Jan Gerber is Founder & CEO of Paracelsus Recovery, a leading mental health clinic for entrepreneurs, leaders & UHNW clientele.
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I’ve worked in high-end mental health and addiction treatment for more than a decade. When I co-founded the Kusnacht Practice in Switzerland and later founded Paracelsus Recovery, my impression was that many considered a treatment model built exclusively around ultra-high-net-worth individuals, top executives and founders to be niche, even unnecessary.
Since then, the sector has grown. I’ve observed new centers promising discretion and five-star comfort open around the world each year. To me, this signals that we’re finally recognizing a significant healthcare need. When an ultra-high-net-worth individual, top executive or founder is struggling with addiction, untreated depression or another mental health challenge, the consequences can ripple out and go far to their families, employees and customers thousands of miles away.
Every human being deserves a high standard of care. But addiction treatment is unevenly regulated depending on location. For example, when it comes to residential treatment for mental health and substance use disorders in the United States, “treatment settings are governed almost exclusively by state statutes and regulations, rather than by federal laws.”
Unfortunately, in my view, uneven regulation can make it easy for hospitality to be sold as mental health care. As our industry grows, we need a more honest conversation about what we’re actually doing, and for whom.
Cultural Competency Starts With Language
Cultural competency rests on a basic idea: To treat someone well, you have to understand the world they come from. That world includes wealth, not only other important factors such as faith and community. Psychotherapist Dr. Paul Hokemeyer has done important work here, arguing in his book Fragile Power and in his research that the ultra-wealthy are a distinct cultural group whose mental health deserves respectful care.
Yet the stigma around wealth can be so pervasive that, from my observations, even centers built for the ultra-wealthy can emphasize the views, the spas and equine therapy rather than the clinical team. That framing paints wealth as indulgence. To many prospective clients, that framing can confirm their fear that no one will take their pain seriously.
Consider the term, “luxury rehab.” For most of our clients, a private room, good food and a calm, beautiful setting aren’t luxuries; they constitute their everyday lives. That familiarity serves a clinical purpose. In research that examined “44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities.” One of them was “homelike environments.”
For years, many of us in the industry have used the label ourselves, because that’s what people had a tendency to type into search engines. That’s how stigma works: It becomes so normal we stop noticing it. But there’s something quite cruel about branding a person’s everyday life as excessive in the very name of the place meant to help them.
Why Privacy Is A Clinical Requirement, Not A Perk
At my organization, we treat one client at a time, with a staff-to-client ratio of 20-to-1 and a therapist who lives in-house throughout their stay. We’re often asked: “Isn’t that just feeding their narcissism?”
I can understand the reaction (when I try), but it misses the clinical reality. Group therapy is the backbone of many traditional programs. It’s a helpful option for many people. But for top executives, founders and ultra-wealthy clients, group therapy usually isn’t viable. Imagine you’re the CEO of a Fortune 500 company. Would you disclose something to a room of strangers that, if leaked, could drop your share price? Most people wouldn’t, and therapy without honesty doesn’t get very far.
Even when secrecy isn’t the main concern, as with many public figures, would you want to share the darkest moments of your life with people who might be fascinated to hear how bad things got? One-on-one treatment isn’t about exclusivity; it’s about creating the conditions for someone to tell the truth.
That’s also why the live-in therapist is crucial. Much of the value of group work lies in connection, and addiction is profoundly lonely. Wealth and fame often deepen that loneliness, and the relationships clients build with their therapist and the wider team become a genuine community. The key is for those of us in this space to re-create the benefits of a group dynamic in a way that’s workable and safe.
Recovery should be built for the life a person actually lives. For our clients, the key challenges are running a business under intense scrutiny, managing family wealth, knowing whom to trust and potentially living with access to substances. The goal isn’t opulence. It’s normality: an environment ordinary enough to the client that the focus stays on their health.
The Importance Of Addressing Therapist Bias
I’ve found that clinicians carry more assumptions about wealth than they realize. Some believe rich people’s problems aren’t real problems. Others become starstruck or deferential and shy away from the hard conversations a client needs. Both undermine treatment.
This isn’t a criticism of individual therapists; we’re all shaped by the culture we live in. But our industry needs to train for, supervise and discuss it openly, as we should any other form of bias in healthcare.
In addition, centers should leverage dual diagnosis in their work. Addiction rarely arrives alone; depression, anxiety or trauma almost always travel with it. Yet from my observations, many centers still treat addiction alone.
A Conversation That’s Overdue
The growth of specialized treatment for ultra-high-net-worth individuals, top executives and founders is a positive sign, but growth alone isn’t progress.
If we want this corner of healthcare to be taken seriously, we need to stop selling comfort and start talking honestly about what these clients need: cultural understanding, absolute privacy, environments grounded in their reality, dual-diagnosis and clinicians who can see past the wealth to the person.
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