work shifted. Um, I started wanting to be in the outdoors, and I quickly realized the thing that actually gave me value in the experience was not just being in the outdoors, it was the types of relationships that were being built with these small groups um in the backcountry. Um, I remember there was actually a specific experience I had with this kid who was from New York, had very little outdoor experience, came here, um, was felt very, was very insecure, didn't feel like they could do anything. Um, I was working with them one day. They, you know, didn't there was an act, there was an assignment they had to do. They they were uh supposed to make a primitive fire using a bow drill. This uh individual um thought like there's no way I'll ever do this. We worked on it for a few, I mean did been there for a while, but we had really focused on it for a few days. And when that individual got their first fire, it was it, it was like a light bulb went off. It was like a spark ignited in that individual at that uh uh in that moment. And uh Steven, are you a metaphor junkie as well? I think that comes with the territory. I think that comes with the territory. Um, but that spark uh and then sometimes it's a slow change, but for this individual, it was it was quick. They went from uh I can't do this simple activity, um, and it started to translate into so many other things. It wasn't very long until that person was taking on a leadership role in the community. I mean, it it it the dominoes that fell after that individual had that first success that they genuinely believed they could never do completely transformed the their trajectory and and and they left there a completely different person. And that experience right there, I was just like, this is this is more than just the spending time in the outdoors. And so that and that's when it shifted for me. I was actually on a a different career track. I was studying biology, wanted to go into um, was uh interested in ecology, and it was my junior year of my undergrad. I was like, I'm switching to psychology, like I love the outdoors, but there is something special about the uh the helping and the human service side of what we're doing. So so that that so that was my introduction to the field and and what got me started on it.

SPEAKER_02 7:56

Just as a parallel, I too started, was like a major AP biology guy, walked into college and thought I was gonna major in biology, tried doing so for the first year, realized that I I not only do I love the outdoors, but telling me that I need to sit in a lab for hours on end was like, I I don't think I can do that, and switched to psychology.

SPEAKER_01 8:19

I uh my my minor ended up being in biology and my uh my my research project with microbiology. I spent a year in a microbiology lab growing bacteria, and that's what did it for me. I was like, I cannot grow another uh petri dish of bacteria. Yeah, so yeah,

Why Families Hesitate On Treatment

SPEAKER_01 8:41

right.

SPEAKER_02 8:41

I think that uh we're we're we're talking today uh in the midst of a world that is from the treatment standpoint. I think our world is in turmoil in all kinds of ways. But the treatment world is a bit of turmoil. Um, that we've got, you know, uh not just wilderness programs, but also just treatment programs in general. They're they struggle with census or they struggle with, you know, uh finding families that are willing to commit to treatment, even when their child clearly is indicated for it, because they've got all this the hyperbolic news that's out there from from Paris' story to everything else, trying to kill treatment programs. I always I've always said, I said, look, if you if you want to go and find treatment programs that are doing a really bad job, just go to all your state programs and you won't have to look very far. But they're coming after the they've been coming after private pay folks and you know, trying to saddle them with all kinds of you're terrible and you do terrible jobs. I'm not saying that our field hasn't had, you know, times of development. You know, you talk about this first time you went in as a wilderness guide and you were you were uh you're a high school student, you know what I mean? Like it's like, well, you know, technical skills can be done by a high school student competently. Processing skills, on the other hand, might require a little more training. Um, you might want that person to have at least an undergraduate degree before they step into a role that they're processing with individuals at that level. So at any rate, our field has has, you know, from census to uh theoretical models and the way that we approach trauma and all the pieces that kind of go into this. I don't think people really understand what treatment looks like. I don't think they understand the depth and breadth of ideology and approach and professionalism and all the things that you have to that you really want to consider while you're doing this. You're a person who's you know invested yourself in supervision and research, your doctorate, you speak, I've seen you speak across the country. I love watching your presentations. In your mind, if you if you had a family that's sitting on the fence right now, and they've got a child who's and I I love to say this, it's like, well, if you had Paris Hilton as a 15-year-old, what would you have done with her? Keep her in the house, let her keep running around the way that she was? Probably not. You probably would have wanted to do something. So if you had a family that's sitting on the fence and they've heard all this news on one side, but they're faced with this challenge, this child that they can't control, they need treatment, they're they're they're reluctant to press the go button. What is the what is the one or two things or a key piece of information that you would provide for them to weigh in on that decision?

