A Death In the Woods

When Mary Daley, 18, heard about the death of a 12-year-old camper at Trails Carolina in February 2024, she wasn’t surprised.

A year earlier, her parents had sent her to the wilderness therapy camp in Transylvania County after a stay at a psychiatric hospital in New England for suicidal ideation. Mary spent 104 days at Trails. During that time, she said, she became so ill while hiking with her group in Pisgah National Forest that she was unable to keep food or water down for a few days. 

“I can’t remember a lot of it,” said Daley, who asked to use a pseudonym to protect her privacy. “I blocked a good amount of it out, but I remember hiking, and I would have to stop to throw up. At some points, I would have a puke bag connected to my backpack.”

When Daley started throwing up tea, she said, she was taken to a hospital and was given an IV for dehydration.

Daley’s mother said she was only informed of her daughter’s illness when she ended up in the hospital. 

Her mother said in an interview that she sent her daughter to Trails Carolina after exhausting local options to treat her anxiety and suicidal ideation, including day treatment programs. “I trusted [Trails],” her mother said. “And that she’d go, she’d be out in the woods in beautiful surroundings away from technology.”

Last February’s death wasn’t the first at the camp. In November 2014, the body of a 17-year-old was found in a small stream in Jackson County with a broken hip, dead from hypothermia. Investigators said he had walked away from a group camping trip, scaled a tree, slipped, and fell into the stream. 

The deaths have brought new scrutiny to Trails, and to wilderness therapy camps more generally. Kody Kinsley, the former N.C. Secretary of Health and Human Services under Gov. Roy Cooper, has suggested they should be banned.

“I don’t blame anyone who ended up there,” Kinsley said in a March telephone interview, noting many families have felt they had few viable options to help their struggling children.

But such programs have no place in the state’s continuum of care, he said. “Shipping kids off to tough-love institutions … is not a recipe for success,” he said. 

Parents who send their children to wilderness therapy programs are, like Daley’s mom, feeling desperate for a solution to their children’s worsening mental health and have already exhausted local resources. So they turn to private, for-profit options like wilderness therapy programs–sometimes taking out loans as high as $15,000 a month to cover the costs–in hopes they might nudge their children out of their comfort zones while teaching them flexibility and perseverance. 

A Failure of Oversight

The final hours of the life of the 12-year-old boy from New York City are captured in an unsparing report DHHS released in April 2024. On his first night at camp, he was placed in a bivy–a lightweight bag that covers the camper and is used outdoors in place of a tent.

“Based on multiple accounts and investigation, the decedent was placed to sleep in the bivy without incident. Sometime around 2300 [11 p.m.] he was noted to be moving around and making noise in the bivy and counselors removed him at that time. He relaxed and fell to sleep outside the bivy a short time later. Due to protocol, he was made to wake up and re-enter the bivy at which time he was again secured with the alarm device.

“A counselor did note he was moving around again about 1-2 hours after the initial incident but stopped moving shortly after,” it reads. “Routine checks were performed throughout the night, but due to the outer, opaque layer of the bivy being closed, he could not be visualized. In the morning, the counselors attempted to wake him up but noted he was not moving.”

A state autopsy later concluded his death was a homicide, and that the bivy had suffocated him. While officials initially suggested a charge of manslaughter or involuntary manslaughter would be filed, no charges were brought. 

Andrew Murray, district attorney for Henderson, Polk, and Transylvania counties, said in a recent telephone interview that his office had not found enough evidence to charge any of the four “20-somethings” working in the child’s cabin with manslaughter or gross negligence. “They were being pretty diligent. … They didn’t hear anything that caused them to respond” or indicated that the child was in distress, he said. 

Last November, his office issued a news release explaining the decision: “The law requires us to meet a high threshold when considering charges of involuntary manslaughter. While we are deeply saddened by this tragedy, we must follow the law and make decisions based on the evidence and our legal standard of proof beyond a reasonable doubt.”

The state revoked the camp’s license in May 2024 and suspended admissions, based on deficiencies found during a March 21 visit. Those deficiencies included improper procedures for administering medications and documenting their distribution to clients, and the practice of staff reviewing letters between children and their parents. 

“Based on record reviews and interviews, the facility failed to ensure that each minor client retained the right to communicate and consult with his parents or guardian and receive telephone calls,” the state’s report said.

They were also cited for putting children into a restrictive bivy on the floor on their first night. “If during the night a client needed to use the bathroom, they would have to ask staff to let them out of the sleeping system they were assigned.

“Clients were not provided dignity or respect,” the report states, “as evidenced by having to sleep on the floor of the cabin with a thin sleeping pad, surrounded by plastic that was tied at two ends, while the other clients in the same cabin were able to sleep on bunk beds with mattresses.”

