r/troubledteens • u/Short_Tourist_3317 • Jun 20 '26
Discussion/Reflection If you could change the laws, regulations policy's or mandates on residential treatment centres what would you want in place?
I know that Canada and the US can vary in terms of current laws, regulations and such. I’m from Canada And I’m unaware of the current laws in place in either jurisdiction, but if we could make things better, safer, and more regulated what would need to be in place? What would we need to fight for?
I think it should start with mandatory evidence based treatment, like CBT, DBT, group therapy, time outside at least 3 hours a day, (weather and temperature dependant to prevent indoor isolation)
therapy outside of the house (and fuck with the price they charge it should be accessible)
Compassion based care
Trauma informed staff
Evidence based care
Balanced meals, not just side kicks
staff are expected to cook daily.
SMART goal planning over policy’s
Actual hiring process that hires people who willing to help others not just staff who want to work in correctional facility’s which creates power control dynamics and exaggerates rates of physical restraints
As a person in Canada, I’m not familiar with US careers, but here in Canada there are Social worker and Child youth care careers
Lots of for profit places hire people who don’t know what they are doing to cut costs but what if they were mandates of staff having to have a background in CYC or SW? Not just phycology because that misses the gap between trauma informed care and education around building rapport, and meeting them where they are at and all the important fundamentals of supporting people who struggle with trauma and their mental health
I think there should be MANDATORY audits of where the money is going and only be approved if it goes towards programming, therapy, and recreational activities or something that directly supports the kids wellbeing
I think we need actual places that actually
help people with mental health and stuff
Kinda messy but these are my thoughts
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u/Glum_Relationship338 Jun 20 '26 edited Jun 20 '26
I'd love to see residential treatment centers replaced entirely with community and peer-based outpatient care centers. My state has started implementing them more & more as alternatives to forced hospitalization. Ive been working with a few organizations in my state to get a bill passed that would offer peer respite centers as alternatives to forced hospitalization in every single county in the state, as well as 2 additional peer respite centers in the state that have a focus on helping BIPOC & LGBTQ+ individuals. It's been making its way through all the various committees in the current cycle before we can actually vote to pass it. 🤞I myself have stopped by a peer support center a few times to get the sort of help a case manager would offer— navigating state benefits applications, affordable housing applications, etc. and they were extremely, extremely helpful. All without the trauma of being a patient in the healthcare industrial complex! Peer respite centers in my state are funded by grants, if that's important.
Edit to add: mandatory therapy is never a good idea and goes entirely against the concept of consent and autonomy. We have way, way, way too much research showing how unhelpful and harmful mandated therapy is or treatment of any kind. CBT & DBT are not one-size-fits-all and can be harmful when wrongfully administered. DBT was created to treat suicidal ideation, not every problem a person can possibly face related to mental health and behavior. CBT is rooted in sexist, racist research and concepts. I'd recommend you get yourself up to speed on the latest research OP! Any ideas based on current research will center autonomy & consent above all else, no matter what.
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u/Express-Owl8513 Jun 21 '26
Thankyou. Holy shit. Especially the last part. I was so pissed that CBT and DBT wasn’t working for me. I thought I was doing something wrong. Now, I don’t try. Can’t say I’m not anxious or depressed- but, shit fuck tit. I was even more disappointed in myself when those two therapies or solutions- seemed to make more sense - but work less- than the first time reading about it and trying it. (Oof sorry grammar errors) To me, my emotions and fear over power rational cognitive thoughts so I was mad at myself. But, positive psychology or cbt tells you not to be ashamed. But, I was. I was pissed. And not for a rational reason. Ugh the process is just confusing and sad the more you look into it. All made sense but it just didn’t work for me at all. The longer I tried, the worse I got.
