Beyond protecting assets, wealth managers and family office professionals often tackle complex crises like mental health and addiction, which can deeply affect entire families. In affluent families, these challenges are often magnified by additional layers of complexity. For further insights, we asked Arden O'Connor, founder of Intent Clinical (formerly O'Connor Professional Group), to weigh in. Intent Clinical provides customized care and support for individuals, families, and organizations facing various challenges, including mental health, addiction, dementia, autism, eating disorders, and more. The transcript has been edited lightly for clarity.
Q. It certainly seems like mental health issues are more prevalent now than before. Is that actually the case? Or have we, as a society, become more aware of the mental health crisis in America?
Arden O'Connor: I think it's a bit of both. It is true that there is more of a mental health crisis than prior to the pandemic. The Journal of the American Medical Association (JAMA) health forum records 38% more people receiving health care—specifically, mental health care—than prior to the pandemic. We also know there are pretty alarming stats with adolescents. If you look at 14- to 17-year-olds, suicide is the second leading cause of death within that demographic. So, there is definite evidence to suggest that it is more significantly impacting the country.
However, from the perception standpoint, I think what the pandemic allowed people to do is read about mental health, substance use, etc., topics that have previously been siloed to medical journals or psychological pieces that psychiatrists read. But now we saw coverage in the Wall Street Journal, in the Boston Globe, and mainstream media publications. So, in addition to higher statistics, I think we also see more general awareness. And the benefit is there's a little bit of a reduction in stigma related to people accessing care.
Q. If you have a loved one who you are concerned about, are there early signs that indicate when it might be appropriate to seek professional help?
A.C. It can be tricky because a lot of the signs mirror symptoms that could be dismissed as, “Boy, this person is just overworked or tired.” The interesting part about mental health is that we use a lot of terminology in daily discussion, “I'm depressed. I'm anxious.” But people don't necessarily mean, “I'm clinically depressed.” They just mean they're generally feeling blue. But there are patterns that we see when the struggle is more than episodic.
Things like, is it impacting their functioning? Can they not attend work, go to school? Are they less engaged in those activities than they were before? Are things not bringing them joy? Did they previously enjoy spending time with children, animals, outdoors, exercise—whatever it might be—and then suddenly those things aren't bringing the same amount of enjoyment?
Things like impacting sleep and eating behaviors. Do we see any type of crisis? So, somebody who has a mental health episode where they wind up in the hospital. Did someone wind up in a DUI or some kind of car crash due to using a substance? Those are obvious flags that something is going awry.
Are the behaviors existing for a longer period of time? Again, if we have somebody break up with a boyfriend and they're upset just over a course of a couple of days, that's understandable. But if after two or three weeks, they're still having trouble sleeping, they're not really attending work or they're not as engaged as they previously were. Or perhaps they're still overusing a substance or they're using maladaptive coping strategies—they’re sleeping too much, eating too much, spending too much money. Those are signs that this is a more significant issue.
Q. If you're noticing this behavioral pattern, what are some of the first steps that you can take either as a family member or as a professional advisor?
A.C. I think it depends on which role you're in. If you're a family member, we often recommend an approach using, “I” statements. Not saying, “You are worse than you were. You look terrible.” Because nobody responds well to what they interpret as judgment—particularly people who feel like they're not doing well. But if you can say, “I am concerned. I want you to be healthy.” Language that's centered around that person's mental well-being and stressing that you want to be supportive. “Can I help you with this? Is there something you need?” One of the tricky parts about mental health care, and most families that we work with will report this, the person oftentimes won't acknowledge that they don't feel well. Or they'll say, “I don't feel well, but I don't really want to do anything about it.” That's a separate topic.
Advisors can do something similar, but oftentimes, in their role, they're not necessarily there to address a mental health issue. So, we frequently recommend starting with something like, “Can I raise a sensitive topic?” That could be to the person themselves or it could be to a family member when you're seeing a pattern of behavior that's alarming.
Q. It's often perceived that with wealth, you can pay for better access or better resources. But there's actually quite a complicated dynamic between wealth and the natural consequences of some of these behaviors. When is having wealth an advantage and when can it be a disadvantage?
A.C. It is a double-edged sword. The advantage is you can literally afford better quality treatment, if it's directed correctly. I'm going to give that caveat. If you Google “luxury treatment” or “best-in-class treatment,” who knows what website you land on. It may not be the best just because it's the most expensive.
