Wealth and Well-Being: Navigating the Complex Relationship Between Wealth and Mental Health Issues

This transcript has been generated by an A.I. tool. Please excuse any typos.

Stacie Jacobsen: Thanks for joining us today on The Pulse by Bernstein, where we bring you insights on the economy, global markets, and all the complexities of wealth management. I'm your host, Stacie Jacobsen. Over time, especially during and since the pandemic, mental health has become a much more pressing concern for Americans.

In fact, statistics from the World Health Organization reveal a 13% increase in reported mental health disorders over the past ten years. Thanks Nearly a third of all adults in the U. S. reported symptoms of depression and or anxiety in 2023. And in a 2022 survey, 90% of respondents agreed that America has a mental health crisis.

In addition to safeguarding families’ assets, wealth managers and family office professionals are often find themselves grappling with complex and crisis driven situations, such as navigating mental health and addiction issues. These issues can have a profound impact across an entire family. And moreover, in wealthy families, the complexities of these situations may be further compounded.

Our guest today, Arden O'Connor, founded the O'Connor Professional Group to address the needs of families and individuals struggling with an array of behavioral health issues, including addiction, mental health disorders, and developmental challenges. Arden, welcome to The Pulse.

Arden O'Connor: Thank you. Happy to be here.

Stacie Jacobsen: To get started, I wanted to set the stage for the mental health issues that we're seeing across the country today. It certainly seems like it is 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: So, I think it's a bit of both.

It is actually true that there is more of a mental health crisis than prior to the pandemic, the JAMA health forum records 38% more people receiving health care, mental health care specifically than prior to the pandemic. So, we have that data point. We also know there are stats that are pretty alarming with adolescents being, if you look at 14- to 17-year-olds, suicide is the second leading cause of death within that demographic group.

So, there is definite evidence to suggest that it is more significantly impacting the country. I would also say though, from the perception standpoint, I think what the pandemic allowed people to do is read about mental health, substance use, these topics that have previously been quite honestly 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 do see more general awareness. And the benefit of that is there's more a little bit of a reduction in stigma related to people accessing care.

Stacie Jacobsen: So, if you do have somebody in your life that you are concerned about, are there early signs that you can look out for to see when it might be appropriate to reach out for professional help?

Arden O'Connor: Sure, I'll name some of them and it can be tricky because a lot of them mirror symptoms that we would say, boy this person's just overworked or tired.

I think the interesting part about mental health is that we use a lot of terminology in daily discussion; you know, “I'm depressed. I'm anxious” and people don't necessarily mean “I'm clinically depressed.” They just mean in general; they're feeling blue. But in general, the patterns that we know to be true, when we start to say to family members or an advisor or somebody, hey, this is somebody who's struggling beyond just an episodic: “I had a bad day because this happened.” This is more concerning.

So, 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 that was happening previously?

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, something maybe even a little less significant to somebody wind up in a DUI or some kind of car crash due to using a substance, you know, those are obviously flags that something is going awry.

And then are the behaviors existing for a longer period of time? Again, if we have somebody just over a course of a couple of days, they break up with a boyfriend and they're upset, 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 in work as previously they were, and they're still overusing a substance or they're using maladaptive coping strategies, they're sleeping too much, eating too much, spending money too much.

Those are signs that this is a more significant issue.

Stacie Jacobsen: All right. So, what are some of those first steps that you can take either as a family member or as a professional advisor? If you're noticing this behavioral pattern,

Arden O'Connor: I think it depends on which role you're in. If you're a family member, what we often recommend just approaching somebody and using “I statements,” not saying you are worse than you are.

You look terrible because nobody responds well to anything that can be interpreted 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 wellbeing and the importance that you want to be a support.

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. The question around how do you even approach it is really to use “I statements” and to indicate that you're concerned. Advisors can do something similar, but oftentimes, you know, in their role, they're not necessarily there to address a mental health issue. So, what we recommend frequently is that you start by saying something like “can I raise a sensitive topic” and 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.

Stacie Jacobsen: And it's often perceived that with wealth, you can pay for better access. You can pay for better resources, but there's actually quite a complicated dynamic between, you know, wealth and the consequences of some of these behaviors. Let's talk through that. When is having wealth an advantage to helping somebody with a mental health issue and when can it be a disadvantage?

Arden O'Connor: Sure. It is exactly what you said, Stacie, it is a double-edged sword. So, the advantage piece is you can literally afford better quality treatment if it's directed correctly. So, I'm going to give that caveat. If you google luxury treatment or best in class treatment, who knows who, what website you land on.

And it may not be the best just 'cause it's the most expensive. But we know that even despite all the laws, the parody laws and, and all the legislation that's been put into place, mental healthcare and care for things like substance abuse disorders or eating disorders, still a good portion of it is out of pocket.

