Meg Ortiz tried to end her life by jumping out of a moving car at 80 miles an hour. She was 15—gripped by depression, anxiety, and suicidal thoughts. After cycling through several short-term therapeutic placements, her parents turned to what felt like their last option: a residential treatment center in Utah called West Ridge Academy. There, Meg finally found the support she needed. Over eight months—removed from the pressures of daily life—she began to stabilize. She credits the program with saving her life.
For 61 years, West Ridge Academy served high-risk youth in Utah. It was one of many licensed residential programs for teens in crisis: young people whose needs had exceeded what their families could manage alone. The program offered long-term care in a communal setting, where residents lived together, received intensive therapy, attended school, learned life skills, and were supervised around the clock.
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But today, even well-run treatment facilities are under critical scrutiny. A single incident—regardless of context—can provoke backlash and swift regulatory action. In February 2025, West Ridge Academy shut its doors, a casualty of the growing public panic over residential care. Nationwide, the number of residential treatment programs has dropped by 61 percent since 2010, with nearly every state scaling back their use. Part of that trend reflects a shift toward community-based care, in keeping with the broader movement toward deinstitutionalization. But much of it has been driven by fear.
It wasn’t always this way. Residential treatment was once seen as a vital part of the mental-health-care continuum—an intermediate step between outpatient therapy and psychiatric hospitalization. That consensus began to unravel in 2020, when one celebrity transformed her personal story into a national crusade.
That year, Paris Hilton released the documentary This Is Paris, alleging that she had been abused in the 1990s at Provo Canyon School, a Utah-based residential treatment center. Her shifting, unverified claims were accepted uncritically by the press. The story went viral.
Hilton soon branded herself an activist and vowed to dismantle the “troubled teen industry.” She built a following of self-described “survivors,” whose campaign is aimed not at reform but at the total abolition of residential care—with no clear alternative for the young people and families who still depend on it.
Leveraging her fame, Hilton began lobbying lawmakers. By her own reckoning, she has helped shape and pass at least 12 state laws and has inspired a federal bill—the Stop Institutional Child Abuse Act—which President Biden signed during his final month in office. The act pledges to commission a national study of residential treatment programs—the only provision to survive after Hilton’s more ambitious federal reform package failed to gain bipartisan support.
Since Hilton’s advocacy began, attacks on residential care have intensified. Documentaries, podcasts, exposés, and emotionally charged government and advocacy reports have driven a new narrative: that youth treatment centers are unregulated, profit-driven operations that mislead parents into institutionalizing mildly disobedient children—and where abuse is the rule, not the exception.
The reality is more complex.
Residential care includes a range of licensed programs—from wilderness therapy and therapeutic boarding schools to group homes and secure psychiatric facilities. The most intensive settings serve high-acuity youth who can’t be safely treated at home or in the community. These youth may be suicidal, psychotic, emotionally dysregulated, or involved in violent or criminal behavior. Other programs focus on issues like substance abuse, eating disorders, developmental disabilities, or trauma from sex trafficking.
An estimated 70,000 youth enter residential treatment centers each year, with about 85 percent referred through child welfare or juvenile-justice systems. Others are placed by families using private pay, insurance, or school-based support.
States regulate these programs, though oversight varies. Those receiving Medicaid must meet federal standards, and many seek independent accreditation. The field is diverse, with wide variation in treatment models, therapeutic approaches, and quality. Some programs have drawn valid criticism, while others are well regarded and offer services that families often can’t find elsewhere.
The question isn’t whether harm has occurred—every child-serving system has cases of abuse or neglect—but whether the entire sector should be defined by those incidents and what happens when families are left with nowhere else to turn.
Many lawmakers have never paused to ask. Instead, they have responded to emotional appeals and passed sweeping reforms that have sharply reduced access to care. As residential capacity shrinks, other public systems are left to manage youth they weren’t designed to serve.
No state has felt the consequences—or the controversy—more than Utah. Long the epicenter of youth residential treatment, it has housed more than 100 programs over the years. A strong professional community formed around the industry in Utah. Today, that community feels the backlash more acutely than most.