Go Earlier And Match The Care

SPEAKER_01 11:21

Yeah, there's there I there's a there's a few thoughts that I have on that. And and the first one, and I think it's just the yeah, just a few. Um, and and then I'll I'll try to stay as focused as I can. And you can tell from my introduction that being focused is not my strength. Um, so the the first thing that I would want to tell that family is there is no better time to seek out uh higher levels of treatment care than it is right now. It there's no time where it's safer, there's no time in our treatment history where it's more effective, there's no time in our treatment history that um that it's more efficient in providing the services that we're doing. So the first thing I would want to highlight is um they're entering the the mental health um and uh treatment field at a time where it's um you couldn't be entering at a better time. Um the programs that that they're gonna be looking at, especially if they're working with a consultant, are gonna be programs that are licensed by their state. Um and we're at we're at a time where many of the states are have really professionalized the way that they are overseeing their treatment facilities. Um the accreditation right now um is is become standard for mental health, where 10 years ago it um you you wouldn't see uh you wouldn't necessarily see programs uh that that were accredited, where now um it's unusual to see a program that's not accredited, right? And so the the the bar has just been risen. And part of that has come from the outside pressures. Um and and part of it has come like the mental health field, if like at any given point, if you look back 30 years, you look back and be like, man, we've grown a lot. It's because mental health is is one of those fields that is improving and it's improving in a pretty significant and exponential way. Um the other thing, and it did so so one thing I'd want to tell that family is is there the uh the the uh the treatment field is is is at at kind of its prime right now. And I my guess is in 20 years like it'll be better, but that's that's one of the cool things about this field is one is you're not you're seeking help of probably the best that the mental health field has been. Um the other thing I would want to tell them is early intervention, you're gonna have better impact. The earlier you can intervene, the the the greater impact you'll have. Not only that, the more options you'll have, the longer um uh the longer a the distress or dysfunction continues, the more ingrained those uh behaviors have, the harder it is to disrupt, the harder it is to intervene. Um there's there's uh there's a saying in uh in in some treatment areas that you know somebody needs to hit rock bottom before they're willing to train. That's only true if you wait too long. Like if you can intervene soon, you don't have to get to that rock bottom. You don't have to wait for that individual to to to be in the hospital fighting for their life before they'll become willing to seek treatment. Um, the other thing is is there's a little bit of a narrative out there about the higher levels of care, the the residential, the inpatient, that those are um um there's like this pushback and saying, like, hey, those aren't necessarily needed. Um, we you know, all of these things could be treated in a community mental health setting. That is absolutely not true. The experts, the professional societies do not agree with that. That is coming from your social media, but it is not coming from the experts. You know, if somebody needs a higher level of care, needs a residential or an inpatient setting, um, get them the level that they need.

SPEAKER_02 15:13

Like, don't get the right level of care, you know.

SPEAKER_01 15:16

Yes, get them the right level of care, get them match it. Um, one of the worst things you can do is to underserve that individual because then they're gonna have treatment failures, and and that may will make it harder later when they have a history of treatment failures.

SPEAKER_02 15:32

And then they're gonna think that treatment doesn't work when they've got this kind of trauma related to treatment and everything else. You see, we see a lot of families that have got something like that where they tried to do something that was not enough, it didn't work, and then you know, they've got this idea about what treatment is, except they've never really, you know, they've gone to Reddit and social media to understand what they're supposed to do. They've not actually consulted with a professional who knows the full breadth and spectrum of treatment, and now they're faced with a situation that things have gotten worse. I but you know, the you know, what you're saying about you know, start now and don't don't wait. You don't have to be in a crisis. It's true across there's not a condition in the world that's not that that's not true. It's like the earlier you catch it and treat it, the better off you're gonna be. Yeah. Let's take it, let's take it another level though.

