Thousands of miles from his Palo Alto home, a former Paly student folds his tent, shoulders his day pack and sets off on his daily trek to a new campsite. For almost three months, he’s lived enveloped by nature in the heart of North Carolina’s wilderness as part of the Trails Carolina substance abuse therapy program. Deprived of all but his most basic needs, he reflects on his recent behavior with a mix of disappointment, regret and shame.

He is just one of many people who has undergone such an experience. In recent years, schools across the nation have experienced an unprecedented spike in the prevalence of mental health disorders — one in five teenagers is diagnosed, according to Health and Human Services. These issues often permeate every aspect of one’s life, from health to academics to relationships.

According to Paly Wellness Outreach Worker Angelina Michael, some students are able to manage less severe issues with support from their community and campus therapists; others, however, require drastic changes in their lifestyle.

“It’s really hard to get the type of mental health support that you need if it (falls outside of) the scope of our school (services), which are really limited,” Michael said.

Rehabilitative facilities can fill the gap between students’ issues and those covered by school services. These issues range from anorexia to drugs, as in the Paly alumnus’ case.

Although some students may not report their personal issues to the school, the Wellness Center has a protocol for when they do. If it becomes apparent that a problem is beyond the breadth of the Wellness Center, faculty usually refer students to independent organizations. The Children’s Health Council (CHC), one such organization, provides therapy and other counseling services to students.

“I think people that are struggling just need a lot of support and in a non-judgmental way. I think it’s critical to let young people know that there are adults that really care and that want to support them and help them through a really, really difficult time.”

Ramsey Khasho

Khasho said this support manifests itself in a variety of ways — often, CHC refers students with substance abuse  problems or anorexia to consulting firms such as the Bodin Group. Douglas Bodin, who founded the Bodin Group in 1979, works with his team of education and therapeutic consultants to combat high-risk mental health disorders.

According to Bodin, while the firm encounters a multitude of issues, children most commonly struggle with substance abuse of tetrahydrocannabinol (THC), the main psychoactive ingredient in marijuana. Still, Bodin maintains that every patient requires a unique approach — his team makes it a priority to connect with each individual to develop personalized strategies.

“When a family hires us, we then need to go through what I call (a) mutual education process, where we educate them about the options,” Bodin said. “Sending (students) somewhere without a cohesive plan doesn’t work, so our job is to become a planner.”

According to Khasho, the addictive nature of certain substances can result individuals developing many debilitating issues.

“(Students) get into the cycle of using (substances) to cope with difficult feelings or experiences, and then it just becomes a vicious cycle … that needs to be addressed,” Khasho said.

This was certainly the case for the Paly alumnus, who said he struggled with substance abuse disorder throughout high school.

“Paly is a pretty harsh environment for a lot of people, which puts a lot of pressure on students to do well and compare themselves to others, and a lot of the time that results in drug use (as a form) of release,” the Paly alumnus said.

During his junior year, his substance abuse disorder began to impact his life significantly, and his parents urged him to seek treatment.

“Throughout my junior year, I cut a lot of classes to go and smoke and tried a couple other drugs,” he said. “I was barely ever at home, so my parents decided that I couldn’t keep going like that.”

In April 2018, he left Paly to attend Trails Carolina, a North Carolina-based wilderness therapy program designed to help students overcome substance abuse and foster healthier relationships.

“(The) wilderness is sort of like a rude awakening, where you realize how bad all of the s— you were doing was. It deprives you of everything except for the most basic things like food and water, and you spend all of your time in nature figuring your s— out and talking to your parents (on the phone).”

Paly alumnus

He currently attends boarding school at New Summit Academy Costa Rica, which specializes in teaching students who are recovering from substance abuse. He said the relaxed environment of the school gives him valuable time to reflect on his behavior and plan for his future.

“I don’t think anybody fully ‘recovers’ because addiction is always a part of your life,” he said. “You can obviously make progress and have a better understanding of your limits and how it affects you, but not (trying harmful substances) again is really challenging for anybody.”

He said his experience in treatment has not only helped him cope with substance abuse, but also develop emotionally.

