The World Needs More Mental Health Services

In 2019, I lived in a small cowboy town in Mexico known on the map as Hidalgo, Nuevo Leon but known internationally to climbers as Potrero Chico. While sitting in the famous El Buho coffee shop that overlooks the canyon walls, I interviewed a climber from Canada named Kelsey.

“What do you think the world needs more of?” I asked her after she sat down next to me and I endured the bore of small talk for a few moments.

She looked at me with alert eyes. Without hesitating she answered, “More mental health services.”

“Will you say more about that?” I asked, surprised.

“There doesn’t seem to be any support,” she shook her head, launching into an explanation. “People tell me to talk to Canadian Mental Health Services, they’re in Ottawa. But they only work on high level policies; none of it trickles down. You either have to be in crisis, or you have to be fine. If you call, you just get Zoloft.”

Zoloft is a potent antidepressant with possible side effects of an increased heart rate, nausea, loss of appetite, increased sweating, diarrhea, headache, confusion, unusual rashes, bruising or bleeding, seizures, dizziness, low blood sodium, and manic episodes with racing thoughts, irritability, increased energy, and unusual risk taking.

“Any doctor will give you Zoloft,” Kelsey continued, shaking her head and rolling her eyes. “And they will also give you another pill to manage all the side effects. I am not taking a pill that I need another pill to offset with.”

“Any doctor will give you Zoloft,” Kelsey continued, shaking her head and rolling her eyes.” And they will also give you another pill to manage all the side effects. I am not taking a pill that I need another pill to offset with.”

“I’m with you there,” I nodded in agreement. “But what would more mental health services look like?” I asked.

“More family doctors instead of going into a clinic. In Canada, if you’re depressed, you get put on a waitlist to see a psychiatrist. I was put on a waitlist for 6 months to a year. I might have moved out of province by that time. And there’s no follow up. If a doctor prescribes a medication, they should have to do check ups. There’s no check ups, no therapy, no talking, just a pill. What’s terrifying is that we live in a first world country, and we don’t have access to mental health services.”

The United States isn’t much different.

“In Ontario, it’s all the system. I don’t trust the system. People go from mental hospitals to the streets, to jail, and back- it’s a vicious cycle,” Kelsey said.

At the time of our conversation, I didn’t have too many personal experiences with the mental health system. Listening to Kelsey, I was full of questions.

“Okay, so doctors could do a better job. If they prescribe pills, they need a check up. But what I’m hearing is maybe there could more than just pills? Besides doctors, what services would be helpful?” I asked. 

“What we need is community, but depressed people want to be isolated,” Kelsey said. “I read somewhere that a local tradition in Africa when someone is depressed- they give them food, and sing and dance. There’s something in England called Black Dog something- they do mental health support through outdoor activities. They go hiking, rock climbing…they go outside. They organize outings for people to help and teach you.”

“Well that sounds incredible,” I said, and Kelsey nodded.

The world needs more mental health services. Kelsey’s response stuck with me throughout the years, it’s one I have revisited in my mind over and over.

(The interview above with Kelsey is an excerpt from my upcoming novel: What Does The World Need More Of? To protect her privacy, her name has been changed. The following piece discusses my experience working with a wilderness therapy program, which I chose not to name because my intention is not to advertise or sell the program. All names of participants in the wilderness therapy program have also been changed.)

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Shortly after leaving Mexico, I moved to Colorado and began working in the wilderness therapy industry. The company I work for has three separate programs that work with 12-14 year olds, 14-18 year olds, and 18-25 year old students. Students come to wilderness for a variety of reasons: anxiety, depression, self harm, suicide attempts, drug abuse, victims of domestic violence and sexual abuse, eating disorders, bullying, learning disabilities, lying, stealing, or themselves may be accused of abusing others. To name a few things.

For two years now I have worked as a field guide, and I have witnessed first hand the United State’s use of medication as a solution.

I met a thirteen year old girl in wilderness therapy who was diagnosed with depression and ADHD when she was seven years old. “I’m depressed, I always have been,” she said, casually.

Right out of her sleeping bag- her day began with taking five pills, followed by three pills in the afternoon and another five pills before bed. 

“You don’t need water?” I asked, watching her dry swallow five pills.

She laughed at me and rolled her eyes. “I’ve been doing this since I was seven.”

It’s still difficult for me to imagine a seven year old who is told she is depressed, and how that might affect her psyche growing up.