People like Tony Mosier were caught off guard. He began his career at Provo Canyon School in the early 2000s. Though he didn’t witness anything that he would call abuse, he did see a rigid behavioral model, too focused on control and ill-equipped to address the underlying causes of behavior. He thought: we can do better than this.
In 2005, he cofounded Telos, a residential program for boys in Orem that integrates athletics and physical activity into a trauma-informed therapeutic model—an approach that recognizes how past trauma shapes behavior and that emphasizes trust and emotional regulation. Over the past two decades, it has served more than 1,000 students through its flagship program, Telos Academy, where the average length of stay is eight to ten months, typical for initiatives of this kind.
Today, Telos operates two campuses and offers various services: mental-health and substance-abuse support, highly structured care for kids with serious behavioral challenges, a short-term coed program, and a transition program for young adults. It holds national accreditations, maintains a strong compliance record, and allows unannounced parental visits as part of its commitment to transparency.
Mosier spent years building an institution that he could stand behind. But after Hilton’s activism took hold, public perception shifted—and the last few years have been tough. “I used to be proud to tell people what I did,” he said. “Now I keep it vague.”
When the backlash began in 2020, Mosier was president of the National Association of Therapeutic Schools and Programs (NATSAP), a professional organization representing licensed residential and wilderness initiatives. He reached out to Hilton’s team with an offer to collaborate—inviting her to speak at conferences, join NATSAP’s board, and help improve the field from within. The response didn’t come from Hilton herself but from a cofounder of Breaking Code Silence, the activist group that she helped launch. The answer was no; they would continue their adversarial approach. The phrase they used, as Mosier recalls, was that they still wanted their “pound of flesh.”
The industry that Hilton and her allies rail against is mostly a relic. More than two decades ago, the programs of greatest concern closed down, and the remaining ones largely shifted from behavior-modification models to trauma-informed, relationship-based approaches. Wilderness programs have evolved, too—shedding their boot-camp reputations and emerging as some of the most effective interventions available. Even Provo Canyon School changed with the times and remains a reliable placement for high-acuity youth.
Yet activists continue to treat the field as if nothing has changed. Those working in residential care have been doxed, defamed, and harassed—even labeled “murderers,” “child abusers,” or “traffickers.” Some have received death threats, including against their families. Several programs have faced bomb threats, and some individuals have had their homes vandalized. These incidents have occurred nationwide, according to accounts from staff and providers in several states.
Online reviews of residential-care facilities are often flooded with coordinated one-star ratings—many from individuals who, based on timing and content, appear never to have attended. Parents are discouraged from seeking residential care, and insurance companies have grown increasingly reluctant to approve placements. These pressures have strained organizations and contributed to closures. NATSAP’s membership dropped from 164 programs in 27 states in 2020 to 89 today, despite programs being held to high standards through independent accreditation and outcome-driven data collection.
Many in the field are now afraid to speak up. Three dozen people spoke with City Journal only on condition of anonymity, citing safety concerns. Some have changed careers under pressure. Though the cost of silence is high, many believe that the cost of speaking out is higher still.
Some have tried. According to a NATSAP representative, dozens of op-eds from program alumni, parents, and professionals have been submitted to Utah newspapers, but editors routinely reject them, often saying that they aren’t newsworthy. The result is widespread misunderstanding about what residential treatment is, what it does, and whom it serves.
Judging by the headlines, one might think that abuse is rampant. But these stories are often stripped of context; actual incidents are rare relative to the number of youth served. Professionals in the area, including those at NATSAP, recognize that when one program fails, it erodes trust across the system. That’s why many have supported stronger oversight to ensure accountability—but they’ve largely been excluded from shaping the reforms.
After filming her documentary, Hilton began working with legislators to draft bills targeting the industry. Her first to pass was SB 127, a 2021 Utah bill sponsored by Republican State Senator Mike McKell, a personal-injury attorney with no mental-health background. Despite its sweeping impact on youth residential care, the bill advanced without provider input; providers were notified only at the last minute, and their warnings were ignored. Among its provisions, the bill sharply restricted interventions such as seclusion and physical restraint—now widely equated with abuse.