Further, the state found the facility had “failed to implement their own policies and protocols regarding increased sleeping precautions by not having same-sex staff sleep within arms reach of clients” at least 23 times between November 18 and December 28, 2023, in incidents involving five different campers. DHHS fined Trails $18,000 for violations last March. 

Efforts to reach Trails Carolina executive director Graham Shannonhouse by phone, email, and through third parties were unsuccessful. The 32.27-acre property is currently listed for sale for $3.2 million. Charlotte-based attorneys for Trails Carolina LLC did not respond to emails or phone messages.

Trails Carolina opened in 2008, with gender-segregated programs for both teens and preteen children. Licensed by the North Carolina DHHS, its programs included equine therapy, backpacking trips in Pisgah National Forest, and experiential learning–that is, learning by doing rather than through traditional teaching methods such as classroom lectures.

That hands-on learning appealed to adolescents who struggled in traditional school, said Paula Leslie, a therapeutic placement specialist and educational consultant based in Montana who regularly referred families to Trails. She recalled an instructor installing plastic tubing on the ceiling so students could observe snakes and other creatures, and involving students in projects like building solar-powered devices. 

Leslie said she was deeply saddened when she read the 12-year-old’s autopsy report but believed Trails Carolina had offered help and healing to many families. “No death is an acceptable death,” she said. At the same time, “if my child needed help, I don’t want to have to send them to an inpatient residential facility.”

A Growing Mental Health Crisis

Mental health advocates describe a patchwork of underfunded, understaffed resources across the state that rely on well-meaning but overworked mental health professionals. “It’s not fundamentally a system,” said Dr. Gary Maslow, a professor in the Duke Department of Psychiatry and Behavioral Sciences and co-director of the Division of Child and Family Mental Health and Community Psychiatry.

But even in a state with few options for struggling adolescents, sending them to wilderness therapy programs is not an effective solution, Maslow said. 

“The strong evidence we have for youth who have conduct disorders, for youth who have suicidal behavior, even people who have psychosis, is that treatment in the context of a family with caregivers is vital,” he said. 

Among adolescents, mental health is worsening, and in particular suicidal thoughts and behaviors are rising, according to a 2021 report by the Centers for Disease Control and Prevention.

Many factors have fueled the mental health crisis, including the social isolation resulting from COVID lockdowns, poverty, and a lack of access to resources.  Last June, then-U.S. Surgeon General Vivek Murthy called for warning labels on social media platforms, saying social media can cause “significant mental health harms for adolescents.”

A multiyear study released in 2023 and cited by the Annie E. Casey Foundation, a Baltimore-based private philanthropy that funds evidence-based research on family health, noted two-thirds of children and young adults report­ed expe­ri­enc­ing at least one men­tal health prob­lem in the past two years, a statistic that was low­er for all old­er gen­er­a­tions. That study was conducted by the Oliver Wyman Forum, a New York-based management consulting firm. 

Parents tend to inquire about wilderness therapy programs when they’ve exhausted a range of other options and their child’s mental health has not improved, said Leslie, the placement specialist in Montana.  About half the time, those children have been hospitalized for severe issues, such as suicidal ideation or attempts or extreme behaviors. 

Parents often are wary of inpatient psychiatric settings. “Some kids come out of those environments very traumatized,” she said. “And the cure is worse than the problem.”

But assessing the safety and efficacy of a wilderness therapy program is key, Leslie said, including whether the program has diagnostic and assessment services, and what accreditations it has beyond state licensure. Field instructors should have advanced medical training, and mental health professionals should visit children at least weekly and be on call 24/7. 

Hope for One Family

Both of Benjamin Healy’s teenagers are on the autism spectrum and highly gifted intellectually, among other diagnoses. He and his wife, who live in Durham and are not using their real names here to protect the identity of the children, credit a stint at Trails Carolina for helping their son Noah (not his real name) regulate his behavior. Their daughter also attended a wilderness therapy program in Utah and had a positive outcome.

Noah was 12 when he tried to hurt himself at home in October 2021. “But leading up to that, there were a series of incidents where he would become dysregulated with increasing frequency and severity,” said his father. Both at home and at school, “it could be anything from him, like elevated pitch of voice, elevated volume, crying, flopping on the floor.”

The family already had been working for years with a number of well-regarded local outpatient providers in the Triangle. Noah’s diagnosis kept changing–including ADHD, signs of obsessive-compulsive disorder, and sensory processing disorder.

“We were out of outpatient options locally,” Healy said. “There was literally nothing else that was going to be able to meet him where he was.”

After Noah tried to harm himself, the family spent three weeks in South Florida, where he was finally diagnosed with autism spectrum disorder at the private Neurobehavioral Institute of Weston in Broward County. 

