Despite the prevalence of mental health issues in society and their vital importance to estate planning trust administration, the topic remains taboo. Without an honest conversation about the challenges a client or the client's family and loved ones may be facing, there is often no way to tell if there is a problem or what it might be.

Although our society generally assumes that the wealthy have fewer mental health problems, in part because money can provide protective factors against the development of some mental health disorders up to a point and pay for access to certain types of treatment, statistics show that Ultra High Net Worth Individuals (UHNW) are at greater risk for developing higher rates of substance use disorders, depression, eating disorders, and anxiety than their low-income peers or middle class. The age-old saying rings true: money can't buy happiness. Worse yet, society doesn't have much empathy for the rich and their challenges.

To complicate matters, clients may be in denial, embarrassed, or uncomfortable discussing their challenges. They may not appreciate the important role their counseling team can play in developing plans that help their loved ones cope with mental health challenges. Practitioners must, in the planning phase, address the reality of clients' reluctance to talk and the practitioners' own concerns.

Checklist

Here is a checklist of some dos and don'ts when dealing with clients or beneficiaries with mental illness.

Do:

• Be non-judgmental. Eliminate any opinion statements or stories about what's going on and end with a curious question, allowing for different answers. “I've noticed that in the last three weeks, every time I call or email you 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 are not allowed to process money requests, document changes, or information exchanges without speaking directly to you in real time to protect against fraud. In the past, you usually called me to talk together these kinds of requests and I am wondering if you are okay?
• Understand your limits, their limits, and what needs they are trying to fill right now. Most people have a stated goal that they are trying to achieve by making requests. To help them, you need to understand their goal, when they are willing and unwilling to compromise, what you are able to do and what you are not able to do, and how you can create a win. favorable.
• Validate and reiterate their needs and perspectives. Whether someone is manic, making excuses to get drugs or pay off a debt to drug dealers, or is actively psychotic, what they are experiencing feels real to them. They need to know that you understand their point of view before they are willing to listen to anything you have to say. For example, you could say, “I know you're frustrated because you expected me to give you $10,000 right now. I heard you say it was urgent because you want to buy a new wardrobe today. Did I understand correctly? I want to make sure I understand the problem before I start helping to brainstorm solutions that might fit our company policies (or maybe terms of trust) and meet your needs.”
• State facts and observations. For example, “I've noticed that you're making some requests outside of what you normally ask for. I also noticed that you seem more anxious and impatient when we talk. are you ok?”
• Ask relevant questions. “Are you okay?” “Do you need help?”
• Help them play the tape forward in their options. When people are in crisis (real or perceived), it's hard to think about anything beyond the immediate moment. If their ideal solution is an option, you need to help them consider how two or three options might play out so they can choose the best choice. No one makes good decisions in a crisis, and making yourself a thinking partner can be critical to helping them.
• Be clear about your purpose, state your purpose, ask the client what their purpose is and see if it matches. For example, “My goal is to help you save enough money to see you through retirement. At the rate you're spending, I'm afraid you won't have the money you need to accomplish this goal. I'm wondering what your goal is for the short and long term so 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 talking to a beneficiary who is making unreasonable demands, the answer might be something like this: “The trust requires us as the trustee to manage the funds to support you throughout your life (or whatever that is appropriate based on the current terms of the trust instrument). We cannot make such a large distribution that could harm the achievement of this objective.”
• Create a mutual agreement to move forward. Mutual agreements allow customers to feel like they are part of the decision and solution. Through a series of mutual agreements, you can arrive at a solution that works by gradually testing your levels of self-control. For example, “As we talked about your spending habits, it seems like a lot of these purchases are impulse buys that you regret later when you can't afford the things you want. I wonder how you feel about making a 3-day rule for yourself so that you don't make any purchases outside of food and entertainment right now, and if there's something you want to buy, wait three days to see if they still want it at that moment. Are you willing to try it for a month to see if it works?”
• Know the relevant resources available to help. Have a resource list of freelance case managers, interventionists, consultants, and advisors in advance so you can feel confident directing clients to the right parties to meet their needs without feeling like you have to do it yourself.
• Take action. It is important to remember that, as with a medical emergency, you do not need to be the one providing care. You should know who to contact (for example, call 911 for a medical emergency) and do
  the connection.
• Escort. Those in crisis have difficulty remembering things due to increased anxiety, mental health symptoms, and an inability to organize and complete tasks in their current state of mind. Following up can encourage 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 include more statements that feel accusatory or judgmental, such as, “You keep changing your mind, and that's why nothing is being done” or “Your request makes no sense.”
• Come as a protector. Individuals struggling with how to deal with a family member (or beneficiary in the case of a trustee) with mental health problems can often say things in a heightened state that sound or feel accusatory. Their first instinct may be to protect 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. I feel like I'm missing something and I'm wondering what am I missing here?”
• Scale tone, volume, and body language: Eighty-five percent of communication is nonverbal.¹⁵ People will get more from what you're not saying than from the words that come out of your mouth. Do your best to relax your muscles, spread your arms and moderate your tone.
• Close the conversation with general statements like: “That's the way it is, and you're going to have to accept it.”
• Make promises you can't keep. When someone is verbally aggressive or intimidating, it can 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 will need to tame. If you don't know an answer or think the answer might increase the volatility of the interaction, buy time by saying something like, “Giving the right answer is important to me and a critical part of your decision-making. Will you give me 24 hours to respond with an answer to this question, and then we will continue to think towards an adequate solution?” Ending with a mutual agreement will help them feel in control of the situation.

*This article is an abridged summary of “Addressing Mental Health Challenges
In Estate Planningwhich appears in the September 2024 issue of Trusts & Estates.