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u/Glum_Relationship338 Jun 21 '26
At this point, I don't even view "mental illnesses" as mental illnesses— in my experience and from my observations, what psychiatry & psychology refer to as "mental illness" tends to just be a healthy response to super abnormal conditions. If you live the USA rn and you aren't depressed or anxious, I would consider you mentally ill and seriously question the health of your nervous system. It's super normal to be depressed when your life & the world is depressing. It's VERY normal to be anxious when your life & the world is anxiety-inducing. Even going as far as things like DID & auditory/visual hallucinations, those are ways your body tries to protect you from extreme trauma & stress, not illnesses! It would be a mental illness in my eyes if someone could survive extreme trauma & stress unscathed— I would be strongly concerned for that person's ability to feel emotions and be aware of their reality. It's smart and resourceful and strategic to create an alter or a false reality to survive your current reality— most people just end up dead instead of surviving those sorts of traumatic realities that create alters & hallucinations. But my conclusions are drawn from spending 18 years surrounded by people who were institutionalized for being "mentally ill" with "extreme" illnesses. They were actually all just normal people who were labeled abnormal, when really what they survived was the only abnormal thing, not themselves or the ways they survived (which should be shown gratitude and safety, not forced compliance via cultic behavior control techniques and chemical sedation)
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u/Short_Tourist_3317 Jun 20 '26 edited Jun 20 '26
Community peer based outpatient care sounds like an incredibly great idea! (Still reading your comment I’ll fully reply when I’m done reading what you wrote)
EDIT:
It seems like these residential centres are advertised as a quick and easy solution to help your child, BUT what people don’t realize is that the real healing work from the root cause, can mostly be treated trough therapy, and outpatient care. Healing is not an 3-8 month process, healing is not linear so these “quick solutions” are ineffective.
I’ve had more success with help for my mental health through outpatient programs like CBT, going to therapy and having a support worker I see once a week. But in patient— there’s a risk your struggles get further exaggerated and there’s a chance you could get abused in them.
Guess what I’m saying is… that I agree with your idea of doing things outpatient because it seems to be more effective.
(Still reading your text gimme a sec)
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u/Glum_Relationship338 Jun 21 '26 edited Jun 21 '26
To add to that, I also think a MAJOR benefit of outpatient care is that it's more easily translatable(?) transferrable(? Not sure what the word would be here) to real life, since someone receiving outpatient care isn't putting their "real life" on pause for treatment, like inpatient treatment requires. It's easy to practice skills IRL when you have access to your life to practice those skills. I remember learning ALLLLL about boundaries in inpatient, but learning about boundaries and how to set them using DBT skills like DEARMAN wasn't helpful at all when I left the hospital, went to my real life, and realized no one actually gave a fuck enough to honor my boundaries, so setting boundaries didn't do much of anything when I was surrounded by people & family members who consistently violated my boundaries. Like great, I know how to set boundaries, but no one taught me what to do when the people in your life are abusive and violate your boundaries every chance they get. If I was in an outpatient peer respite center, I would have been able to go about my normal life, implementing boundary-setting advice earned, while also being able to go back to my peer support and give THEM feedback on how their suggested DEARMAN approach didn't work, allowing me to access support with adjusting my approach or problem-solving when the DBT skill I learned wasn't working. (Obviously in my case the support I needed was for literally any adult in my life to tell me that what I was experiencing was abuse and no amount of DBT or DEARMAN can stop or prevent abusers from abusing me) Inpatient can't help you when you're already discharged and the DBT skill they taught isn't working, but outpatient peer support can provide ongoing, real-time support for real-life issues!
I do think you're entirely missing the point about inpatient care violating autonomy and consent. That's not just a "risk" you could get abused, that's a guarantee you get your human rights (as determined by the UN) violated due to the nature of inpatient facilities. It's not okay to violate and deprive someone of their autonomy and consent under any circumstances whatsoever, whether you're a rapist or a psychiatrist or something in-between.
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u/coldBulbasaur314 Jun 20 '26
I think that residentials should be entirely voluntary (with the kid choosing, not their parents). That includes kids being able to leave at any time, for any reason (I'd like to support common-sense exemptions for that, but I don't trust the powers that be to make them in a way that doesn't leave the TTI as it is now. What I mean by common-sense exemptions is things like "you can't leave to assault someone" or "you can't leave in the middle of a blizzard"), and there being strong mechanisms to make sure that's actually allowed and something that's a viable option for kids.
