A closer look at involuntary treatment and the use of transport service in outdoor behavioral healthcare (wilderness therapy)

Outdoor behavioral healthcare (OBH or wilderness therapy) is an out-of-home adolescent treatment option serving tens of thousands of youths annually for behavioral, substance, and mental health issues in the United States. About half of OBH participants attend involuntarily and are transported by services specialized for “uncooperative” youth. Transportation has been argued by some researchers to have little impact on youth in treatment, and Tucker and colleagues found little difference in outcomes between not transported and transported youth. Ethical and empirical concerns arise from these findings, and we apply a critical perspective to address these concerns. Specifically, we examined the claim in OBH research that being transported has no significant bearing on client treatment outcomes. We propose that the findings of no difference were random, rather than systematic, because they were constructed on a post hoc measure of perceived voluntariness. To demonstrate, we used data from OBH to construct five different measures of voluntary/involuntary, also fabricated post hoc. All five operationalizations resulted in statistically significant differences across a variety of social and psychological outcomes, demonstrating inconsistencies across the findings. Further independent and rigorous research is called for in OBH to understand the use and ethics of forced transportation, coercion, and involuntary treatment.