Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

This paper is a direct response to a recent article in this journal by Gass et al. (JAMA 39: 291–302) in which the authors describe an “ethical” model for the involuntary transport of youth into Outdoor Behavioral Healthcare programs, often synonymously referred to as wilderness therapy in the literature. These authors suggest that international law supports involuntary transport and that their approach is research-based, trauma-informed, ethical, and does not interfere with client outcomes. We believe each of these claims to be in error: The international laws cited include strict rules about involuntary transport, professional codes of ethics forbid all but exceptional uses of force, and there is a large literature on the harms of involuntary transport and admission that appears to be ignored. We suggest that involuntary transport is almost always contraindicated for wilderness therapy and this practice is a symptom of what has been called the “troubled teen industry.”