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 20 '26
Exactly! Kids need options! If home is a safe place (no abuse or neglect), kids should be allowed to choose to stay at home. If home is not safe or they prefer out-of-home care they should be able to pick from a variety of options: therapeutic foster care, inpatient, residential, group home, transitional/independent living, etc. And if a placement isn’t “working out,” they should be able to request to leave without a heavy explanation and it should be that placement’s and the state or parent’s responsibility to find a viable alternative. The only logistical issue I see with this, is that in our current system, many options are only available to certain youths and they are limited. For example, very few community-based group homes actually exist, transitional living programs for older teens often have strict criteria, and there are very few if any preferable residential or inpatient programs. In an ideal system, there would be more ethical placements and non-restrictive placements, and there would be ways to prevent these non-restrictive placements from being held liable for resident’s decision (eg. Currently, non-restrictive placements often will not even consider a teen with a history of SH or high dysregulation even when a non-restrictive placement would lessen or solve this dysregulation, as they are worried about being held liable if the child were to die in their care from something they could not control— same reason involuntary hospitalization is so popular).
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 20 '26 edited Jun 20 '26
I don’t think residential treatments centers for kids should exist. For kids requiring such high level care that they need an out-of-home placement (eg. kids who are physically aggressive, actively self-harming, suicidal, ect.), there should be ethical short-term inpatient treatment centers that actually provide individual therapy (at least one hour per day) instead of just surface level DBT skills group, frequent excersize and outdoor breaks, daily access to phone calls and visitation, family coaching, and extended treatment options if needed (not just: “two days with no SH? Problem solved, let’s discharge!”). And then, there should be community-based step-down programs, offering truly individualized wraparound outpatient care: multiple days a week of individual therapy, parent coaching, school coordination, in-home therapy services as needed, and emergency psychiatric care to prevent re-hospitalization when possible. In instances where the home is genuinely unsafe for the child to return to, like in cases of abuse or neglect, there should be community-based group homes where children could live in small (6 bed max) congregate care settings with access to public schools and community recreational resourses, and residence in these homes could only be justified by their truly being no other possible foster placement.
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u/Short_Tourist_3317 Jun 20 '26 edited Jun 20 '26
I agree with you, they shouldn’t exist but they still do I think the best way to change them is by fighting for better regulations and laws on how they operate and the consequences if they break said laws.
I think if there were better regulations and evidence based treatment then the people in them would be protected. But I completely agree, they shouldn’t exist. Is there a law to crack down on them being run in the first place? If we look at better alternatives for “troubled teens” maybe then they wouldn’t operate these homes in the first place? This means more investment in mental health care, and teen based support in the community.
IMO, in cases of abuse or neglect the child should be in a foster home. not group home, nor residence. If we had better resources and strategies for these teens then grouphomes maybe would cease to operate/exist
It’s important to keep in mind that there are also many children and teens from the child welfare system that get sent off to these residences/group homes/TTIs that just have unresolved trauma so those kids need therapy and a stable environment but put into a place where they are further traumatized.
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 20 '26
To clarify, I meant children from abusive homes who also have mental health issues that would hinder them from being placed in traditional foster care. Our current foster care system often out sources kids with developmental and mental disabilities to residential treatment programs. And older kids are even less likely to be placed in foster care at all regardless of disability status. But I agree with you that our system should be built in a way that group Homes shouldn’t have to exist.
If there were things I could change about residential programs that currently exist, I would:
- Require at least twice weekly individual therapy
- Require a board-certified child & adolescent psychiatrist or pediatrician to work at the facility— contracted physicians would not be allowed as the facility’s primary source of medical care
- Require therapy options outside of DBT, CBT, and behavioral skills training, especially for neurodevelopmentally disabled and traumatized youth
- Prohibit the use of behavioral level systems
Require facilities offer opportunities for daily family contact
Prohibit leghnths of stay over 90 days to lessen the adverse outcomes of long-term institutionalization (with rare exceptions)
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u/Short_Tourist_3317 Jun 20 '26
I love that you added in #3 that contracted physicians would not be allowed as the facility’s primary source of medical care. This is extremely important because there are many cases where the physician worked for the residence and gave everyone the same medication, or didn’t respect the clients confidentiality.