But we know that even despite all the laws—the parity laws and all the legislation that's been put into place—mental healthcare and care for things like substance abuse disorders or eating disorders are still funded predominantly out of pocket. And families of means have flexibility in how they receive care. It can be done in the home. They can extend a program for more than the 30 days that insurance typically reimburses. They can afford extra sessions with a psychiatrist, or instead of a social worker. There are lots of ways that they can enhance the efficacy of their loved one's care that are different, frankly, than a family member who has to rely on in-network insurance. So that's the good news.
The complicating factor is making sure you're navigating the system in a smart way. And there are all sorts of resources that can help you do that. The downside, however, is that wealthy families often have people who don't hit what they call “rock bottom” (as they say in AA). Families who have means often can prevent natural consequences from occurring.
Here, I can give an example in my own family, in my brother's case. He had a significant substance use disorder. When he got in trouble with the law, my parents hired two different attorneys to argue the case, he wound up being able to get out of a serious jail sentence and go to a private program that my parents were willing to pay for.
Now, I don't regret that he didn't serve time in prison. I'm not sure that would have helped a substance use disorder or his mental health issues. But I think at the same time, the message he heard is that our family would save him under any circumstances. And many of the affluent families that we serve, that's the message they're sending. That means the loved one can up the ante. There's not always an impetus to get into recovery faster because they don't necessarily feel that if they don't, there's a natural consequence that's going to follow. So, we often see in wealthy families that both the period of time and the severity of the issues are elongated.
Q. You mentioned an alarming statistic about the suicide rate in adolescents. In your experience, do you see that children from wealth have more pressure, more anxiety, more stress? Or is that prevalent across all families?
A.C. We definitely see it. And there have been some studies. For instance, Dr. Suniya Luthar did a study of children with higher socioeconomic backgrounds and found higher rates of depression, anxiety, and substance use. There's been a similar study done at Columbia.
And I think there are a number of factors that go into it. Children from those backgrounds often have higher pressure around issues related to achievement and there's a lot more comparison.
I think the world has become much more competitive. So, if you think about an affluent city like New York and the private schools there and the pressure to get into the best college, the best graduate school. That impacts the mentality of somebody who is 14 years old and perhaps isn't at the top of their grade in terms of their academic achievements, it weighs more heavily.
We also know that the influence of social media can be very challenging. And for a lot of young people, they aren't able to filter in the same way adults do. My simple analogy is if my friends didn't invite me to something when I was a young child, I just didn't know about it. I would find out the next day on the playground and it had already happened, but I wasn't watching something live without my presence and feeling badly about it.
Q. You brought up social media and the comparison society that we find ourselves in today. There's more and more research coming out about the impact of social media on kids. How do you think about kids who are always looking for “likes” on their phones versus kids who maybe don't have phone access and have other activities that pique their interest.
A.C. Well, I think you've relayed one of the most important things. The longer you can delay access to smartphones, specifically, the better. I just heard an author who talked about his recommendation to buy kids “dumb phones” until they're aged 14, 15, 16, and then switch to a smartphone. I think delaying is great. I think one of the questions becomes, what are you replacing the time that kids are on social media with?
And that comes back to modeling behaviors as adults. If Mom and Dad are also looking on their phones the entire time, it's very hard to tell children, “We need to be off our phones and have time for each other at dinner and we're going to sit and talk about your day.” Or if their parents are very sensitive to, “Did you see where so and so vacationed?”—kids really internalize that messaging.
So, I don't think it's realistic that we're all going to go off Instagram and Facebook and all the various social media outlets. But I think it's putting it in context and increasingly encouraging real-life interactions. And that's the world our children are growing up in and will continue to grow up in. And so, I think the question as a parent is, “How do I model better behaviors? How do I encourage them to be mindful and present in the activities they're doing now?” And how do I put in context a disappointing episode—whether it's a full-blown bullying incident, and we have to address it in a more serious manner, or it's something as simple as not being invited to someone's birthday party.
Q. You started to share your family's personal story of addiction with your brother. You've actually shared that in a deeply honest way in a moving film. Can you tell us a little bit more about your family's experience and how that's shaped your perspective?
A.C. I grew up outside of Boston in a wealthy suburb and we were a classic family that had the means to go to private schools and really didn't have a lot of economic hardships that we had to overcome. My last name is O'Connor, so most people can guess that I'm Irish Catholic by descent. And we have a known predisposition towards alcoholism. The running joke at our firm is that we could stay in business just serving the O'Connor family and friends.