Why Wilderness Creates Real Change

SPEAKER_02 16:22

Um, and this is, you know, I want you to be able to speak to this because the while the treatment industry itself has has been taking some heat, the wilderness, you know, wilderness and outdoor-based experiential programming has taken the most heat. You know, the focus has been, you know, we even see even in the news recently we saw Provo Canyon, you know, lost their license and had to close and everything else. And you know, they they've been fighting that battle, and I don't think particularly well for a long time. You know, you can find bad actors just like you can in any field, um, which is why we have standards and certifications and all the things that you're talking about. But why wilderness? You know, for the you got a family they're sitting on the fence about treatment, and maybe wilderness is the thing that's indicated for them, but they're very they're they're averse to the what they feel to be is the risk that you take by going to uh an outdoor program versus a facility-based program. Speak to that for us a little bit.

SPEAKER_01 17:23

Yeah, so I'll I'll uh I'll address it in two in two areas. One is treatment-wise, why, and then I'll speak a little bit to the risk associated with wilderness, that or the perceived risk associated with wilderness. Um on one side, do you have so why why why the wilderness? And so one way that I like to frame this is one of the things that I think wilderness um does better than than many of the other treatment settings and environments that I've experienced is is the the the wilderness or outdoor programs are are both acknowledging and embracing some of the wisdom traditions of our past. So, like we've evolved over many years, decades, centuries, millennia. Um, and and during the through that evolution, if you look through the records, we as a species have been going to the outdoors for healing since Yeah, since we could write about it, since we took a footstep, right? Exactly. We were going to the mountains for inspirations, we were going to the valleys for introspection. I mean, we have been going to the outdoors as a healing place. Um, and we're wired to go to the outdoors as a healing place. I remember watching um with my kids uh the that frozen two when they're going to the enchanted forest, and Olaf just right on the nose says as they're walking into the enchanted forest, he's like, Enchanted forests are a place for transformation or something like that in his goofy voice. I mean, just like foreshadowing the whole story of like, hey, we're gonna go into this enchanted forest and we're all going to grow and we're gonna come back um improved individual. I mean, that's that's just in it's just an archetype, it's just in our in our we're wired to to find healing there. And there's reasons for that. Um, but wilderness then combines kind of those those wisdom traditions of our past with kind of our modern understanding of change and healing. And so there you're going and you're having these transformative experiences that we've had, you know, since the since our species has been documenting these experiences. Um, and we're combining it with uh kind of our modern theories. You mentioned narrative therapy. Narrative therapy is a structured um way for us to build a relationship with our stories and to change our relationship with our stories. And there's no better place to do that than sitting around a campfire. You get somebody around a campfire, they they won't be able to resist storytelling. That's what you do when you sit around a campfire, is you tell stories. And so taking that on what we understand from our from from this narrative therapy approach, and we can help people change the relationships to their stories, uh, help them be able to identify the problems within their stories and and and adapt their relationship so they're not they're not these problem-saturated stories. Um another reason for the outdoors is for many individuals, they've had uh experiences with treatment that hasn't um hasn't had the impact to uh to redirect them. Um, because of the novel environment of the outdoors, both in the environment, but the more so in the kind of this the social setting is novel. There's just such a high level of interdependence in a wilderness program where you are just highly dependent on your community. The opportunities to give and receive feedback is outstanding. Um, it's particularly impactful. Um, and developmentally for youth, if you want to have impact with youth, um, it's not gonna happen on a one-on-one level. I mean, that's the Adlerian part. Adler believed that individual therapy with youth was a waste of time. It has to be done within a community. Um, that's that's that's my beliefs as well. That's why I've attached so much to Adler is like you got to do it in a peer setting if you're gonna work with youth, um, with in this kind of hierarchical counseling setting. It's it's not you're not gonna have the impact that you want to have with the youth. And it's particularly potent in a wilderness community. Um, like I said, the kid, if a kid's not doing their part, um, the community of peers feels it, and that kid gets that feedback at home. If the kid's not doing their part, they stay in bed. There's society has created buffers, so the kid just stays in bed. You know, the family gets punished a little bit, depending on the state. They might have the school come you know chastising the parents about the kid not getting up, but the kid is just like, I'm good, I'm gonna play video games in the basement. You deal with it. We're in a wilderness setting, that kid isn't insulated from the impact of those behaviors.