And families of means have flexibility and how they get care. It can be done in the home. They can extend a program for more than the thirty days that insurance typically reimburses. They can get extra sessions with a psychiatrist instead of a social worker. You know, there's lots of ways that they can increase the efficacy of their loved one's care that are different, frankly, than a family member who has to rely on in network insurance to get something. So that's the good news.

The complicating factor to that is making sure you're navigating the system in a smart way. And there's all sorts of resources who can help you do that. The downside, however, is that wealthy families often have people who don't hit what they call an AA, the rock bottom, you know, families who have means often can prevent natural consequences from happening. They can hire.

And I can give an example in my own family, in my brother's case. He had a significant substance use disorder. My parents hired when he got in trouble with the law, 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.

And the message it sent to my brother on the one hand, I don't regret that he didn't mind observing 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 got is that our family would save him under any circumstances and many of our affluent families that we serve that's the message they're getting so that means they 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 that the family won't step in there's not necessarily a consequence that's going to follow so we often see in wealthy families the period of time and the severity of the issues elongated.

Stacie Jacobsen: Arden, you gave an alarming statistic about the suicide rate in adolescents. In your experience, do you see that children with wealth have more pressure, more anxiety, more stress? Or is that prevalent across all families?

Arden O'Connor: No, we definitely see it. And there's been some studies, uh, Dr. Tanaya Luther did a study of children with it.

Higher socioeconomic backgrounds and found higher rates of depression, anxiety and substance use. There's been a similar study done at Columbia. I think there's 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 that exist there and the pressure to get into the best college, the best graduate school and how 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 has much more of a waiting effect.

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. I mean, I laugh because most adults will say, if they look at Facebook on a bad day, it makes their day worse. So, if you can imagine what that is at fourteen, you know, 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.

You know, I would find out the next day on the playground and it had already happened, but I wasn't watching live something happening without my presence and feeling badly about it.

Stacie Jacobsen: Arden, 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 have these phones and who have access and who are always looking for those likes on their phones versus, you know, kids who maybe don't have them and have other activities that pique their interest.

Arden O'Connor: 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 of a book who talked about his recommendation of getting kids dumb phones until they're 14, 15, 16, and then you can switch it into a smartphone. But instead of starting that trend in middle school, so, I think delaying it is great. I think one of the questions becomes, and you mentioned it about other activities, you know, what are you replacing the time that kids are on social media with?

And that comes back to modeling behaviors as adults. I think 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.” If dad and mom are also looking on their phones the entire time, or if they are very sensitive to, did you see where so and so vacationed and kids hear that 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 the more that kids can be engaged in real life interactions. It's not even an in-person interaction all the time, it's a virtual one where it's very easy to bully someone because there's nobody in front of you showing their emotions and how you're impacting them.

And that's the world our children are growing up and it will continue to grow up. 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 of the activities they're doing now? And how do I put in context a disappointing episode, whether it's a full 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.

Stacie Jacobsen: 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?

Arden O'Connor: Absolutely. So, I grew up outside of Boston in a wealthy suburb and we were, you know, a classic family that had the means to go to private schools, really didn't have a lot of economic hardships that we had to overcome and our family, it's, I always laugh, I smile when I say it because 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 O'Connor professional group could stay in business, just serving the O'Connor family and friends team.

My father's 30 years sober. So, we knew in our family system that this was going to be an issue. So, my brother, very young, very early in life, started experimenting with alcohol and eventually marijuana and cocaine. And my parents took it very seriously given my dad's history, but he 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 wheel sort of fell off there. 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 thirteen 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 thirteen 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, you know, not only for our family, but it's not a, unfortunately it's not a unique story.

So, he had attended, finished college, was getting his master's degree. He hurt his back and decided to solicit pain pills from a doctor, not as typical doctor, but he got pain pills for his back and he wound up relapsing. And then wound up on heroin and eventually died of an overdose that was fentanyl waste heroin.

And so, the film is a lot about addiction just as a category and how to 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 it probably kept him alive for many, many years, but it also allowed him to reach a bottom way in a way 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 directly to your rent, 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 the sort of dysfunction within our family and trying to address this as well as trying to access care is really what the basis of creating O'Connor professional group is about.

Stacie Jacobsen: Well, thank you for sharing your family story. I know that many can learn from it. I do have a few follow up questions on that one. If you do have a family history and clearly as parents we’re concerned for our children, what can be done maybe even ahead of a first incident? Is there education for the children that you can talk about what's gone on in the family and ways that you might be able to prevent even a first try?

Arden O'Connor: It's a great question. So, I think One of the things is thinking through the messaging around prevention and having really a strict policy around no alcohol use until you're twenty one and no marijuana use. And these are the two areas where we see the most flexibility with parents who say, but everybody's smoking marijuana.

