“Ibarely recognize my own son. Where did we go wrong?”

Their sobbing and desperation fill the room. We want to respond with reassurance that their son will turn out as they hoped, eventually become “normal.” We know better—we know that the journey toward “wellness” will challenge these parents to their cores and force them to examine their preconceptions, hopes, and plans for their son. We respond, “There are strategies to improve the issues you describe, and qualified professionals to help. The path is not easy, nor straight or simple. Your son's issues will likely impact your family system, and we will want to take a holistic approach to maximize our chances for success.”

Affluent families are not immune or protected from experiencing behavioral health challenges. Stigma, shame, and entitlement often accompany clinical diagnoses, making them hard to treat. While money allows families to afford best-in-class care, it also allows natural consequences to be avoided and families to remain in denial in even the most acute situations. Our clients need help determining how to support loved ones with mental health or substance abuse issues, while simultaneously holding them accountable for their behaviors and maintaining their own realistic expectations.

Our questions in this chapter aim to promote self-reflection, exploration into issues ignored or avoided, and uncomfortable conversations. Silence protects the status quo of dysfunction. The first crucial step in addressing behavioral health issues is talking to professionals and each other.

Section I. Warning Signs of Behavioral Health Issues

Purpose: To explore whether a loved one is showing signs of or experiencing a behavioral health issue

Identifying signs of behavioral health issues and knowing when to seek help can be challenging even for the savviest and most psychologically sophisticated families.

1. Do you notice a sustained change (more than two or three weeks) in appearance/hygiene, personality, behavior, interests, performance, ability to think, motivation, sleeping patterns, and/or appetite with a loved one?
2. Is there a genetic predisposition toward substance use, mental health diagnoses, eating disorders or autism in your family system?
3. Have you or has someone else commented on a loved one's maladaptive coping strategies (i.e., excessive drinking, sleeping, eating, spending)?
4. Has a loved one had a medical, vocational, legal, or financial crisis as a result of a behavioral health issue (i.e., DUI, school suspension, job loss, psychiatric hospitalization, debt)?
5. Did the concerning person suffer trauma in the past? If yes, did they receive treatment?

Conversation starter: What would it take for you to believe that a loved one's behavior has crossed the line from acceptable to problematic, i.e., behavior that may warrant clinical investigation and intervening measures?

Section II. The Family Toll

Purpose: To assess how a loved one's maladaptive behavior impacts others who love them

Family members often respond to a loved one’s plight by engaging in coping strategies that compromise not only their own personal well-being but also the overall integrity of the family system.

• I regret lowering my standards of what I consider to be normal and acceptable.
• I am exhausted by the pretense I maintain that everything is okay.
• I feel isolated from friends and family.
• I am resentful toward my loved one.
• I am afraid to leave or change the relationship with my loved one even though I have thought about doing so for years.
• I used to dream of the future; now, I just want to make it through the day.
• I feel like this couldn't possibly be my life but have felt unable to do anything about it.
• I no longer expect that my feelings will matter.
• I dwell on my loved one's plight continuously.
• I feel drained because I sleep poorly at night due to my constant worrying.
• I am satisfied if a conversation with my loved one or other family members doesn't turn into an argument, even if nothing changes.
• I am disturbed by the negative impact my loved one's behavior has on other members of the family and the tension it causes in our family.
• I have made excuses to stay away from home rather than admit my loved one is making home uncomfortable for me.

Conversation starter: How can family members work together to create the healthiest dynamic possible?

Section III. Protecting the Status Quo

Purpose: To assess the level to which you may be protecting the problematic behavior

Family members often engage in activities that alleviate the natural consequences of a loved one’s behavior, which results in a family dynamic that not only promotes dysfunction but also increases the odds of high conflict between other family members.

• I have canceled social plans with a false excuse at the last minute because of my loved one's poor behavior/intoxication.
• I have forgiven insulting behavior, i.e., aiming disrespectful language at me, being dishonest, stealing from me, manipulating, or bullying me.
• I have made excuses for my loved one's failure to follow through on personal or professional obligations.
• I have kept my loved one's behavior a secret from people close to me, even when they express concern.
• I have called in sick to work or school for my loved one.
• I have anticipated my loved one's neglect of household duties and filled in the gaps.
• I have paid my loved one's bills or taken care of other financial obligations despite his active substance use.
• I have reminded my loved one to eat, sleep, or perform other basic activities of living.
• I have provided excuses for my loved one's absence when she has failed to come home.
• I have made emotional excuses for my loved one's behavior, such as “he had a rough childhood” or “she is under a lot of stress.”
• I have minimized, rationalized, or justified the actions of my loved one, such as by believing her stories even when my instincts told me she was lying.
• I have avoided discussing any problems with my loved one.
• I have bailed my loved one out of jail.
• I have asked for help from police or lawyers to avoid criminal charges.

Conversation Starter: Can you envision anything positive that might come from allowing a loved one to experience the negative consequences resulting from poor behavioral choices?

Section IV. Managing Crisis

Purpose: To assess whether your family has supports in place for managing a crisis

Notwithstanding ample wealth to afford best-in-class care, knowing what approach to pursue and which treatment professionals to trust can be a confusing and overwhelming process when a family member experiences a behavioral health crisis.

1. How equipped are you to navigate the systems that exist to help with behavioral health issues in the event a family member experiences a crisis?
2. Are you able to name a qualified professional to whom you would go for advice and guidance in the event of a crisis, someone who would handle these types of delicate issues discreetly and competently?
3. Would you be able to identify the most beneficial use of financial resources to allocate toward resolving a behavioral health crisis and supporting a loved one's immediate and future needs?
4. Would family members agree on which of their loved one's behaviors they would be willing to support versus which behaviors they would distance themselves from, both in the short term and the long term?
5. Would your estate planning benefit from including additional contingencies focused on substance use, mental health, or other related disorders?

Conversation starter: How can you best preserve both the short- and long-term interests of your family in the event of a crisis?

Note that these questions should help you think about your family's holistic wellness; they are not meant to replace professionally facilitated assessments or advice from qualified medical or behavioral health practitioners. If these questions raise any concerns about your loved one's health or of any family member, please seek medical or clinical attention. We do not accept liability for failure to follow this instruction.

The Chinese character for crisis is said to be composed of two characters: “danger” and “change point” (which some read as “opportunity”). Daily, we remind families that while all crises are anxiety-provoking by their nature, they also may be the very thing that interrupts the status quo of dysfunction and propels a family and their advisors to have frank discussions and make necessary shifts.

There are even unforeseeable upsides to this discomfort. The very same parents who fill our offices with words of hopelessness and despair regularly reflect a few months later that they feel like they can breathe for the first time in a very long time. They now feel hopeful for their family's future—such a simple statement on the surface, yet so impactful when taken in context and measured against the depths of where this family has been. There is no fanfare or shouting from the rooftops, only the simple satisfaction of peace in this moment. While fraught with bumps along the way, steps forward and steps back, this family has traveled the distance from dysfunction to the road to recovery.

Following, you will find resources for continued exploration.

Additional Resources