SPEAKER_02 21:41

Um it's Ericksonian as well, right? Yeah, yeah. You know, you get to this uh I mean, we we have this argument about age, age, and development, or necessarily necessarily lining up as well these days, but you you look at this a kind of adolescent age, and Ericsson's like they're gonna get more from their peers than. They are from you. Just beware that you your importance as a parent diminishes your opinion. And your importance as a parent diminishes when they turn into teenagers. Um I certainly have a personal experience with that.

unknown 22:14

Yeah.

SPEAKER_02 22:14

I'm sure you do too, but it's like you can't do it without having their peers around them because that's where they're gonna get the the they're gonna get the message.

SPEAKER_01 22:21

Yep. And I and I love it when I'm on a phone call and I'm doing a family session, and the kid goes in there and he's like, guess what? I learned this week. I was doing this activity with my peers, and somebody said this. And the kid says something that they learned that the parents have been telling them for like the past four years. And the parents are like, What do you mean you just learned that? I've been trying to emphasize that for you know, since you were eight years old, and now you're coming to me. I just learned it. It's like, and it became you know, I'd have to sit down with the parents like this, and you know, it's it's the novel environment. It's there's you know, no, this isn't the first time they've heard it, but it's the first time that they're starting to internalize it.

SPEAKER_02 22:57

Well, it's also an intentional social group, you know. When a kid goes, if a kid's getting in trouble and they're going to school, you know, they might be isolating or they're hanging out with kids who are gonna support the current behavioral set that they've got going on. Pull them out of that environment and you put them around kids who are, you know, getting professional help being redirected and give, you know, guided conversations and guided peer uh relationships, and all of a sudden that tone shifts and they start to they start to alter because then you put them in a pool with a positive and positive message instead of a negative one. So I mean, you know, that's it's hard to do in a home. That's part of the argument I believe you're making here.

SPEAKER_01 23:41

It's hard to do in a home when you've got yeah, and part of the reason it's hard to do in a home is there is something about the familiar environment. When we're in a familiar environment and we're doing what we normally do, whatever maladaptive uh behaviors we have, um, it's really hard in a familiar environment for us to experience that differently. When our parents are telling us, like, hey, that's not a good idea, or our therapists are telling us that's not a good idea, or teacher, like when we're in a familiar environment, um, uh the consequences of our behavior aren't as noticeable for the individual. And this comes out of the outward bound process model. However, you put somebody in a novel environment like the outdoors, they begin to experience themselves and their impact on others in a different way, simply by changing from a familiar to a novel environment. Um, and that's why you oftentimes hear people say they go on this uh backpacking trip and they come back with all of these new insights. Well, those insights come in part and and heavily because of that novel environment that they're in. They're they're they're doing what they normally do, but because it's in a different environment, both community-wise and just environmentally, environmental and in the outdoors, they begin to experience themselves and their decisions differently, which then leads to new insights. And that's why we go to the outdoors for insights. We see things differently when we're in a in a in a novel environment. Um, and that's why kids can sometimes say, like, oh, I realized this while I was out here, versus why they've missed many opportunities to realize it at home or at school.

SPEAKER_02 25:09

So my master's degree is outdoor ed, outdoor experiential ed as well. So you and I are gonna, we could just nerd out on this.

SPEAKER_01 25:15

I know, we can geek out on this topic.

