Across the country, teenagers with mental-health issues who need placement in secure residential treatment facilities are instead being held in juvenile detention because no treatment beds are available.
That is the central finding of a new bipartisan investigation led by Georgia Senator Jon Ossoff and Virginia Representative Jen Kiggans. Juvenile detention facilities in 25 states reported incarcerating youth who were awaiting placement in psychiatric residential treatment or other structured therapeutic settings but remained in custody because those placements could not be secured.
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The lack of placements tracks with a long-term decline in the number of residential treatment facilities and beds. Since 2010, the number of residential treatment centers in the United States—programs that provide 24-hour structured care for adolescents with serious mental-health conditions who cannot be safely treated through outpatient services alone—has fallen by 60.9 percent, and the number of beds has declined by 66.2 percent.
That contraction reflects a sustained policy shift away from residential care and toward community-based alternatives—a direction lawmakers are now seeking to accelerate through additional federal reforms.
Adult deinstitutionalization followed the same theory. States closed psychiatric hospitals on the promise that community services would replace them, but the promised infrastructure never materialized at sufficient scale. Many adults with serious mental illness instead ended up homeless or incarcerated.
The findings of the bipartisan detention report suggest that youth mental-health policy is now producing a similar result. As residential treatment options disappear, juvenile detention is absorbing adolescents who cannot secure placement elsewhere.
That dynamic is visible in Utah, long a national hub for private residential and wilderness-therapy programs, offering nature-based therapeutic interventions for struggling teens.
A longtime wilderness-therapy professional who requested anonymity because he currently works in the state’s juvenile justice system told City Journal that he sees evidence of the pipeline from residential treatment to detention every day. In his estimate, roughly half of the youth in his facility had been in private residential programs before arriving in custody—typically after violent incidents that raised safety concerns at these programs.
He described one recent case in which a youth at a residential program was transferred to detention after choking a female staff member unconscious. In the past, he said, such youth would have remained in secure treatment settings with staff trained to manage violent behavior. Now many are discharged after serious incidents because programs are no longer permitted to use certain physical restraints during violent episodes.
He identified Utah’s SB 127 as a turning point. The 2021 law limits when and how staff in residential and wilderness programs can use physical restraint. SB 127 was the first bill championed by Paris Hilton after she launched a national campaign against what she calls the “troubled teen industry.” Through media appearances, lobbying, and testimony, Hilton framed residential treatment as abusive in its design. In the anonymous juvenile justice worker’s view, lawmakers accepted this premise and codified it into policy.
After SB 127 passed, he said, staff injuries increased dramatically, many employees left private programs for positions in state-run juvenile detention centers where intervention authority is clearer and compensation more stable, and numerous wilderness and residential programs shut down. Others stopped accepting adolescents with a repeated history of violence. As capacity contracted and admissions narrowed, the youth did not disappear—they went to detention.
The Ossoff–Kiggans investigation confirms that this problem is not limited to Utah. Seventy-five facilities across 25 states reported holding youth eligible for release to residential or other mental-health programs but remained detained because no placement was available, sometimes for extended periods. Some facilities acknowledged detaining youth with minor charges or no charges at all simply because no appropriate treatment setting existed. Others reported keeping children in custody even after their cases were resolved for the same reason.
Most of the responding facilities described the cases cautiously, referring to youth as “awaiting placement.” One facility in North Dakota was more direct, writing that there is “no secure and safe public placement option for mentally ill youth who have violent outbursts . . . and so they come to corrections.”
These findings come amid a series of state legislative changes over the past five years that have imposed new limits on restraint and seclusion, expanded reporting mandates, and increased legal exposure for residential providers. Paris Hilton has publicly claimed credit for helping shape and pass nearly 20 state laws and two federal bills targeting youth residential facilities.
That same framework now underlies proposed federal reforms. On December 18, 2025, Oregon Senator Ron Wyden, the ranking Democrat on the Senate Finance Committee, introduced the BRIDGES for Kids Act in response to the committee’s 2024 “Warehouses of Neglect” investigation, which claimed that abuse risks are “endemic to the operating model” of residential treatment facilities. My Manhattan Institute analysis found that the investigation drew sweeping generalizations from isolated incidents and ignored evidence showing that substantiated cases of abuse are rare.
The BRIDGES Act seeks to “divert youth from institutional settings” by offering states a 90 percent federal funding match for home and community-based services, while imposing new reporting requirements, inspections, staffing mandates, and financial penalties on youth residential treatment facilities. Those mandates raise operating costs, increase insurance premiums, and heighten legal risk for programs that already operate on thin margins. At the same time, the bill directs millions of taxpayer dollars into community programs that are not equipped to manage violent psychiatric crises, leaving families with fewer options and rising costs.
The policy direction of these efforts is clear: reduce residential treatment and rely more heavily on community-based care. For more than a decade, federal and state reforms, including the Family First Prevention Services Act, have redirected funding on the assumption that outpatient services would absorb the need.
The data suggest otherwise. A recent national study found that while 94 percent of states reported declines in the number of youth receiving care in residential psychiatric facilities, and 79 percent reported declines in the number of youths in in-patient settings, there was no corresponding increase in youths receiving outpatient care. In fact, 81 percent of states saw reductions in the number of youths using outpatient psychiatric services during the same period, with average declines exceeding 50 percent.
When both residential capacity and use of youth outpatient services decline, adolescents in crisis do not disappear—they often end up in emergency rooms, homeless, or, as the Ossoff–Kiggans investigation confirms, sitting in juvenile detention while awaiting treatment.
If lawmakers continue to treat residential care itself as the problem even as capacity is collapsing, detention will remain the system’s default answer for youth who need secure, structured mental-health treatment.
Photo by Jahi Chikwendiu/The Washington Post via Getty Images