“(Treatment) definitely benefited my life in that I know how to handle myself and make better decisions instead of only ever smoking, but I can’t say for sure that I’ll never do it again,” he said. “I do know how to deal with it properly and prevent it from affecting my life negatively, though.”

While his parents significantly influenced his decision to seek treatment, many students learn about their treatment options in other ways. Audrey, a current senior whose name has been changed to protect her identity upon her request, said doctors played a more major role in her experience treating anorexia.

According to Audrey, her condition developed from consuming an insufficient amount of calories and nutrients to self-induced vomiting in the summer between her sophomore and junior year. Her concern grew after she fainted twice due to orthostatic hypotension, a form of low blood pressure.

After another student in her regular therapy group mentioned their struggle with anorexia, Audrey grew concerned and made a confidential doctor’s appointment at Palo Alto Medical Foundation (PAMF).

“California has a law that states that all minors are entitled to a confidential doctor’s appointment, and so you can see a doctor without your parents ever knowing,” Audrey said.

PAMF Scheduling Representative Jordan Mincarelli said employees are prohibited from disclosing information about minors’ confidential appointments, even to patients’ parents, under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

“The doctors (are) the only ones who have authority to release things like that regardless if it’s confidential,” Mincarelli said. “If it does become serious, then it is up to the doctor.”

According to Audrey, after telling her doctor about her recent behavior, she was diagnosed with anorexia nerviosa, an eating disorder characterized by extreme weight loss and difficulty maintaining a healthy body. Audrey said her doctor informed her psychiatrist of the condition, who in turn explained the situation to Audrey’s family.

“She (said) ‘this is a real problem,’ and then the devastating part was she couldn’t keep confidentiality, which was the whole point,” Audrey said.

According to Audrey, she dreaded discussing her eating disorder with her family at the time, to the point where she left the room before her psychiatrist began discussing her anorexia with her family.

“I think (my mother) was really confused (when the psychiatrist told her about my disorder),” Audrey said “I don’t think it really like settled into her mind that I had a real problem.”

After several weeks of discussion, Audrey began attending an intensive outpatient program at the Healthy Teen Projects (HTP) for up to five hours each day. Audrey said each session included a variety of activities such as art projects, mindfulness exercises and yoga.

According to Audrey, the activities, while occasionally therapeutic, were not as valuable in comparison to the emotional support provided by the staff and patients on a daily basis.

“The girls there knew exactly how I felt, and that was something I’ve never experienced before,” Audrey said. “They knew every single thing that I was afraid to say — things that someone without an eating disorder just wouldn’t understand.”

The treatment, however, was cut short when Audrey’s insurance provider suddenly informed her that they would no longer cover the $1,000 to $5,000 cost for each day of treatment.

“I wasn’t even close to remission or anything,” Audrey said. “I think the excuse that insurance gave us was I hadn’t thrown up for the month that I’d been there.”

Audrey said she reacted erratically to leaving treatment on her last day, sparking concern among the HTP staff.

“I just completely freaked out, and they thought it wasn’t safe for me to go home,” Audrey said. “So they just sent me straight from the treatment center to the hospital.”

The HTP staff placed Audrey at the Mills-Peninsula Medical Center, where she underwent an involuntary assessment and evaluation under California Code 5150, which takes patients into custody at a specialized facility for up to 72 hours if the patient is considered to be a danger to themself or others as a result of a mental health disorder. Audrey said she spent a total of four days at the center after the psychologist recommended she remain for an additional day beyond the standard 72-hour stay.

According to Audrey, this time allowed her to reflect on her experience in treatment and its effects on her life.

“I felt really supported by the other patients there and by the staff,” Audrey said. “I think the worst part was coming home every night, because at home… I lost all that support, even though (I knew) I was going back the next day.”

Audrey said the support system established during her time in HTP and at the Mills-Peninsula Medical Center was integral to her eventual remission.

“I mean, (it) was the right choice to go to treatment,” Audrey said. “I didn’t know how affected I was (by anorexia) and how awful my life was.”