SPEAKER_02 25:18

But you know, the the thing, the one thing that I I try to tell families when they're contemplating a decision like this is I think, well, you gotta remember that nature is uncompromising. And I, you know, my next question to you is gonna let's talk about risk a little bit, but but nature is uncompromising, which means that cold is cold, wet is wet, you know, dark is dark, hunger, you know, hunger is hunger. Uh, and it's not gonna relent. You know, you might be in a family environment where boundaries are loose and they've been hard to set, and the person, all these behaviors and familiarity are part of the equation. You go outside and it's like, I'd like to yell at the sun for setting now. Well, you can yell at the sun as long as you like. The truth is, is the sun does not care and will continue to set. So you might as well make you might as well plan accordingly. And when you've got that kind, there's a there's a reliability, there's a safety to knowing what happens. Uh to like, hey, this thing is gonna happen whether I like it or not. Now it's on me to prepare. Um, and and in that way, like, that's part of this relational message, this experiencing things different that that I think that you know, everyone, including adolescents, um, and probably as profoundly uh adolescents, get that message that's like, oh wow, I uh my agency is in what I can control, not in adjusting the environment, you know, not in the blaming things on the outside of me, but in what I can control. Now I think that the place where they and and maybe parents will realize that piece, maybe they think about it that way. It's like, oh, yeah, you know, build skills and and that's a good thing and independence and so on.

Perceived Risk Versus Actual Risk

SPEAKER_02 26:58

But then they get to the point where they're like, yeah, but it's dangerous in the woods, right? It's like there's all these, there's lions and tigers and bears. Yes. So speak a little bit, you know, for a person who's been at every level of the of the wilderness and experiential programming field and world, and now sitting in as executive director of two different programs in a family of programs, uh even as recently as fires in Utah, one of your groups had to move to a different location so that they can handle those things. Like talk about managing risk and doing therapeutic work in the in in wilderness settings.

SPEAKER_01 27:33

Yep. So um uh uh I'll do a conceptual and I want to I'm gonna talk a little bit about the data as well. Um so conceptually, when you look at from an ad an adventure therapy lens, um, one of the ingredients and one of the things that that makes adventure therapy uh impactful is the perceived risk, right? You perceive that like, hey, when I'm doing this rope course, like like there's not, I mean, there's there's always going to be some risk, but those things are very controlled and and the risk is is pretty small. There has to be some significant negligence for there to be an accident. But that perceived risk is important. It it brings in a lot of the impact, a lot of the introspection, a lot of those shared experiences where you where you learn about yourself stuff that you didn't, you you know, wouldn't have known or couldn't have known. Um, and so there is some of that in the wilderness where there's this perceived risk is like I'm in this unfamiliar environment, I'm outside, there's no walls, what's out there? Um, and so that that perceived risk is one of the active ingredients on why it why the wilderness can have such an impact. And I use the term perceived risk because on one side there is risk, there are there are injuries, there are bug bites, there are things that can happen and do happen in when you're whether in a wilderness therapy or just out camping with your family and friends. Like there, there are things that can happen. You could roll your ankle, you could slip and fall, things like that. Um, however, when you contextualize that risk within um within uh um the risk of of other activities, you can begin to realize like, okay, this the risk associated with wilderness therapy um is no more or less risky than pretty much any other activity that teenagers are doing. So, so for example, in 2012, uh Outdoor Behavioral Healthcare Council published a study where they took about 10 years of risk data and they said, okay, like what is the risk of participating in wilderness therapy? So kind of the top-level comment was like your the uh participants in wilderness therapy were two to three times um less likely to need um definitive care or emergency care, emergent care than the general population. So when you're just talking about being a teenager um in life, wilderness programs had a two to three times less likelihood of needing uh to uh to go to go to that emergency room or care beyond basic first aid, right? And so so just looking at the general population, it does happen. However, it's no more and it's actually less than general adolescents needing that type of care. You know, but so that's just general. But when you compare it like so, like when they've compared it to just backpacking guiding companies, so the it like you were you're significantly more likely to be injured just hiring a backpacking guide and going on a hike in Zion. Um, you like if you look at snow sports, it was significant, you know, 10, 20 times less likely to be injured doing uh a wilderness therapy program than it is to take your family skiing or snowboarding. Um for the for the for sensational value, they looked at football and it was 140 times more likely to get injured playing football than you are in a wilderness therapy program. Um and I've always wanted them to do cheerleading. Because from what I understand, cheerleading is the sport that has the most injuries of any sport. And so um, so there is risk. I don't want to diminish that. Like if you if you somebody decides, like, hey, I'm gonna go to wilderness therapy, there's gonna be uh an informed consent form that family has to sign that says, hey, there's inherent risks here, you know. And yeah, there are risks. Um, and on one side, the the the increased perceived risk is important to the healing process. And when you contextualize it to other things, um, things can happen. However, the rates at which they happen is much lower than oftentimes they get presented or or um people experience them. And um, I mentioned that uh uh as people, we kind of have this uh collective unconscious around the outdoors as a place for healing. There's another side to that. We we there's this archetype around the collective unconscious, right? Yeah, there's another dimension here where for a long time to keep kids from wandering off, we used to tell them scary stories about the woods. So the woods is on one hand a place of healing. On the other hand, a lot of our modern media representations of the outdoors, it's usually like a scary movie. It's just like, you know, like we're going to the woods, the camp, and then you know, there's monsters out there, right? And so like there's this archetype that it's like it's a scary, dangerous place, and that's also baked into who we are as people, and it tends to get uh um over exaggerated versus the realities of it, of the actual risk associated with going other is much lower, but however, emotionally we experience that risk is much more uh emotionally influential than what it actually is.

