One does not expect to see an article about individual mental illness and efforts to manage it on the front page of the Wall Street Journal. But these are extraordinary times in the sense that we are seeing lots of families struggling with adult children who toggle on and off the grid.

The article published on May 6 focuses on an attorney admitted to practice law in California in 2009. He was suspended from practice in 2019 for failure to keep up with his continuing legal education requirements. Today he is 44 years of age. The Journal reports that he is contentedly homeless, living in Los Angeles. Nonetheless he sat for an interview with reporter Julie Wernau. She found him engaged and interesting. But during the interview it became clear that he harbors huge fears that people are out to get him, including family and now former friends. He has been treated both of a voluntary and involuntary basis. He does not like it and does not want it. He eschews medications which might help with a condition known as anosognosia. He denies needing treatment.

Many readers will relate to these facts because they have experienced or are currently living with a child who displays both the symptoms of mental illness and a refusal to seek effective treatment. Some of these conversations occur in the wealth planning departments of law firms. Others occur in the domestic relations world because otherwise content couples are at war over how much money they are spending on an adult child with no future plan. These parents often feel like they are hostages. “If I make the child leave our house or I stop paying for her apartment, she will be homeless. I can’t come to grips with that.”

A couple of generations ago this wasn’t the same kind of problem. Most parents had little if any ability to support a child in this condition. Wealthy families had the option of depositing their erratic adult children at private hospitals. In 1976 the Commonwealth made it difficult to maintain involuntary commitments to institutions when it enacted the Mental Health Procedures Act. A person had a right to live outside a mental institution unless that person presented evidence of being a “clear and present danger” to himself or to others. 50 Pa.C.S. 301. Many commentators suggest this law and others like it represent the advent of the homelessness crisis we struggle with today.

As the Journal article illustrates, the root of the problem is the refusal of the afflicted adult child to acknowledge the problem. So, what can be done?

Step 1 is to meet with a mental health professional to help diagnose and understand the illness. Needless to say, don’t expect any cooperation from the child. After all nothing is wrong or “You people are the ones with the problem.” It may seem like a fool’s errand, but you need a professional to assure you that you are acting correctly.

Step 2 is, in coordination with the psychologist or psychiatrist to map a course of remediative conduct needed to head in a positive direction. This may involve employment, voluntary treatment or some other positively directed conduct. This is going to require a tentative budget. In the end, the purse is a parent’s only power.

Step 3. All too often the next step involves a kind of game of “chicken” and this is where the pain gets real. “Child, we are working with someone to help us understand what we as your parents believe is behavior that is dangerous to you. Our efforts to discuss this with you have failed.  We have set aside a sum of money [or are prepared to borrow it]. We will deploy that money to support your needs for the next ____ (90-180 days) to help you secure treatment, independent housing and some level of regular employment. To make certain our approach is objective and we are being fair to you, we have enlisted both the mental health professional and a friend who knows us and you. We will disburse funds based upon a 2/3 vote, with the professional having one vote, our mutual friend having a vote and we as parents having a vote. You are welcome to communicate with the other two people involved but their identities will not be revealed. Simply email us and we will forward. We have agreed to fund $—- to cover a transition period of 30 days. After that, further support in terms of treatment or expense support will be decided by the 2/3 voting system. It may mean you will have to become self-supporting if there is no measurable progress.”

The reason for this “system” is to combat a couple of problems. The first is the adult child’s pocket veto. They just don’t respond and effectively dare you to take action. This sets a fixed deadline and involves people who could intervene to stop support after 30 days. Step 3 invokes a system that seems to indicate that you, as parents, are letting others seize control.

The second problem is that all too often, adult children respond to threats to cut off support by reversing the tables and claiming that you as parents caused the problem because you were and are “bad parents.” You fostered the crisis. By involving outsiders, you are distancing yourself from the allegations. Realize that there may be some merit to these allegations, and you may not easily see it. That’s part of the rough road you are on but you can’t get off it without creating a system to enforce positive conduct and punish bad behavior or “calculated indifference.”

Step 4. Stick with the plan and realize that homelessness is not always avoidable. The attorney profiled in the Journal article appears to be contentedly homeless. He wants no contact with friends and family. That is sad but it is also real. The difficult choice is that until you adopt a mechanism with some clear guidelines related to treatment and/or employment your adult child has co-opted your lives as parents. And that’s not fair to you. Part of the problem discussed in the article is that often the adult child cannot see the harm they are causing to you and your spouse. On other occasions, they see it quite clearly and derive satisfaction from your misery.

This may be a battle you will lose. The Journal reports that half of patients with schizophrenia and 40% with bi-polar disorder lack the insight to accept the condition that afflicts them. Your child may fall into that category. But unless you act, you are destined to years where both your child and your finances may be out of control. Sadly, while we embraced the rights of those with mental illness to enjoy their civil liberties unless they became a “threat” we also allowed a once robust system of mental illness treatment to whither to a point where this country has a shortage of 8,000 psychiatrists and a homeless population estimated to exceed 650,000. That’s twice the population of Pittsburgh.