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Paul Peeler

Industry Spotlight > Advisors

Making Hard Financial Decisions When Teens Have a Mental Health Crisis

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“Stick to your financial plan” are advisor words to live by. But when teens or young adults in crisis are unexpectedly diagnosed with late-onset serious mental illness (SMI), parents must make enormous financial planning changes to provide for their care.

“All of a sudden, they may be [facing] an outflow of tens or even hundreds of thousands of dollars each year they weren’t planning on,” Paul Peeler, financial advisor and partner with Integrated Financial Group, tells ThinkAdvisor in an interview. “You have to figure out a way to do it without bankrupting yourself.”

Peeler knows from personal experience about the effects of a sudden diagnosis of late-onset SMI because one of his own children has suffered from it since 2015.

Apart from the emotional shock, it “certainly changed my own financial plan,” he says in the interview.

Peeler specializes in helping caregivers of children with late-onset SMI, which is typically diagnosed as schizoaffective disorder, borderline personality disorder and bipolar disorder.

He works with caregivers to ensure that they’re adjusting their financial plan to “save appropriately” and make the right decisions for “how to spend their money for care,” he says.

In the U.S., “5% of the population deals with a serious mental illness,” according to Peeler.

But the “health care system for mental health isn’t a system at all. It’s a hodgepodge of dysfunctional programs,” he argues.

Peeler helps parents revise their retirement plans to conform to their new need and plan long term for their severely mentally ill child.

Based in Atlanta, Peeler, 56, is a 30-plus-year veteran of financial services, having worked earlier for Ameriprise, Charles Schwab and Harris Bank.

Mostly fee-based, he manages more than $50 million in client assets.

In the interview, he describes specific cases of children with late-onset SMI and related challenges.

He is founder of The Preparedness Project, a pro bono organization, which he explains in the interview. All fees are donated to the National Alliance on Mental Illness.

ThinkAdvisor recently held a phone interview with Peeler, who was speaking from Atlanta.

He says: When a child goes into crisis and is diagnosed with SMI, parent caretakers must make “a very quick pivot” in their financial plan to handle their now-higher expenses “without completely derailing [their] own personal finances.”

Here are excerpts from our interview:

THINKADVISOR: What’s the financial impact on caregiver parents of a child with late-onset serious mental illness (SMI), typically showing up in the late teens through the early 20s?

PAUL PEELER: When a child is born with autism or developmental disabilities, a parent has a lifetime to plan for their care.

With late-onset SMI, a crisis occurs out of the blue like a freight train and requires a very quick pivot in the middle of it.

What constitutes SMI?

Schizoaffective disorder, borderline personality disorder, bipolar disorder and major depressive episodes.

What sorts of crises might occur?

It can be that the person tries to harm themselves or someone else.

I had a client whose son was dealing with [severe mental health] issues, but when they let their guard down, all of a sudden they got a call from the Atlanta police that he was living in the woods.

They thought he was living in his apartment and going to his job every day.

What does a parent need to do when they get a shock like that?

You swing into action. You’re engaging care. You’re engaging medical professionals. You’ve got to engage law enforcement. You have to engage the legal community.

That’s what I mean when I say “crisis.”

Please explain the quick pivot required during a crisis that you mentioned a moment ago.

It takes a pivot to be able to absorb [the high additional expenses] without completely derailing the parents’ own personal finances.

Maybe they’re in the prime of their careers, and then all of a sudden, they may be [facing] an outflow of tens or even hundreds of thousands of dollars each year, with increasing maintenance costs of thousands a month that they were never planning on.

Their child may even have started to make their own way in the world, but now the parents need to make an enormous monthly outlay with, maybe, big medical costs that they were never planning on.

Do government programs help?

Many people who aren’t in this situation assume that the government provides a lot of benefits and Social Security for these [individuals and families]. But no. It falls on parents or other [caregivers, like a sibling].

It can be very shocking for a family when this happens. They were expecting to have a certain financial plan of saving and spending their money. But all of a sudden, there’s this crisis.

What do they need to do if they don’t have the kind of money that’s required? Cut back and shift priorities?

Yes. they have to make hard decisions. I recommend that people make them when they’re not in the middle of a crisis and write down the trade-offs they’re willing to make between their [needs and plans] and their child’s [or those of another family member with SMI] who’s in their care.