Whenever I administer meds, I ask the same question: “What are you taking today? How much are you taking? Do you know why you are taking these medications?”

More times than not, the answer to, “Do you know why you are taking these medications?” was no.

More times than not, the answer to, “Do you know why you are taking these medications?” was no.

Every time a student answered no, I don’t know what it is or no, I don’t know why I’m taking it, my heart sank. It’s easy to sit in the woods and judge parents from afar, wondering why they medicated their children without their consent or their knowledge, why they didn’t explain it and do they care what side effects they are subjecting their kids to?

I’m not a parent or a psychiatrist, but I can read a piece of paper. I enjoy reading to the students what their medication is called, what dosage they are taking, what the side effects are and what the drug is for. For many students, it may be the first time someone has ever asked those questions. For others, they may have been administered the medication when they were so young they forgot.

Administering medication can be a controversial part of the job for some guides. Maybe it goes against their morals, maybe they don’t believe in taking medication, or who have had their own past with being prescribed too many pills that in their opinion did more harm than good.

Like all jobs, not every part of your job description is going to align with your own values. We can’t impose our opinions on kids who are listening to their parents and doctors. As a wilderness therapy employee, you are going to administer a lot of medication.

When I first started working, I was more shocked than anything to see the list of medications students were taking on a daily basis: Risperdal, Lexapro, Prozac, Xanax, Trazodone, Zyprexa, Seroquel, Zoloft, Effexor, BuSpar, Klonopin, Ritalin, Adderall, Lamictal, Lithium, Wellbutrin. Rarely were students ever taking just one of these.

Are all these medications really necessary? Are they really helpful, or part of the problem? I don’t know.

I worked with an adult student who was twenty three years old, and she knew exactly what she was taking: 40 mg of Adderall and 75 mg of Effexor in the morning. Another 55 mg of Effexor in the afternoon and 50 mg of Trazodone at night.

“I don’t know who I am without adderall,” Britney told me. “Do I really love organizing the basement or am I just cracked out on adderall? Sometimes I don’t know why I’m cleaning and making lists, but I can’t stop. I begged my mom for help, that’s why I came here.”

“Oh,” I said, pausing. We were sitting twenty feet away from the main fire and the other students. I asked her how long she had been taking adderall and she said since she was twelve. She told me she had seen four different therapists and had changed psychiatrists three times in the last eleven years. She claimed that nothing worked and nothing helped.

“I see tears welling up in your eyes, what’s going on?” I asked.

“I’m afraid of who I am if I don’t take anything,” she said. We agreed to bring this up in session with her therapist a few days later.

“I hear you are afraid. I wonder- are you curious about who you are without taking medication?” her therapist asked.

“Yes,” Britney responded without hesitating.

“That’s something we can explore here. If you choose, we can work with your parents and psychiatrist to lower your medication, or take you off entirely.”

Her tears were back. “I want to try that,” she said with a quivering lip.

Two days later, she met with the program’s psychiatrist. Every other week, her dosage of Adderall was lowered in combination with a change in diet, an increase of daily exercise, weekly therapy, and she was living in community with peers. Ripping away medication without support and lifestyle changes is not our tactic.

I am not unbiased. Personally, I would like to see less kids medicated. I don’t believe in a magical “fix it” pill. My heart hurts every time I think of a child under ten who’s funny, active, creative, talkative, and antsy in their seat; and they are told there’s something wrong with them. That they need to shut up and listen and answer the test questions A, B, C, or D. But maybe their brain is thinking about E and F and what about Z? If they can’t conform to the rigidity of the public school system- medicate them. If a teen feels sad and anxious- well that’s not normal they should feel happy- medicate them. A teenager can’t sleep after sitting in school for eight hours staring at screens, coming home to sit down and complete four hours of homework? They don’t need exercise or fun, they must need medication.

I am proud of the wilderness therapy program I work for. I don’t work for a mental health service that prescribes, prescribes, prescribes. Statistically, students leave the program on less medication than they come in with.

One morning Britney woke up and told me, “I sleep so much better after a long hike.”

“Are you telling me you like hiking?” I teased. The day before we had completed her longest and hardest hike since she had been there: a whopping four miles with backpacks on. She was not complaint free that day.

“No, I still hate it,” she quickly retorted. “But it’s kind of good for me. At home I never exercised. I literally watched two movies a day and would scroll Tik Tok for eight hours.”