While the child is at the center of the treatment programs, the process can have an equally profound impact on the parents. Jane, the mother of a former Paly student whose name has been changed to protect her identity upon her request, watched her son participate in treatment for his substance abuse disorder.

Jane said she noticed changes in her son’s behavior after he transferred to Foothill Middle College, where Jane said older students influenced him.

“He pretty much stopped going to class, and his whole life was about smoking pot,” Jane said. “So, my husband and I decided that that was not an acceptable thing to do, and hired Bodin to get an idea of what our options were.”

According to Jane, she sent her son to Aspiro, a wilderness therapy program and then a therapeutic boarding school. Jane said she sent her son to treatment without hesitation, knowing he would receive the help he needed.

“It’s like when you have a problem that you have been thinking about for a long time, and you make a decision,” Jane said. “You know it’s the right decision, and you feel relieved.”

Despite this, she recalls some of the difficulties of seeing her son leave home.

“You feel guilty, wishing you had done things differently so that this hadn’t ended up happening,” Jane said.

Bodin said underlying issues of a patient’s family dynamic are common and addressed by successful experiences in treatment.

“A lot of people try to point fingers at parents, but that’s not usually the case. Usually parents are doing the best they can, and the kid gets unlucky and falls in with the wrong crowd. It’s their friends, who they are exposed to, and their depression and they start smoking weed, and it’s off to the races.”

Douglas Bodin

According to Bodin, however, a high pressure environment and a patient’s friendships rather than parents’ actions play a significant role in the prevalence of certain substance abuse issues.

“Being in the shadow of Stanford itself has got to be difficult,” Bodin said. “So if you think about the anxiety it creates for kids, and the fact that THC relieves anxiety for a minute, it’s going to become appealing.”

For the first couple weeks, Jane said she had no communication with her son, but as the program progressed, it became more frequent. However, both parents maintained constant communication with their son’s therapist throughout the program.

“We would talk on the phone with (the therapist) and go over things,” Jane said. “Some of it was just logistical — they had been hiking different places, and they would send pictures for awareness of what was going on.”

However, treatment programs are not solely focused on the children; many parents also go through programs to help themselves throughout the process.

“We need to make sure parents are also getting their needs met because, more often than not, we want the kid to be able to return home,” Bodin said. “So the family has to get healthier too. If the parents aren’t doing their work, it is going to be harder for the kid to return home successfully.”

Treatment centers, as well as consultant offices, often offer therapy or support groups for parents to help alleviate the issues they experience.

“Families come out for family events, multi-family therapy events, and connect with other families who are in similar situations,” said Kreg Edgmon, director of Catalyst Residential Treatment Center, the therapeutic boarding school that Jane’s son attended.

Edgmon said students’ behavioral changes result from the nurturing environment and positive reinforcement cultivated at treatment facilities.

“Kids are kind of getting all of their needs met,” Edgmon said. “They’re living there in a supportive atmosphere attending school full time while also getting therapy and they have well balanced meals… with a lot of fun activities.”

Jane said she noticed tremendous progress when her son returned home from Catalyst.

“(There was) just an amazing difference, like even in that short period of time,” Jane said. “You’re stuck in the wilderness and you learn to do hard things. He was a lot calmer, more organized, more focused and a lot more confident.”

Jane said that despite these positive changes, she was unprepared to face the fact that her son would never live at home again.

“One thing they don’t tell you is that your kid’s probably never coming back,” Jane said. “If you think about sending your 16-year-old son away, and he may never come back or live at home again, it’s a weird thing to think about.”

According to Edgmon, many students retain the benefits that they gain from treatment. Although some will experiment with drugs again at some point, they will be able to use the lessons that they learned in treatment to prevent themselves from relapsing.

In addition to learning how to prevent themselves from relapsing, students gain insight about their own capabilities.

“Probably the biggest takeaway from this therapeutic stuff was letting your kid know that they can do hard things, because a lot of times they don’t think they can,” Jane said.

According to Edgmon, developing these skills can have a profound impact on students’ lives.

Edgmon said, “It’s pretty common for students to report that the whole experience saved their life.”

Update: The name of the Paly alumnus source for this story has been removed at his request.