That perception distorts reality. Seclusion is often used to give dysregulated children space to calm down—a noncontact intervention meant to prevent escalation. Restraint is an emergency measure, already tightly regulated, used when children pose an immediate threat to themselves or others. Under the new law, these interventions became so restricted that many programs could no longer safely serve the youth they were designed to help.
The result has been a quiet crisis: more teens with severe behavioral and psychiatric needs are being turned away. A recent survey by Voice: Utah, analyzed by an independent consultant, gathered data from 19 licensed programs across the state. Between 2019 and 2024, rejections due to safety concerns rose 78 percent. At Youth Care, one of Utah’s largest facilities, 571 teens were turned away in 2024 alone.
With fewer programs able to serve these youth, the burden has shifted to systems ill-equipped to handle them. Reports to law enforcement rose by 220 percent, according to the survey. Juvenile detention centers are absorbing more high-acuity cases. Youth homelessness has surged—often when families reach a breaking point. In 2024, Primary Children’s Hospital reported boarding 169 out-of-state youth in its emergency department—some for days, others for weeks or even months—while they waited for placement.
This comes amid an unprecedented youth mental-health crisis: suicide is now the leading cause of death for children aged ten to 17 in Utah. Survey respondents reported that self-harm, including suicide attempts, increased by 349 percent, while critical incidents rose by 77 percent.
Staff injuries from student assaults rose 139 percent, according to the survey. At Discovery Ranch, average annual staff injuries requiring medical attention rose by 344 percent after SB 127 took effect. At Havenwood Academy, assaults on staff now lead to monthly ER visits and cause four to eight concussions per year. In one recent two-week span, seven windows were smashed on campus.
High staff turnover has long challenged residential care, but a recent spike in abuse allegations has intensified the problem. In Utah, reports against residential staff nearly doubled from 2021 to 2022 and have remained high, according to the Division of Child and Family Services, even as substantiations remain low and continue to decline. Many allegations appear retaliatory or stem from misunderstandings about what constitutes abuse.
Even as activists push for new restrictions, some states are rethinking their opposition to residential care. Michigan offers a clear example. After limits on restraint and seclusion took effect in 2021, providers reported rising violence, staff injuries, and difficulty managing high-acuity youth. At Wedgwood Christian Services, staff assaults rose 64 percent, and hospital and police interventions jumped over 400 percent. At Spectrum Juvenile Justice Services, staff injuries rose 153 percent. As regulatory pressure mounted, contracted residential beds had fallen from 1,200 in 2020 to 423 by 2025. In a 2025 hearing, lawmakers described “catastrophic failures” and called for urgent action.
Oregon is also reversing course. In 2021, the state passed SB 710 (again supported by Hilton), which restricted the use of restraint and seclusion in youth settings. It became a flashpoint for providers already strained by broader reforms. Since then, staff injuries have risen, and more youth are being discharged from programs. Foster and residential placements have dropped 60 percent. According to Representative Emerson Levy, central Oregon now has no residential beds, and in 2024 alone, 110 children were boarded in emergency rooms. Youth suicide rates in the region are now twice the state average. In response, the state introduced HB 3835, a bipartisan emergency bill that clarifies definitions of restraint and seclusion, streamlines investigations, and expands placement options. The bill has advanced through hearings and awaits a House vote.
Utah, however, is continuing to build on previous legislation. In 2025, the state advanced SB 297—again developed by Hilton and sponsored by Senator McKell—to reinforce SB 127. During a February hearing, McKell cited the deaths of seven teens in congregate care since 2021 as justification, but the Utah Department of Health and Human Services clarified to City Journal that six youth died in these settings between 2016 and 2024. Media reports have linked three of the deaths to medical complications and three to suicide. Utah’s licensed congregate care capacity is nearly 5,000 beds, and roughly 3,000 out-of-state youth are placed in the state’s congregate facilities every year. Assuming that 3,000 to 5,000 youth are served in these settings annually, the suicide rate between 2016 and 2024 appears to fall between 0.7 and 1.1 per 10,000 youth per year. For context, a 2017 meta-analysis found a suicide rate of 15.8 per 10,000 among adolescents discharged from psychiatric hospitals—a high-risk group comparable with those admitted to residential treatment.