My father is 30 years sober. So, we knew in our family system that this was going to be an issue. Very young, very early in life, my brother started experimenting with alcohol and eventually marijuana and cocaine. And my parents took it very seriously given my dad's history. But my brother managed to use pretty significantly throughout his high school years. He was quite smart and was able to sneak it by my parents. Even if they caught him, he was able to do okay in school. So, he didn't have major life ramifications until he got to college and the wheels sort of fell off. And we did what I call a homemade intervention where we showed up on campus and eventually ushered him to treatment a few months later. And that became the first of 13 different programs that he went through.
He wound up getting in trouble with the law, was incarcerated for over a year and then had many, many years of bouncing in and out of over a dozen different rehabs all over the country, but primarily in California. He eventually did get sober, and he had about four and a half years of sobriety. And this is one of the hardest things, not only for our family, but unfortunately, it's not a unique story. He had finished college, was getting his master's degree. He hurt his back and decided to solicit pain pills from a doctor who was not his typical doctor. And he wound up relapsing. And then wound up on heroin and eventually died of an overdose that was fentanyl-laced heroin.
And so, the film is a lot about addiction just as a category and how families deal with it. And what are the recommendations not only of the folks on our team, but other well-known experts in the field. But it also talks about the intersection of wealth because my brother had a lot of things given to him. And in many ways, that probably kept him alive for many, many years. But it also allowed him to reach bottom in a much longer timeframe because it took my parents a long time before they were ready to say, “Okay, we'll pay for a sober home.” We will pay your rent directly, but we're not going to give you any type of cash because of the experiences they had. And it really informed the way my parents approached the process. Our own familial anxiety—and trying to address the dysfunction within our family and trying to access care—was really the basis for creating Intent Clinical.
Q. If you do have a family history, what can be done proactively or even ahead of a first incident? Is there a way to talk to your children about what's gone on in the family and ways that you might be able to prevent even a first try?
A.C. It's a great question. One of the things is thinking through the messaging around prevention and having a strict policy around no alcohol use until you're 21 and no marijuana use. And these are the two areas where we see the most flexibility with parents who say, “Wow, lots of kids experiment with drinking,” or “But everybody's smoking marijuana. I smoked marijuana when I was in my twenties.” The marijuana of today is not the marijuana of many years ago. So that analogy really doesn't hold up.
We do know that both alcohol and marijuana use impact the developing brain. And so it’s important to avoid really permissive policies, where a young person believes, “Well, my parents don't think it's a big deal because this is what they did.” That’s the first message, especially if you have a genetic history. Because we know that sons of fathers who were alcoholics or had addiction issues are far more likely to develop an addictive disorder later. The most compelling statistic I've seen in the past 15 years—it was a direct correlation with our family's experience—was if you start using alcohol by the age of 13, your chances of developing an issue later in life are 49%. If you wait until you're 21, it goes down to 9%. And that's very much my brother’s story. I was a nerd. I waited until I was 21. I don't have a problem. He developed one quite early. So, prevention is the big thing.
At the same time, it’s important to foster open communication, answering questions. We know that the scared straight model of many years ago—scaring kids into trying to be sober, or abstinence—doesn’t work. A lot of the conversation has to be around health, wellness, what you're doing to your brain, how you're going to limit your options later in life. I do not envy parents of teenagers or those in their early college years because distinguishing between significant issues and just problematic behaviors that are somewhat developmentally appropriate is very difficult.
Q. It seemed that your parents did eventually let your brother hit rock bottom, but it took a little bit longer. As parents, how do we know when to let go and when it's actually best for our children to reach rock bottom?
A.C. We don't often tell parents, “Do not intervene at all”, especially parents who have the wherewithal to do so. Partially because that’s very hard advice to follow. If you're a parent who has the means to afford the next treatment center, I think it's almost impossible to say, “Don't pay for treatment.” But there's a big world between absolutely no intervention and cutting out any economic support completely. So, a lot of people respond well to a parent saying, “I'm going to make life difficult.”
An example of that might be a parent paying for a beautiful apartment in New York City. The person is not engaging in anything useful, there's suggestions that they have a substance use and or a mental health issue, but they're refusing any treatment for it. There are options that parents have around relocating them into a more modest living arrangement, paying rent directly, not giving them any cash, giving them grocery cards.
And we've used these strategies with clients, and it does often have an impact. I think what many parents think is, I either cut off everything completely, which is almost impossible to do, or I do absolutely nothing and let the status quo continue. I don't think we have to live in a world of those dichotomies.
That being said, there are some extreme circumstances where we will say, at this point you have tried everything, and I think this person really needs to figure it out on his own. Typically, we try not to do that in cases of mental illness. Because it's much more complicated if the person is unmedicated, the chances they get better just toughing it out are slimmer. And we try to do it in cases where we've tried every legal, every emotional type of leverage and intervention we know.
