Family office psychiatry: a new concept for the mental health treatment of ultra-high net-worth individuals

Ultra-high net-worth (UHNW) individuals – defined by owning investable assets above USD 30 million – represent a clinically underserved population whose psychiatric needs are insufficiently addressed by standard models of care. Furthermore, the increasing international need for high-quality psychiatric support in this population stands in stark contrast to the continued poor density of psychiatric care. The authors combine a broad clinical experience with this patient population encompassing over 200 cases. This is the clinical basis for the following practice-derived hypotheses and concepts, and the original starting point from where the development of this new treatment approach derived. Therefore, we introduce the concept of Family Office Psychiatry (FOP), in analogy to the financial family office model, to name and theorize this emerging field. FOP is characterized by system-oriented engagement with the patient’s family and professional network, longitudinal treatment relationships, and an expanded but explicitly bounded availability model. We describe practice-derived clinical aspects of UHNW populations, propose an ethical and legal framework required for multi-patient systemic practice, and argue that psychiatry – covering the wide spectrum from severe pathology to enhancing wellbeing, and training clinicians in the management of power, vulnerability, and countertransference – is uniquely suited to this role. Finally, a core feature of FOP should be the flexible mobilization of a highly professional interdisciplinary network tailored to the distinctive needs of the patient, representing a development from the classical concept of location advantage to the more dynamic concept of network advantage.