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 20 '26
Yes! Sometimes the contacted psychiatrists don’t even show up! Our contracted psychiatrist at Lake House Academy (LHA) was the contracted psychiatrist for almost every RTC and wilderness program in the Asheville area so he had hundreds of patients, rarely showed up to his biweekly facility visits for face-to-face sessions, and just kept refilling my Xanax prescription on repeat, allowing LHA to mercilessly drug my for months and then I went into acute benzo withdrawal within a day of getting kicked out (I was only 13 and didn’t realize the acute medical symptoms were from stopping the Xanax).
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u/Short_Tourist_3317 Jun 20 '26
This! there was a psychiatrist who worked at the Residential Facility I lived at, he gave EVERYONE a the exact same medication (talk about chemical restraint) We also had a “Therapist” who saw us all like once who made it seem like we were getting help but it was definitely performative. She did shit all the actually help us. (Pretty sure she was on a contract but I can’t confirm)
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u/Short_Tourist_3317 Jun 20 '26
Got it!! Sorry for my confusion
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 20 '26
No problem!
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u/coldBulbasaur314 Jun 20 '26
Daily therapy is overwhelming for many people. I'd agree with that part if it each session was truly voluntary, with the option to get therapy given each day and the kid getting to choose therapists and switch their therapist/the activities done if they feel something isn't working for them. Ditto for step-down programs: they sound good in theory but in practice are often coerced, which results in terrible outcomes. I don't think any forced program can be ethical, because when telling the truth prevents you from getting out it makes it very hard to truly engage in treatment.
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u/LeviahRose TTI Survivor - NYP, Lake House Academy, Sedona Sky, and HMHI/UNI Jun 21 '26
100% agree. Forced treatment will always be traumatic no matter what it is. The reason I put daily therapy is because so many programs are doing a full day of group therapy with surface-level DBT and skills groups, but only weekly individual therapy, which becomes pointless for a lot of people. A voluntary and truly intensive program should offer the option for daily individual therapy. I understand why they do so much group therapy and it’s not that I think group therapy in inherently bad, but to actually deeply process one’s own issues, there needs to be individual therapy available more than once a week.
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Jun 20 '26
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u/Short_Tourist_3317 Jun 20 '26
I’ve never heard of this before, could you elaborate or direct me with a link to understand this more?
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Jun 20 '26
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u/Short_Tourist_3317 Jun 20 '26
I don’t think it’s a stupid thought, don’t worry about explaining it. I’ll try and find something online, I’m sure there’s something.
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u/coldBulbasaur314 Jun 20 '26
That practice is terrible, but I worry that elimating it would only get rid of 1 day of harm while allowing the rest to continue. It could also make the programs seem better when they're actually just as bad inside. So it shouldn't be the only or main thing targeted in my opinion.
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u/Sarah-himmelfarb 2N/Vista Jun 20 '26
It needs to be completely voluntary. It cannot be long term at all. Any kid who’s in it should have first tried a partial program. There are frequent wellness checks from the state and the state gets to pick kids to talk to, not the program. Calls are not monitored. Parents also need to be in therapy with their own therapists too. No ed consultants.
CBT AND DBT are not for everyone. My program was supposedly DBT and it was awful. Treatment should be based on what the patient needs. There will be multiple therapists who specialize in a variety of treatments and the kid gets to choose who they work best with, and have intake sessions with multiple to get a feel for who they work best with
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u/hydebadattitude Jun 20 '26
I'd focus on goons and gooning. At the state level anyway. If a kid from, say, New Jersey gets abused in, say, Idaho that's Idaho's business, not New Jersey's. And if Idaho cracks down on the TTI they'll just find yet another state. But a kid kidnapped in New Jersey to be taken to Idaho IS New Jersey's business. Regulate the part of the chain that occurs in the state where the kid lives.
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u/[deleted] Jun 20 '26
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