They need to make those hard choices when they’re not in the [upheaval] of a crisis, so they know how they’re going to handle such a situation [if and] when it comes up. It’s a tough deal.

What else does your role with these families involve?

I work with the caregiver to help them adjust their personal financial plan to make sure they’re saving appropriately and ensure that they’re making sound financial decisions on how to spend their money for care.

You have to figure out a way of doing that without bankrupting yourself.

What’s The Preparedness Project?

A pro bono organization that I run for families in crisis who may not have the resources to engage the help they need.

We do basic financial analysis for them and prepare four or five action items they can move forward with, on their own or with an intermediary.

There’s a $50 fee — they can certainly pay more if they choose — which we donate to the National Alliance on Mental Illness.

What about the probable need to make changes to the parents’ retirement plan?

I help them make hard decisions about providing for their own retirement, including overseeing their insurances, because now they have another generation they need to plan for [long term] other than themselves.

Are caregivers legally responsible for a person with SMI?

Not if they’re an adult — there’s no legal obligation.

The caregiver can petition to be a guardian, but that can be a laborious process depending on the state they’re in.

Being a guardian isn’t necessarily the be-all and end-all. It solves [a few] problems, but it doesn’t solve a lot of the big ones.

What drew you to this specialty?

Early in my career, I had some clients with family members who dealt with [SMI]. These caregivers had a much different retirement scenario than my “traditional clients.”

It became clear that there were dynamics that caregivers were dealing with that my other planning clients didn’t have to deal with, or dealt with a lot less.

Has there been anything else that prompted you to make caregivers of people with SMI your client niche of sorts?

Later in my life, my own family was impacted by [SMI].

In 2015, a child of mine went into a mental health crisis. We spent a year getting this individual stabilized.

It was a challenging situation that certainly changed my own financial plan.

Then other people in my line of work in similar situations began to reach out to me.

How is your child doing now?

Very well. By all standards, they’re doing great. But there’s no cure. It’s a lifelong situation. Each day has its own challenges.

Was there help readily available to guide caregivers financially at the time your child went into crisis?

There was very little in the public domain directed toward caregivers about how to pivot their own personal financial planning while absorbing the tremendous emotional and financial cost of providing maintenance and care for a loved one who was dealing with a severe mental illness.

Are recreational drugs associated with SMI?

There’s a significant link between recreational drug use and the onset of mental illness. It’s not ironclad that everyone who uses will have a severe mental illness. There’s a genetic component.

But recreational drug use is certainly a link to the onset.

If an individual isn’t coping well, they can often turn to substances to help with their situation.

Drug use and alcohol use go hand in hand with SMI. In fact, it’s prevalent. They have to be treated separately, but they’re intertwined.

For some time now, a controversial issue in the mental health area has been involuntary hospitalization to treat people with SMI. Your thoughts?

Particularly with schizophrenia and some bipolar disorders, people don’t know they’re ill. So why would they consent to treatment for an illness they don’t even think they have? That’s called anosognosia — lack of insight about your own illness.

About 50% of everyone with [schizoaffective disorder] do not believe they’re ill. It’s very complex.

What else is complicating the issue?

The health care system for mental health isn’t a system at all. It’s a hodgepodge of dysfunctional programs.

Please cite a relevant example of what a family has gone through.

The son of one of my clients, a minor with SMI, had been sent to jail. When they released him, the court order said he couldn’t go home because he had sexually acted out against his sister and his mother.

His mom asked, “What’s going to happen to him?” The court said, “That’s not our problem.”

The kid ended up walking from the jail to an address that he thought was his but was where he lived years before. He was banging on the door to let him in. [The occupants] called the police.

They took him to another hospital, where everything started all over again.

Do you work with any clients who aren’t caregivers of people with SMI?

Yes. I have pre-retirement clients who are working and saving to provide for their retirement. It’s a little bit less of a challenge with those clients than with the SMI-caregiver segment.

Do you get referrals from the latter segment, your main focus?

Yes, but there’s a tremendous amount of stigma associated with mental illness. It’s a challenge for individuals to disclose it even amongst themselves.

When I do public speaking, people come up afterward and ask for my number.

But quite frankly, it’s tough to get people to engage because of that stigma around these disorders.

I imagine there aren’t many financial advisors who specialize in this. Right?

I know of one other than me. It’s not a profit center. I’ll tell you that.

But it’s certainly a labor of love and, kind of, my way of giving back.

(Pictured: Paul Peeler)


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