Framed as an oversight measure, SB 297—like its predecessor—was drafted without provider input. Its original version introduced redundant safety protocols and gave the state more control over admissions, limiting access for out-of-state youth and raising treatment costs for families.
This time, however, the residential treatment community was ready. Alumni, parents, program directors, and staff packed the state senate hearing room, wearing green ribbons for mental-health awareness. For years, the industry had stayed largely silent at public hearings, wary of backlash. But SB 297 marked a turning point. Despite short notice and limited time to testify, they showed up to be heard.
Justin Levine, a Telos alumnus, was among them. At 15, he looked like a success story—straight-A student, decorated track athlete—but beneath the surface, he was gripped by anxiety, intrusive thoughts, and perfectionism so severe that a single bad race could unravel him. Eventually, he gave up trying to meet expectations and began acting out, engaging in criminal behavior. He was arrested, charged with a felony, and briefly held in juvenile detention. In his words, he was “bent on self-destruction”; he believes that, without intervention, he would have spiraled into addiction or worse.
His parents intervened—first with wilderness therapy, then Telos. There, he found the structure and support to begin real change. He rediscovered his love of running—not as a metric of achievement but as part of healing. Today, at 27, he holds a neuroscience degree and helps lead the neuro-fitness curriculum at Telos. “I wouldn’t say I’m a survivor,” he told lawmakers. “I’m a thriver.”
Meg Ortiz also testified—alongside her father, Scott Dixon, who left his job to become a teacher at Telos, inspired by the role that residential treatment had played in his daughter’s recovery. “I genuinely would not be here without the help of these facilities,” Meg, now 25, told lawmakers. Today, she’s happily married, a successful wedding florist, and an award-winning mental-health advocate.
Until that hearing, Utah lawmakers had heard only from self-identified survivors of residential care. Meg and Justin were the first to testify publicly about what it means to survive because of treatment.
Some activists mocked the ribbons worn at the hearing, and both Meg and Justin were harassed online afterward. But speaking up for treatment was worth the trouble. For the first time, people working in the treatment community were invited to collaborate on a bill. Senator McKell met with them, took their concerns seriously, and made substantial revisions. A second hearing was held in March, and the revised measure passed with broad support.
In May, a new law took effect, imposing penalties for filing knowingly false child-abuse reports. That same month, McKell accepted an invitation to visit Telos. He toured the campus, sat in on a classroom, fielded questions from students, and spoke candidly with team members. His visit may mark a turning point in the dialogue between lawmakers and the treatment community in Utah. However, when reached for comment, McKell questioned the motivations behind this article and speculated—without basis—about possible financial ties between City Journal and the treatment industry. He also withdrew permission to use a photograph taken during his visit to Telos. The exchange underscores the lingering mistrust that continues to hinder collaboration between providers and lawmakers.
For all its imperfections, residential treatment remains one of the few settings capable of stabilizing youth who can’t be safely served elsewhere. But this form of care is in steep decline. In a new Manhattan Institute report, I address the dominant anti-treatment narratives now shaping public opinion and policy and call for a more data-driven understanding of the field—one that distinguishes outdated practices from today’s clinically grounded models.
That course correction is urgently needed. The U.S. faces a youth mental-health crisis—one that demands more treatment options, not fewer. From 2009 to 2019, pediatric hospitalizations for suicide attempts and self-injury rose 163 percent. The youth suicide rate increased nearly 50 percent between 2011 and 2021. One-third of kids accessing mobile crisis services are repeat users; more than a quarter of those visiting the ER for psychiatric emergencies return within six months. These are precisely the individuals who benefit most from long-term residential care.
What’s happening now across the U.S.—boarding children in ERs, placing them in shelters, sending them home without adequate support—isn’t a solution. It’s what happens when lawmakers act first and ask questions later. If ideology continues to override evidence, it’s the most vulnerable youth who will pay the price.
Top Photo: “I genuinely would not be here without the help of these facilities,” said Meg Ortiz, 25, who tried to end her life when she was 15.
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