SPEAKER_02 32:36

So I'm thinking about this family we're talking about, right? Um, this family that's on the fence about treatment. It's like, all right, we've we've we've covered the if you're being recommended for treatment, you should go get that as soon as you possibly can. And and the right level of care. And if residential is indicated, you shouldn't hesitate. Pull the trigger, get it done if you can. And then you're like, okay, well, what about the you know, what about the the modality? Okay, well, we've talked about the value of the modality. Um, and you and I could nerd out on that and talk about addiction to metaphors. Yeah, yeah. I could keep going, I could keep going, so don't get me started. Right? And then and then we talk, well, what's the risk? You know, it's like, well, if you survive the drive to and from there, then you probably, you know, you probably that's the riskiest thing you'll do. Yep. Let's let's be clear. Um you got in a car today and you survived the experience, then you're probably gonna be do just fine in wilderness therapy. So let's let's get a little nuanced for a second before you know we we run out of time because you and I could probably just spend hours about this. Yeah.

Preventing Harm With Modern Standards

SPEAKER_02 33:43

We get to the place where the abuse and neglect have happened, and it's happened in the past. We know that it has. We've had there's been bad actors. Um, and even as a field, there was a period of time when, you know, wilderness and wilderness was used as a methodology to work with at-risk teens, you know. And by at-risk teens, I'm talking court-referred teens. I'm talking kids that were in pretty serious trouble. They were doing that as an alternative to jail, is what they were doing. Yeah. And, you know, there's a very punitive style basis that came out of that ideology that where a lot of the field started. It's like, you know, the whole tough love, and you're gonna you're gonna sweat it out, and you're gonna grind it out, and you're gonna be uncomfortable, and you you know, you're gonna be in danger, and and nobody's gonna nobody's gonna coddle you, kind of ideology. And you saw things like, you know, bad staffing ratios and w and and withholding food and uh abuse scenarios where you know kids were being abused and things like that. Now, you mentioned, of course, right now there's no better time because our our our field is in general is at its height. You know, not only we've seen a lot more people going to treatment, like there's a lot of research, there's a lot of data, there's a lot of training, there's a lot of certification, all the things that go into this. Speak to what it's like to manage, you know, and I've said this about the will about wilderness before. It's like wilderness is incorruptible. Now you've got people who can do it badly. Yes. You got bad therapists, and you got people that don't know how to maintain safety when they're doing field guide kinds of roles and things like that. That stuff exists and has happened in the past. We've seen it. How is it that you manage your staffing, both clinical, technical, and otherwise, in in conducting safely, not only just like physical safety, but emotional safety for uh the adolescents that you serve in your programs? What's the what's the trick there in your mind?

