The Dos and Don’ts of Tackling Client Mental Health Challenges

Despite the prevalence of mental health issues in society and their vital importance to estate-planning trust administration, the topic remains taboo. Without a candid conversation about challenges that a client or the client’s family and loved ones might face, there’s often no way to discern whether an issue exists or what it may be.

Though our society at large assumes the well-to-do have fewer mental well-being issues, in part because money can provide protective factors against developing certain mental health disorders to a point and pay for access to certain types of treatment, statistics show that ultra-high-net-worth (UHNW) individuals are subject to greater risks for developing higher rates of substance use disorders, depression, eating disorders and anxiety than their low income or middle-class peers. The age-old adage rings true: money can’t buy happiness. Worse yet, society doesn’t have much empathy for the wealthy and their challenges.

To complicate things, clients may be in denial, embarrassed or uncomfortable discussing their challenges. They may not appreciate the important role their advisory team can play in crafting plans that help their loved ones facing mental health challenges. Practitioners should, at the planning stage, address the realities of clients’ reticence to speak and the practitioners’ own discomforts.

Checklist

Here’s a checklist with some dos and don’ts when dealing with mentally ill clients or beneficiaries.

Do:

• Stay nonjudgmental. Eliminate any opinion statements or stories about what’s happening and end with a curious question, allowing for various responses. “I noticed that in the last three weeks, every time I call or ask you through email to talk on the phone or come into the office, you say you can’t because you’re busy, unavailable and not in a private place. Unfortunately, we’re not allowed to execute requests regarding money, document changes or exchanges of information without talking to you directly in real-time to protect from fraud. In the past, you typically called me to talk these types of requests over together, and I’m wondering if you’re okay?”
• Understand your limits, their limits and what needs they’re trying to meet now. Most people have a stated goal they’re trying to achieve by making requests. To help them, you need to understand their goal, when they’re willing and unwilling to make compromises, what you’re able to do and not able to do and how you can create a win-win.
• Validate and restate their needs and perspectives. Whether someone is manic, making excuses to get drugs or pay off a debt to drug dealers, or they’re actively psychotic, what they’re experiencing feels real to them. They need to know you understand their perspective before they’ll be willing to listen to anything you have to say. For example, you can say, “I know you’re frustrated because you were expecting me to give you $10,000 right now. I heard you say it was urgent because you want to shop for a new wardrobe today. Did I get that right? I want to make sure I understand the problem before I start helping brainstorm solutions that can fit within our company policies (or perhaps the terms of the trust) and meet your needs.” 
• State facts and observations. For example, “I’ve noticed that you’re making some requests outside what you typically request. I also noticed that you seem more agitated and impatient when we talk. Are you okay?”
• Ask relevant questions. “Are you okay?” “Do you need help?”
• Help them play the tape forward on their options. When people are in crisis (real or perceived), it’s hard to think about anything beyond the immediate moment. Whether their ideal solution is an option, you should help them consider how two or three options can play out so they can pick the best choice. Nobody makes good decisions in a crisis, and making yourself a thinking partner can be critical in helping them.
• Get clear on your goal, state your goal, ask the client what their goal is and see if it aligns. For example, “My goal is to help you save enough money to get through your retirement without running out of money. At the rate you’re spending, I fear you won’t have the money you need to accomplish this goal. I’m wondering what your goal is for the short term and long term so that we can see where we can find a middle ground between having a good quality of life now and having a good quality of life later.” If a trustee is speaking to a beneficiary who’s making unreasonable demands, the response might be something like: “The trust requires that we as trustee manage funds to assist you throughout your lifetime [or whatever is appropriate based on the actual terms of the trust instrument]. We can’t make a distribution that’s so large that it may undermine meeting that objective.”
• Create a mutual agreement to move forward. Mutual agreements allow clients to feel like they’re a part of the decision and solution. Through a series of mutual agreements, you can come to a solution that works by incrementally testing levels of self-control. For example, “As we talked about your spending habits, it seems like many of these purchases are impulse buys that you regret later when you can’t afford the things you want. I’m wondering how you feel about creating a 3-day rule for yourself so you don’t make any purchases outside of food and entertainment at the moment, and if there’s something you want to purchase, wait three days to see if you still want it at that point. Are you willing to try that for a month to see if it works?”
• Know the relevant resources available to help. Have a resource list in advance of independent case managers, interventionists, consultants and counselors so you can feel confident directing clients to the appropriate parties to meet their needs without feeling like you must do it yourself.
• Take action. It’s important to remember that, much like with a medical emergency, you don’t need to be the one to provide care. You need to understand whom to contact (for example, call 911 for a medical emergency) and make
  the connection.
• Follow-up. Those in crisis have a hard time remembering things because of heightened anxiety, mental health symptoms and inability to organize and execute tasks in their current mental state. Following up can prompt them if they haven’t made the connection and show them you care about their well-being.

Don’t:

• Put people on the defensive. This would involve more statements that feel accusatory or judgmental, such as, “You keep changing your mind, and that’s why nothing is getting done,” or “Your request doesn’t make any sense.”
• Come across as defensive. Individuals struggling with how to deal with a family member (or beneficiary in the case of a trustee) with mental health issues can often say things in heightened states that sound or feel accusatory. Their first instinct may be to defend themselves. Take a deep breath and ask open-ended questions to gather more information, such as “I want to take a moment to slow things down. It feels like I’m missing something, and I’m wondering what I’m missing here?”
• Escalate your tone, volume and body language: Eighty-five percent of communication is non-verbal.¹⁵  People will get more from what you’re not saying than they will from the words coming out of your mouth. Do your best to relax your muscles, unfold your arms and moderate your tone.
• Shut down the conversation with blanket statements like, “That’s just the way it is, and you’re going to have to accept that.”
• Make promises you can’t keep. When someone is verbally aggressive or intimidating, it could be easy to agree to end the interaction. The biggest problem is that it will blow up in your face later, and there will be more that you’ll have to smooth over. If you don’t know an answer or think that the answer may heighten the volatility of the interaction, buy time by saying something like, “Giving you the correct answer is important to me and a critical part of your decision making. Will you give me 24 hours to get back to you with an answer to that question, and then we’ll continue brainstorming toward an adequate solution?” Ending with a mutual agreement will help them to feel in control of the situation.

*This article is an abbreviated summary of “Addressing Mental Health Challenges
In Estate Planning,” which appears in the September 2024 issue of Trusts & Estates.