Pine River Institute and the Private Pay Paradox

Let's recap what it is we're doing here for a minute: we're trying to bring to life a program that will help families with a troubled youth in crisis navigate and access the mental health care system and its resources. Necessarily, this requires us to have a very thorough and nuanced understanding of what resources are available to our future clients, particularly in Ontario. So, last Friday, I found myself in the backseat of a vehicle on the way toward Shelburne, Ontario for a meeting with the staff and students at Pine River Institute I'd arranged a month prior. I'd heard a range of opinions about Pine River Institute and it was my understanding that it has certainly had its ups and downs in terms of success in its short lifespan. About 18 months ago however, PRI acquired a young, vibrant Clinical Director from the US, previously at a therapeutic boarding school and residential treatment centre in Montana; and she brought the therapeutic model from Montana with her. Since then, the program has essentially started anew, with funded beds fully occupied and a long waiting list to boot.

As the 410 becomes the 10, and the rain and slush covered highways become back country roads with fresh snow-covered trees, the hustle and bustle of the city disappears. With the snow falling and few cars on the road, it's both beautiful and calming. Ten minutes down the windy, woodsy road and a turnoff down another windy, woodsy drive, we pull up in what looks like an old summer camp property. The main building stretches across the lawn, with a cabin housing the gym and signs pointing toward the hiking trails on either side. The property is expansive and the views incredible. All this, and we're only an hour from Toronto. Inside the main building, you're greeted with a warm and inviting environment and by staff and students who immediately smile and say hello. And it is here where former troubled teens are making leaps and bounds toward recovery, maturity and a new sense of self.

On paper, Pine River Institute is a co-ed addiction and mental health residential treatment program for teens aged 13-19 who have an addiction (drugs, alcohol, gaming, disordered eating) and often other problematic features like symptoms of anxiety or depression, self-harming behaviours or suicidal thoughts, low self-esteem, or difficulty with anger management. After a 4-8 week Wilderness/Outdoor Leadership component in Algonquin Park, where teens detox, hash out their frustrations and come to a state of acceptance (all while building fires and pitching tents, canoeing and portaging, hiking, participating in group activities, and talking to therapists), they return to the main campus where they'll live until they're ready to transition home - anywhere from 4-12 months, perhaps longer if needed. The teens here go to school, get two hours of physical activity a day in a myriad of sports and activities, and eat a balanced, healthy (and delicious, if I might say so myself) diet, alongside individual, group and family therapy.

Off paper, the program is something you might have to see in action to really understand. That was the case for me, at least. I'd read all the materials, and heard first-hand from my colleagues who have visited PRI and other similar programs in the US about the nature of the program, but until I saw it for myself, I really can't claim that I understood it going in. Speaking with the senior staff, you immediately understand that they believe whole-heartedly in the approach they're taking. Speaking with the students, you understand it's working. The therapeutic model is centered on emotional development and is heavily relationship-based, the idea being that it is through relationships that you discover your sense of self and the support you need to build the internal structure required to survive when (if) you return to your pre-treatment environment. The program values honesty, integrity, maturity and acceptance. Family involvement is strong. The Clinical Director, Dr. Victoria Creighton, is warm and non-threatening; it is easy to see how teens would respond to her. She and her staff teach maturity; she believes that you have to create a positive peer culture, one of empathy and respect. She also believes that time, and a safe, comfortable, and structured environment are key factors to recovery for these kids. And in talking to them, you'll find that they believe this too. It appears they've internalized the therapeutic model and everyone - students and staff - speaks the same language; the kids we spoke with are painfully honest about their past, but are calm, polite, and very insightful, as well as being positive and engaging. I can honestly say I've never encountered a 17-year old boy who speaks with the maturity and insight I saw in my brief encounter with the boys at Pine River.

Of the 36 beds available, 29 are OHIP-funded by the Ministry of Health and Long-term Care. The waiting list is anywhere from 6-12 months. Not surprising, considering they boast an 80% success rate. What is surprising is that the 7 remaining private-pay beds are empty. Yes, empty, while both parents and OHIP continues to send kids to programs in the US. This is both surprising and disappointing to me - call me naive, but I'm only trying to understand. There seems to be this reluctance to pay for care in Canada and this sense of entitlement that even if and when you can pay for top-notch treatment, you shouldn't have to because health care in Canada is free, right? ("Free"). So assuming that you're going private, even if the opportunity arises for you to send a child to a Canadian institution, people seem to have more faith in the American ones - kids are sent to the US because there's this understanding that because everybody has to pay for care, it's more likely that "you get what you pay for." Better quality, in effect. Now I of course understand that sometimes the situation necessitates American institutions, particularly when it involves issues of consent and compliance, but I'm having trouble understanding why you wouldn't want to send your child to a Canadian program if you had the option and it was appropriate, and I simply can't wrap my head around the fact that OHIP is still funding kids to go to American programs without fully funding a Canadian one.

The argument used to be that there is nothing in Canada comparable to what you find in the US, but now, finally, there is. And it's working. Peer-reviewed outcome data, however, is sparse due to small sample sizes, but considering the waiting list and success rate (and, if you want, consider that there was an American teen in the program), I'd say it's worth at least a reevaluation of priorities by OHIP; and by the rest of us, perhaps a reconsideration of what private pay care in Canada means. Would you?