SPEAKER_01 35:38

Yeah. Um, and and it starts from, so let me take a step back. You mentioned some of the bad actors. One of the things, probably one of the biggest missteps in in the wilderness therapy field, was there were some very uh early influential individuals that came from maybe a more punitive militaristic background that said, hey, you know, boot camps are good. Let's do boot camps in the wilderness. And so they brought people to some of the right, yeah, they brought in some of the the deprivation, um, some of the uh kind of breakdown to build up philosophies that that did exist, some of um the the uh the more uh adversive behavioral uh kind of exposure kind of stuff that that that that don't work, they don't work for you, they don't work you know for treatment. Um, however, there were some.

SPEAKER_02 36:26

We probably refer to it all as behavior mod, right? You know, yes, behavior mod days.

SPEAKER_01 36:31

Right, right. And so those pieces came in, weren't effective. The deprivation um the depre deprivation models keep were very sensational. And then a lot of times when you're seeing like the the the media coverage on it, they're focusing on those early programs that had a very poor philosophical origin, right? Now, one of the things that's happened is those programs have moved away from those models um and they've embraced the best practices of the relevant fields. And so the uh the the reason that there are so few injuries and illnesses is because the uh the medical best practices for wilderness therapy are extremely robust. Um, you know, we're tracking calorie intake of our participants, we're tracking water consumption on a daily basis. They're seeing medical professionals, nurses, doctors, um, throughout their treatment. Like there's not gonna be a time where that kid is like they're gonna have EMT level trained staff overseeing them on a daily basis with with daily medical logs. Like they are gonna be so they're so closely monitored that um we're able to catch things really quickly. You know, we we we've had cases where you know kids had these budding health concerns outside of anything that had to do with air. We caught them really quick and we're able to get them to the hospital, get them care that probably they wouldn't have caught as quickly if they were at home, right? And it's because they have we've we've we have very robust um uh medical best practices in our space now. Um in addition, we've adopted the meta uh the clinical best practices of the treatment field. And so we, you know, our theories of change um that are that are happening in wilderness therapy right now are coming out of the best the best practices in the the mental health field um that are informing the the way that we're um engaging with and providing the the services that we're providing now and integrating the outdoor experiences with with uh the these various theories of change and clinical models. Um and so it's um yeah, and and and so because of the adoption of more modern best practices, the services are so much different than than oftentimes how they're represented, which is one of the problems that we're running into right now, is when people characterize the field, they characterize the field as it was 30 years ago, and it doesn't even come close to accurately representing what the experience is like currently.

SPEAKER_02 39:03

Well, and you you know, we were just at a conference together and you had representatives of the state legislature there in Utah. They I I was impressed that they showed up, to be honest. Um, and you know, even in the words that they're saying, and that you know, they're a little bit it was lip service, they're obviously there in front of this group, you know, and and so on and so forth. But you know, you and I have been in the field long enough, like I can hear these guys talk and know that they really don't know what it actually looks like. They really don't have any clue. Yet they're making decisions and advising, you know, policy that is directive towards the treatment industry without having a clue about what any of it means. And that's probably the most frustrating thing I think any of us have it tends to experience.

Policy Choices That Limit Access

SPEAKER_02 39:50

How are what's the way in which you know you combat that? Like what's the what's the drive there for on your end at OBH and all those guys?

SPEAKER_01 39:57

Yeah, so so just to put a finer point on that, we're in this unfortunate place where legislatively, year over year, we are having access to fewer and fewer psychiatric beds for for your for people, but youth in particular. And when you look at the data on the mental health need, it is not going down. So we're having this decrease in access and increase in need, and a lot of that comes there's on the front end that it's you have the the uh the PR, the public relations, the media, the social media uh presentation of it. And then you have our legislators reacting based off of what they're seeing on on this sensational information and the sensational platform, um, and they're making decisions that are that are restricting access. One of the, you know, it's one thing when you have a family that that is like, oh, we can't, we're not sure if we want to pull the trigger, we can do it, but we don't. It's it's horrible when you're talking to a family and they genuinely want to do something, but can't. Like I've had many of those conversations where they're just like, we're ready to go, like my kid needs help. This is the presentation, and you have to say to him, like, you kind of don't have options. Hopefully, not hopefully, how this is gonna play out is at some point they'll probably break the law, they'll get arrested. So, one thing that is going up.