“Are you telling me you’re gonna delete your Tik Tok when you get home?” I teased again. The students knew how I felt about Tik Tok, as I often referred to is as brain poison.

“I didn’t say that,” she laughed. “But I definitely want to use it less.”

Before Britney came to the wilderness therapy program, she flunked out of college. She lived in her parent’s basement. She drank alcohol on a daily basis and to the point of what she called “blacking out” at least four days a week. She gained 35 pounds in six months, she reported feeling depressed, anxious, and hopeless. She was fired from three jobs in four months. She asked her parents for help.

Britney graduated the wilderness program without taking Trazodone. Her Adderall prescription was lowered from 40mg every day to 10mg. She was accepted into an adult care program that was attached to a college university where she would take 5 credits, live in her own apartment with community housing, access to individual and group therapy, tutoring support and was eligible to get a job after four months of settling in.

After I left Mexico, I did a lot of research into the different wilderness therapy programs out there. I’m not an expert by any means, and I know the field of wilderness therapy is controversial. I chose a program that practices non-violent communication, teachers Maslow’s hierarchy of needs, serves organic food, practices yoga and meditation and goes on rad backpacking trips through desert canyons and beautiful mountains.

I can only speak for the company I have worked for. I chose this one for one very particular and strong reason: their family approach.

There’s no “send your kid to fix your kid” here. Like Kelsey suggested in Mexico, providing support to entire families connected to an individual with mental health challenges is crucial.

In this program, parents are expected to own and take responsibility for their side of what led to their child’s declining mental health. Parents meet with therapists once a week just like the kids do. Parents have the same workbook the kids are using in the field. Parents attend Wellness Weekend, where they learn coping skills and breathing techniques and how to share their emotions without pissing everyone off.

Parents attend a Family Quest, where they come into the field camping, on the student’s turf for three days. Their child becomes their teacher. They learn from their kid how to bow drill and tend fire, how to stay warm, how to cook over fire, what plants are around, how to bust an I feel, how to take space when overwhelmed. It breaks the authoritative cycle of “parents know what’s best, kids listen to parents.“

The program doesn’t work if the parents don’t do their work.

During a Family Quest, I worked with a father who grew up in the military. His father resolved conflict by shouting, intimidating, and threatening, and spanking. Naturally, when this child grew to be a parent who fathered children, he employed the same tactics.

His son was soft spoken. He avoided conflict by sitting quietly off to the side of groups. He struggled to speak up when someone did something he didn’t like. He refused to ask for help.

During Family Quest his dad asked, “Why didn’t you tell us you were drinking and smoking? Why didn’t you tell us you were feeling depressed?”

His son looked at him and said, “Because I’m scared of you.”

I witnessed a son see his father cry for the first time. His father listened to him explain the type of environment he was raised in. He did not argue, justify, defend, or explain. I witnessed a mother holding her hand over her mouth with tears streaming down her cheek watching her husband and son hug after an hour of guided therapeutic conflict resolution. She looked at me and said, “I never thought I would see something like this. I am shocked.”

Later that day while hiking, his dad told me that he had never been to therapy until now. He told me he was the first person in his family to ever go to therapy. He told me that he started attending Alcoholics Anonymous (AA) meetings and it was the first time in his life that he’d gone three months without a drink. He told me that his wife and him were fundraising to send other children to the same wilderness program.

Every week and month of wilderness therapy, I watched kids transform. I watch them get stronger, think they can’t do something, work for it, accomplish and then teach someone else. I watch their confidence increase. I watch them go from withdrawn and self deprecating to determined, helpful and proud. A child’s ability to transform is indisputable.

I think it’s less common in our society to watch adults change, especially parents who are working their ass off to make ends meet and raise a family. Personal transformation, a desire to improve communication patterns and a parent’s ability to admit fault and ask for feedback from a child is remarkable.

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The world needs more mental health services that focuses on prevention.

Wilderness therapy is not an example of preventative care. It is often the last on the list. Many student’s families have exhausted mental health services before sending their child to wilderness. They’ve tried talk therapy, cognitive behavioral therapy, dialectical behavior therapy, group therapy, family therapy, eye movement desensitization and reprocessing therapy, and some students have even tried ketamine infusion therapy. Families have usually tried changing schools, hiring tutors, psychiatrists, and educational consultants before sending their child to the wilderness for three months. Many students have been hospitalized one, two, three or more times before coming to wilderness therapy.