I smoked marijuana when I was in my twenties. So, the marijuana of today is not the marijuana of many years ago. And so that analogy really doesn't hold up. And wow, lots of kids experiment with drinking. We do know it impacts the brain as well as marijuana use before your brain is formed. And so really having, you know, strict, this is not to say extreme, you know, you're never going to go outside again, but certainly not permissive policies where a young person believes, well, my parents don't think it's a big deal because this is what they did.

So that's, I think the first message I would say, especially if you have a genetic history, because the chances, we know that sons of parents 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, At the age of thirteen, your chances of developing an issue later in life are 49%.

If you wait till you're twenty one, it goes down to 9%. And that's very much my brother in my story. I was a nerd. I waited till I was twenty one. I don't have a problem. He developed one quite early. So, prevention is the big thing. I think the second thing is at the same time, fostering open communication, answering questions.

We know that the scared straight model of many years ago, scaring kids into trying to be sober or abstinent 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 into the early college years because distinguishing between significant issues and just problematic behaviors at that age that are, you know, somewhat developmentally appropriate but unfortunately is very difficult.

Stacie Jacobsen: in your story with your brother, It seemed to be that your parents did eventually let him hit rock bottom but to your point it took a little bit longer. As parents, how do we know when to let them go and when it's actually best for our children to get to that rock bottom?

Arden O'Connor: So, we don't often tell parents, you know, do not intervene at all, especially parents who have the wherewithal to do so. Partially because I think it's very hard advice to follow. I think it's almost impossible if you're a parent who has the means to afford the next treatment center to say, don't pay for treatment.

What we will say is, there is a far cry and this is where most of our parents get confused. There's a big world between absolutely no intervention and cutting out any economic support completely. So, a lot of people respond well, meaning that they actually react to a parent saying, Gosh, I'm going to make life difficult.

And so, 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. 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 done 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 all being said, there are some extreme circumstances where we will say, you know, at this point you have tried everything and I think this person really needs to figure 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 stuffing it out or 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.

Stacie Jacobsen: 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 that you do support families in crisis?

Arden O'Connor: 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 this very traumatizing, but our goal really is to help families anywhere along the crisis. So 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 try and see what have you 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 to do it as a surprise, but that's one way.

I think the other, the other piece of it 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, it gives families an alternative to that. And it's certainly a personalized and intensive level of care. We often are helping families who are trying to navigate the system.

As I mentioned earlier, it can be really confusing if you just google rehab or google addiction or mental health support. So, we can help in a variety of different ways, but the goal really is to get the family supported as well as the individual. So, lots of our systems, our behavioral health system now focuses just on supporting the person with the diagnosis.

We also want to make sure families. feel like they have a resource to talk to, you know, is it appropriate to bring him to the wedding? What do I do if he says “X” to me? And we do a lot of that type of coaching.

Stacie Jacobsen: So far, we've talked a lot about the adolescents, but young people are not the only ones who struggle with mental health issues or addiction.

How do you approach the situations where there's an older adult, you know, often high functioning, a successful entrepreneur executive, you know, if they're struggling, what are some of the tactics you have there?

Arden O'Connor: Those are always our hardest cases, candidly, because usually these individuals are financially independent.

So, it's not younger people or even older people who are part of a family office where there's a trust involved. 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 what emotional leverage, which sounds so negative, but where is there an opening?

So 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 into recovery or has been successful in the past reigning 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.

But 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.

Stacie Jacobsen: These diagnosis can have a ripple effect through the entire family. So how do you support the entire family system and not just the individual?

Arden O'Connor: So, 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.

So, a lot of it is “Here's what it looks like.” “If you have this, here's what it means here.” What are medication options here? Things to watch out for. If you're a family member, I think with families, it's also understanding and giving them a space to share their own frustrations. I used to say within our family system, you know, my brother was very frustrated that when my other brother, Chris was in the middle of some of his problematic behaviors, he would say, there's no oxygen in the room to discuss anything else because all of our energy emotionally is being pointed towards my brother Chris.

And so, it's really giving whether it's finding therapy resources, whether it's giving them a coach whether it's giving them a space to air their own frustrations And then it's helping especially parents, but it could be adult children of older parents who might have dementia or a substance use issue but it's giving people advice based on what?

The person is going to benefit from not 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 X. 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.

And 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 lot of the work that we do.

Stacie Jacobsen: Arden, you've left us with a lot to think about understanding that implementing effective strategies and then leveraging some of the resources to navigate these challenges is certainly a way for a family to move forward.

So, with that, Arden, I want to say thank you for joining us today and having an open and honest conversation about mental health issues that many families are facing. Thank you.

Arden O'Connor: Pleasure to have the conversation. I appreciate you bringing some education and light to this issue.

Stacie Jacobsen: Thanks to everyone for listening in.

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

I'm your host, Stacie Jacobsen, wishing you a great rest of the week.