Q. You've just alluded to some of the ways that you've helped families. You've built your professional practice around helping families achieve better outcomes. What are some of the ways you support families in crisis?
A.C. So, we do interventions. I always like to bring up the topic that interventions don't always look like the TV show on A&E. I think a lot of people's perceptions is that it's always very traumatizing, but our goal really is to help families anywhere along the crisis. Oftentimes, families come to us and we're doing just some family coaching in the beginning via phone, in person, via Zoom, whatever they need to see what they have tried, what's worked, what hasn't worked.
And then if we get to a point where they've tried a bunch of strategies, and it's simply not effective enough, then we may suggest some type of facilitated family meeting. Sometimes we invite the impaired person to the meeting, so it's not a complete surprise. Other times we do need the element of surprise. The other piece is we can send companions and coaches into the home, which give people another option, especially if the person's very resistant to going into a placement. And it's certainly a personalized and intensive level of care.
We are often helping families who are trying to navigate the system. It can be really confusing if you just Google rehab or addiction or mental health support. So, we can help in a variety of ways, but the goal really is to support the family as well as the individual. Lots of our behavioral health system now just focuses on supporting the person with the diagnosis. We also want to make sure families feel like they have a resource to talk to. “Is it appropriate to bring him to the wedding? What do I do if he says [fill in the blank] to me?” And we do a lot of that type of coaching.
Q. So far, we've talked a lot about adolescents. But young people are not the only ones who struggle with mental health issues or addiction. How do you approach the situation when there's an older adult—who may be high functioning, a successful entrepreneur, or an executive—who is struggling?
A.C. Candidly, those are always our hardest cases because these individuals are usually financially independent. They’re not younger people or even older people who are part of a family office where there's a trust involved. In those cases, there's usually some type of financial leverage. But it can be much more difficult to convince somebody who has been very successful, who might be bipolar and unmedicated, that they have an issue if they're not seeing evidence of that.
And there's usually fear with the support system around them about rocking the boat, either getting fired or getting cut off financially or whatever the case may be. I think it depends obviously on the situation, but I think, in general, we're trying to find emotional leverage, which sounds so negative, but where is there an opening?
Has this person experienced success in the past? What did that look like? Did they respond well to exercise? Is there a person in the family system? Maybe they have a contentious relationship with their wife. So, we're not going to ask her to be the one to intervene, but a brother has gotten the person into recovery or has been successful in the past reining the person in.
We've had extreme circumstances where we've had children say, “You're not going to have access to your grandchildren until I can be assured that you're sober because I'm not comfortable with what happened at the last family gathering.”
It's often trying to find what is the thing that is going to motivate that person externally until they get into a better place mentally where they develop that internal motivation. We really want people to get to a point where they're really thinking about how they can support themselves better, but sometimes it takes an external lever to get them there.
Q. These diagnoses can have a ripple effect through the entire family. So how do you support the entire family system and not just the individual?
A.C. I mentioned family coaching. We do a lot of education with family. Sometimes we'll have a family that has a diagnosis that is genetically inherited. So, there's multiple members of a family with bipolar, multiple members of a family with substance use or another diagnosis.
A lot of it is, here's what it looks like. If you have this, here's what it means. What are the medication options? Things to watch out for.
With family members, it's also understanding and giving them a space to share their own frustrations. Within our family system, when my brother, Chris, was in the middle of some of his problematic behaviors, my other brother would become frustrated and say, “There's no oxygen in the room to discuss anything else because all of our emotional energy is being pointed toward Chris.”
And so, whether it's finding therapy resources, giving them a coach, or just a space to air their own frustrations, that can be helpful. And then it's helping parents—or even adult children of older parents who might have dementia or a substance abuse issue—with advice. We explain that the person is not going to benefit from what they're asking for. And I always like to draw that distinction. We get a lot of clients who are quite bright and say, “I will be fine if you just give me [fill in the blank]. I just need to be able to drive my own car because I need that independence.” And that might be what they want, but it may not be what they need. Helping families feel comfortable, distinguishing between the two, and finding a loving but firm way to say, “This is the boundary I'm setting,” is a big part of the work that we do.
Q. You've left us with a lot to think about. Understanding how implementing effective strategies and then leveraging some of the resources to navigate these challenges is certainly a way for a family to move forward. Thank you for joining us and having an open and honest conversation about mental health issues that many families are facing.
A.C. It was a pleasure to have this conversation. I appreciate you bringing some education and light to this issue. If you or anyone you know is experiencing a mental health crisis, you can call the National Association of Mental Illness Helpline at 1-800-950-6264.