Working in a Teenage Treatment Center...

Between the years 2011 – 2019, I worked for various children/teenage treatment centers in three different states in various capacities – as a behavioral health associate, a mental health technician, and most frequently as a case manager. One of the organizations for which I worked was an agency that served as an umbrella for several different services, all of which I dipped my hand in – including school-based services, ECS, emergency shelter, therapeutic foster care, and behavioral health/drug rehabilitation centers; it was in this facility in which I was a case manager. I worked as a mental health technician in another facility for teenagers with mental health issues.

In all of these facilities, I signed on because I wanted to be an advocate for kids who did not have advocates. My mission was to stand up for kids who didn’t have a voice or any support in their lives, so that no matter what choices they made in life, they couldn’t say that they didn’t have someone in their corner. While I believed for a long time that I was actually doing some good, I believe that these agencies – especially the residential treatment centers for teenagers – do far more harm for the long-term mental health of their clients. I have come to believe that this harm is literally by the business model’s design.

First of all, staff enter the floor with little to no training toward how to keep themselves or their clients safe. De-escalation strategies are more are less limited to putting a teenager (who usually suffers from trauma) into physical holds and/or dragging them into holding cells. This was especially true of the place in which I worked as a mental health technician. Nurses and clinicians were on staff, but clinicians barely stuck around and gave each client about half-an-hour a week of services; it was pretty clear that they were just around to fill out paperwork so that these facilities could continue to receive government funding. Nurses sexually harassed mental health technicians and generally just told us to put the kids into “therapeutic holds” – a nice word for physical restraints. When we tried to engage with the kids in healthier and more therapeutic ways, management had meetings with us to remind us to know our place – we babysat, didn’t interfere with “treatment,” and then they compounded their treatment though physical interventions.

Staff receive no training on how to interact or engage with clients who suffer from mental illness, addiction, or behavioral issues; attempts to connect with the clients to build meaningful relationships in which the clients feel safe to open up and talk about their struggles are quickly discouraged, as are attempts to educate ourselves about effective harm reduction strategies in order to keep clients safe from themselves or others. We hold them down until they submit; that is the #1 priority in our training. Advocating for a client’s needs beyond that are generally ignored by management, as are appeals for the health and safety of staff on the floor. We were told to expect to get punched in the face on a weekly basis.

I remember once a client went AWOL for four days. This was in the dead of winter. When they returned, they were shivering and starving, having not eaten for that entire time. Staff promptly served them food, but were reprimanded by their program coordinator for doing so. Why? Because we can only serve food at meal times. On another occasion, a large and muscular male client got into an argument with a smaller female client and began to choke her – throwing off all the female staff trying to intervene. I had to calmly get into his face and remind him that he had full control of this female client’s life; he ultimately walked away because he chose to, not because any of us had any power to stop him. These sorts of occurrences are common in these facilities, and I reference these two literally because they are the first ones that come to mind. I speak for both myself and many other employees of these companies when I say that I was treated in therapy for PTSD as a result of my time working in these facilities.

After many years of working under these conditions, I came to realize that these agencies were not actually interested in rehabilitating these teenage clients in order to prepare them for the outside world. Treatment centers, wilderness therapies, mental health hospitals, and rehabilitation centers basically just passed these kids around, made a fortune off their Medicaid, and prepared them NOT to succeed in the outside world, but rather for a life of incarceration in a privatized prison system that would continue to make money off of their imprisonment. Kids who weren’t transferred to new facilities were usually returned to the exact same unhealthy living situation that got them into treatment to begin with and were right back in the system within months. Those are the ones who survived

I eventually quit this line of work, because I realized that working within this system – no matter what my good intentions were – simply continued to enable it. I believe that lives CAN be transformed within the system, but not by the rules of the system but rather when clients see that staff care about them despite the rules. Whatever good comes out of a treatment center is more likely to be found in a setting more equipped to cultivate compassion, empathy, and listening skills. These kids don’t need someone telling them what to do, what to think, what to say, what to feel – they need advocates. Treatment centers promise this kind of rehabilitation, but they simply lay the ground not for success, but a life of imprisonment.

~Anonymous