It is a reactive service in the world. A place parents send their kids when nothing else has worked, and there seems to be little hope for their child.

And what does that say about our mental health care system? How effective is talk therapy and medication and extra time on a test? And what happens when they fail? What happens when a family can’t afford any of these options in the first place?

There are wilderness therapy programs in Arizona, Utah, Vermont, Colorado, Georgia, North Carolina, Hawaii, Idaho, Illinois, Maine, and Oregon. The average cost per day for these programs is $558.00 per day. For a 90 day program that is an average cost of $50,220.

How many different kinds of people can a wilderness therapy program serve? Not enough. The world needs more affordable mental health solutions.

When I look at our healthcare options, I see a system focused on crisis intervention, not prevention.

When I look at our healthcare options, I see a system focused on crisis intervention, not prevention.

There are elements of wilderness therapy that could be adopted into preventative health care such as practicing yoga and meditation, which helps build stress tolerance and increases the body and brain’s ability to be resilient through discomfort. Spending regular time outside away from screens, having access to green space and solitude doesn’t only help people in crisis.

According to the American Academy of Child and Adolescent Psychiatry, children ages 8-12 in the United States spend 4-6 hours a day watching or using screens, and teens spend up to 9 hours.

I worked with a thirteen year old student who came to the program, reporting that she spent up to 20 hours on her phone a day, scrolling between TikTok, Instagram, and YouTube. She reported sleeping on average 4 hours a night. When she came to the program, she struggled with an eating disorder because she didn’t think she looked thin or pretty enough like the girls on Instagram. She had tried to commit suicide twice by the age of thirteen. She struggled with relating to people in real life, unable to come up with a conversation topic that didn’t revolve around a funny meme or her favorite movie. In conflict, she would scream or literally run away from the person talking to her. She told me, “I’m used to just blocking people and never talking to them again.”

Comparison to the point of contemplating death because you don’t seem to stack up to what you see on Instagram- this is real.

Surely there’s more we can do as a society to prevent these toxic relationships we are developing with screens. It’s not just teens and kids struggling with too much screen time. Most Americans spend about 10 hours a day plugged in online, according to a 2016 Nielsen Total Audience Report

According to the American Psychological Association, those with the lowest levels of green space exposure during childhood, the risk of developing mental illness was 55% higher than for those who grew up with abundant green space. Why?

Aside from the physical benefits of being active outside, research suggests that spending time outdoors can reduce feelings of loneliness and increase the sense of feeling connected to the world. It can reduce anxiety and help problem solve stressful situations.

I do believe in the healing power of wilderness. When my dad died, the best medicine for me was the mountains. It was there I felt most connected to him. It helped me see that the world is beautiful, not scary and full of death. It actually helped me accept death as a natural and beautiful process, by watching the leaves fall and stumbling upon bones with intricate patterns in the dirt. When I hiked and climbed, I felt strong. When I stayed in bed and watched Netflix, I felt depressed. When I hiked with other people, I felt authentically part of a group, which was essential in moving through grief. Solitude in the mountains was a safe place for me to think, cry, write, and feel whatever emotions came up, free from judgement or response. I rely on wilderness to cope with stress and loss.

We operate on a phrase at work that is, “the wilderness does the work.” It means a lot of things. The wilderness will push us harder than we’d push ourselves. At a gym we can just get off the treadmill when we’re tired, but out in the wilderness, we have to keep walking until we get to water. The wilderness teaches us grit and resilience and gives us confidence that we are strong and capable to push through what we might not have thought we could. When it’s raining, we can’t just go inside. We have to build a shelter and if the rain is pooling underneath, we’ll dig a trench to funnel the water away. The wilderness pushes us to be creative problem solvers and focused on tasks.

The wilderness teaches us consequences. Not contrived punishments, not rules, not unjust torture or torment. If we leave our shoes outside and it snows overnight, we’ll wake up in the morning with wet, frozen shoes. We can either choose to put our feet inside of them and risk getting hypothermia, or make a fire and spend half an hour holding and rotating them over the flame to dry. Or we can tuck our shoes under our tarp every night so they never get snowed on in the first place. The wilderness is not cruel, it’s logical. We learn that we are responsible for our own struggle and our own comfort.

The wilderness does the work.

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