Therapists at outpatient psychiatric facilities in the Triangle never wanted to see Noah at his most emotionally dysregulated, his parents say, which they felt made it difficult to fully assess and treat him. “What you typically hear is: ‘We don’t want to trigger him during a therapy session because we think it’s going to interfere with the therapeutic relationship,’” his father said.  

At Trails Carolina, Healy said, his son had a chance of “being with therapists and a team of people who are not afraid of and understand how to work with kids when they’re at their worst, at their most dysregulated.” Healy personally witnessed the staff members’ calm when it took Noah two hours to get outfitted with his gear at admissions, a process that should take about 20 minutes. His son was so upset at one point he even climbed onto the roof of the family car.  

The value of having adults unafraid of seeing him struggle is that it helped his son start to understand his triggers and learn skills to become less reactive, Healy said. 

Noah is now at a residential treatment center in Utah. “Wilderness programs are not designed to take a kid who is acute and within three months have them ready to come back home,” Healy said. “They’re just trying to get the kids stabilized to the point where they can actually participate in a step-down residential program where they can then continue to work therapeutically on the things they need to work on and build skills to allow them to come back home.”

Healy estimates he spent nearly $300,000 last year on tuition and outpatient care for his children.

“I would love to get to a world where there were local outpatient treatment options where the providers are not afraid to see stuff, where you can do more than have a one-hour session a week with a therapist,” he said. “Where you have the ability to have a group of providers, if you will, having more fluid communication between a therapist, school, whatever, so that they’re working in concert to really meet a kid’s needs where they’re at.”

“If it existed, then you have a chance of being able to reach more kids.” 

Finding What Works

During his three-year tenure as secretary of the N.C. Department of Health and Human Services, Kinsley said, the state prioritized rebuilding a behavioral health system that could “meet people where they are.” That included expanding Medicaid, transitioning to managed care to better integrate physical and behavioral health, and launching a new Medicaid plan for people with behavioral health needs, intellectual and developmental disabilities, and traumatic brain injuries.

Because mental health issues have long been considered a moral failure rather than a medical issue, they haven’t been paid for and carry a lot of stigma, he said. “And so you have people who move into the space offering things that may or may not work.”

As for wilderness therapy, “it’s clear to me that these are not a model that we need to keep in North Carolina,” Kinsley said.

“And I would say not a model that we need anywhere,” he continued. In-home services, or at least services close to home, are “the best hope for long-term support and healing.”

At this point, there’s only one licensed wilderness therapy program in North Carolina: Timber Ridge Treatment Center in Gold Hill in Rowan County, close to the Uwharrie National Forest. 

Maggie Thomas, its clinical director, said should the state move to ban wilderness therapy programs, Timber Ridge would likely ask to be licensed differently, perhaps as a youth group home.

Timber Ridge’s clients are males ages 12 to 17, many of whom have had criminal convictions. Part of the program offers mental health treatment for adolescent sex offenders, she said, many of whom would otherwise be in the juvenile justice system. Some attend due to court orders, and others’ parents send them to Timber Ridge for treatment, Thomas said. 

“We do have a bit of a unique situation here,” said Thomas, who has worked at Timber Ridge for 20 years. “Unlike Trails, we are a campus-based program,” meaning clients sleep in semipermanent structures on metal-frame beds with mattresses. The facility receives Medicaid funding as a group home, with a small portion of the programming being three- or four-day canoeing or camping trips, she said. Compared with other wilderness therapy programs, “they have a lot more clinical contact here,” she said, including licensed on-site therapists. 

So far, neither Kinsley’s successor in NCHHS nor state lawmakers have taken up his call to ban wilderness therapy programs.

Mary Daley, who spent 104 days at Trails, thinks such programs should not be licensed. “They should all be banned,” she said. “Wilderness, maybe even more so than traditional residential treatment centers, are hubs for emotional, physical, and sexual abuse.” 

Daley’s mother said she isn’t sure the programs offer anything of value to struggling teenagers. 

“I do not think our government or healthcare system is equipped to provide the oversight necessary to ensure these programs are actually providing the safe and helpful experiences and treatment they describe in their promotional materials and sales pitches,” she said.  

Daley’s mother regrets sending her to Trails Carolina. “I have a hard time reconciling my decisions, and while I did the best I could at a very desperate and scary time, it haunts me,” she said. “The damage it caused to her trust in me is something she and I continue to work through.”

Allison Salerno is an independent multimedia journalist who also is an avid Appalachian Trail backpacker. Among other places, her work has appeared in The Washington Post, the New York Times and on America Test Kitchen’s podcast, Proof. She won an award in 2024 from the National Association of Hispanic Journalists for her coverage of Venezuelan asylum seekers traveling through Georgia.