SPEAKER_02 41:18

They'll reach that crisis place, right?

SPEAKER_01 41:20

Yeah, they'll read the crisis place where they get arrested and then they can go to the juvenile justice to get integrated. One of the, you know, as mental health beds are going up, um, incarceration of youth is going up. So, I mean, that is playing out as as you would expect, as people aren't getting help, as people aren't being able to help their kids, it's getting too far. We're flooding the juvenile justice system with these mental health cases that didn't get help when they need it, and now they're having to interface with the juvenile justice system because juvenile justice um uh um admissions is is continuous to climb. That system's being flooded right now.

SPEAKER_02 41:54

So you there's there's an obvious problem that it presents that your justice system gets overloaded and your hospitals get overloaded, and then families don't have any place to turn. Um then they run into this sensational media situation where it's like, oh, don't go to treatment, you know, because terrible things might happen to you. It's like, well, you're already sitting on top of terrible things. Yeah, you've been dealing with terrible things already. Um probably probably couldn't get a whole lot worse. That's not an argument there, but like honestly, you really need to do something different. I mean, the the state of North Carolina actually sent a group to Utah during that time to go and find out how they can better create more treatment options in North Carolina because so many have closed.

SPEAKER_01 42:38

Yes. And that same thing is happening across the nation, Oregon, Utah. Uh we are not uh legisl, yes, legislatively, we are not serving our our constituents. We are not, we are not creating greater opportunity and access to the levels of care and to the services that they need. We are doing the opposite right now, and we are restricting them. Um the uh the clientele that I could work with 15, 20 years ago in a mental health has been wildly constricted to where there are many clientele that um used to have treatment outputs that don't anymore. And that's that's legislative.

SPEAKER_02 43:18

Yeah.

SPEAKER_01 43:19

That's because of legislation.

SPEAKER_02 43:21

I'm sure it's gonna reach ahead at some point in time. You and I could uh we could dive a little further into some of these rabbit holes then and talk

Final Thoughts And Sign Off

SPEAKER_02 43:28

about them. Um and I think we will. You know what we should do is we get we get our friend Kinsey, one of your peers over there in the executive directorship, uh uh sit and and uh and have a have uh you know three or four people kind of contributing to this topic. How does it work for females? How does it work for males? Those are the Discovery Ranch folks. I'm supporting I'm I'm wearing the hat today, you know. Yeah. Um at any rate, I I am super grateful to one have you doing the pretty solid work that you're doing because uh, you know, a a thriving and surviving, a surviving and even thriving um experiential and outdoor-based uh program and company of programs that's doing the work that you guys are doing is a testament because it can be difficult out there in the world these days. But um I also know you as a person and and enjoy your company and like hanging out with you. Uh, let's get back on the show again sometime. My guest today has been Dr. Stephen DeMille with Red Cliff Ascent. I'm Todd Weatherly, your host on Head Inside Mental Health. We'll look forward to seeing you next time.

SPEAKER_01 44:28

Thanks, Todd.

SPEAKER_02 44:29

Thank you.

Outro Music

unknown 44:48

I think it's not being I've been done, but I've been on the nuts, they don't need the nuts, be that beat up, I don't know. I don't know. I don't know. I don't know. I don't know. I've now been on it, I've been up there, I come out. I'll feel so no easy and last in here.

SPEAKER_00 45:58

I need to find my way on their own. I feel so lonely, and last in here, I need to find my way home. I feel so lonely, the last in here need to find my way home, I want. I feel so lonely, the last thing he has kill me. I need to find my way home, I'll find my way home.