As mental health has moved up the agenda over the past decade, so has the roster of specialists offering care built specifically around the pressures facing UHNWs and their families.
The advisers featured in the 2026 edition of the Spear’s Index work across psychiatry, psychotherapy and addiction medicine, treating conditions from anxiety and depression to addiction and relationship breakdown, but with an added layer of specialism in how wealth, visibility and leadership responsibility can shape both the presentation of these conditions and the discretion required to treat them.
For UHNWs, that can mean anything from a psychiatrist helping coordinate care across a family office to a therapist working discreetly with a couple whose careers are pulling their marriage apart.
Explore the other rankings within the 2026 Spear’s Medical Indices:
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Emerging themes in 2026
Attitudes towards mental health in general have changed considerably over the past few years, according to psychotherapist Mark Boyden. Some of the credit, he says, can be given to high-profile public figures: ‘I think Harry, Meghan and the Royals have really helped to make it far more acceptable.’
That shift has come alongside more tailored options too. Boyden, for instance, now runs a residential retreat in Dorset that combines intensive therapy with wild swimming and access to the coast, bringing in dieticians or physiotherapists when needed. Increasingly, psychotherapists, he explains, are being brought in for more than crisis treatment to help build long-term and bespoke support structures around a family’s specific circumstances.
Leadership and achievement
A recurring theme that stood out in this year’s research is how leadership and achievement can make it harder for wealthy clients to seek help. Dr Katie Au, who works across psychiatry and psychotherapy with a focus on eating disorders, mood and anxiety, tells Spear’s that many HNW clients are reticent to show weakness. ‘I see HNWs with a lot of demands,’ she explains, noting that many ‘don’t feel they can really share with other people because they feel like they need to hold up to that leadership role and so can’t be seen as vulnerable and weak.’
Advisers are also seeing distinct challenges among adult children of wealthy families. ‘Often there is a lot of expectation and pressure, not directly – it’s felt internally.’
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Cosmo Duff Gordon, a chartered psychologist specialising in addiction, sees something similar play out with second- and third-generation family members, whose struggles are often more existential than those of the wealth creators before them: ‘There’s a different kind of set of pressures,’ he explains, pointing to questions such as “Can I ever be that successful?” and “How do I create my own identity?”‘
Among younger patients, several advisers pointed to social media as a growing driver of poor mental health. Jon Goldin, a consultant child and adolescent psychiatrist, said demand has risen sharply for issues including self-esteem, anxiety and eating disorders, particularly among girls. ‘The algorithms and the pressure that young people are facing has increased in recent years,’ he says, adding that referrals for autism have also grown.
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- Methodology
- The best psychiatrists & counsellors: some names to know
- The best psychiatrists & counsellors: the complete list
- Contact us
Methodology
Each year, the Spear’s Research Unit reassesses and refreshes its rankings of the leading providers in each sector by gathering data from and about the advisers and firms themselves, assessing submission forms, collating nominations, carrying out peer reviews, reviewing data from third-party sources, gathering references and recommendations, canvassing experts and conducting hundreds of interviews.
Advisers are evaluated using a proprietary scoring system that assigns different weightings to certain attributes. These scores feed directly into each new set of rankings in the Spear’s Indices. Each of these indices are published first online (according to the research calendar) and then in print. Print publication takes the form of the annual Spear’s 500 directory, which includes the top advisers in every index.
[See also: A guide to the Spear’s 500: Everything you need to know]
Each featured adviser is profiled on spears500.com. The site allows users to search the Spear’s database of more than 4,000 entities to find one (or more) to meet their specific requirements by filtering for specific attributes such as an adviser’s location, their specialist expertise and information about their client base.
The best psychiatrists & counsellors: some names to know
Cosmo Duff Gordon
- Focus: Addiction treatment
- Position: Founder and clinical supervisor
‘People don’t realise quite how multidimensional a problem addiction is,’ says Cosmo Duff Gordon.
A chartered psychologist and addiction treatment specialist, Duff Gordon founded Chelsea Recovery Associates (CRA) in 2023. CRA provides effective, kind and confidential care around addiction, recovery, behavioural health, trauma and co-occurring mental health disorders.
The belief that recovery from an addiction – whether that is drugs, alcohol, gambling, gaming or others – is ‘a quick fix’ is misguided, Duff Gordon tells Spear’s; true recovery is about ‘long-term continuum of care’.
Read Cosmo Duff Gordon’s full profile on Spears500.com
Mark Boyden
- Focus: Psychotherapy and coaching
- Position: Founder and clinical director
Mark Boyden is clinical director, psychotherapist and executive coach at Mark Boyden Associates. With almost 20 years of experience at the top end of the sector, he counts UHNWs, senior corporate executives and royalty among his clientele.
Boyden tells Spear’s that he also sees a lot of entrepreneurs, namely those ‘in their late twenties, early thirties and some in their forties who have done very well, and they’re looking for more of a mentoring or coaching role from me’. Naturally, discretion is paramount in his clinic.
He says that the tide has turned on mental health in recent years. ‘GPs are referring far more than they used to; I think public awareness has changed considerably,’ he explains, adding that celebrities and high-profile figures have helped to move the dial.
Read Mark Boyden’s full profile on Spears500.com
Katie Au
- Focus: Eating disorders
- Position: Consultant psychiatrist
Dr Katie Au has a private practice as a consultant psychiatrist at the Sloane Court Clinic in Chelsea. A specialist in eating disorders, she also works with patients living with anxiety, depression, and bipolar and psychotic disorders, offering a blended therapeutic and diagnostic service. ‘[My consultations are] not just a box-ticking exercise,’ she tells Spear’s. ‘I think more therapeutically with my patients.’
Au says that many of her patients are highly successful individuals who face external pressures that lead to difficulties in their personal lives. ‘I see high-net-worth individuals with a lot of demands,’ she explains, adding that many ‘don’t feel they can really share with other people because they feel like they need to hold up to that leadership role, and so can’t be seen as vulnerable and weak.
Read Katie Au’s full profile on Spears500.com
László Ürögi
- Focus: Psychotherapy, addiction treatment
- Position: Chief Medical Officer
Psychiatrist and psychotherapist Dr László Ürögi is the chief medical officer at Kusnacht Practice, a treatment centre dedicated to delivering the finest mental health and medical care to private patients.
Based across a number of luxurious residences in Zurich and Geneva, Kusnacht’s team of doctors are renowned for their specialisms in a wide range of psychological and dependency issues. Programmes are personalised for each patient, and security and privacy concerns are taken extremely seriously.
Although the practice initially focused on addiction and recovery, Ürögi explains that the clinic has since expanded its treatments because ‘we found there is almost no case where it’s just pure addiction’. Instead, ‘many patients present with underlying conditions such as anxiety, trauma, or depression’, while ‘others have ADHD or are on the autism spectrum’.
Read László Ürögi’s full profile on Spears500.com
Amanda Falkson
- Focus: Psychotherapy, coaching and mentoring
- Position: Founder
Amanda Falkson is a highly experienced accredited psychotherapist and counsellor at Psychotherapy City. Based in the City of London, she focuses on helping her clients overcome a multitude of personal and professional difficulties, such as anxiety, bereavement and divorce.
Falkson also specialises in wealth counselling, which is a unique type of therapy for people experiencing pressures and personal challenges as a result of wealth. She has been providing this form of counselling to HNW individuals in the UK and abroad for over two decades, working in a supportive and pragmatic way to help her clients build resilience, manage anxiety and stress, and move forward.
Read Amanda Falkson’s full profile on Spears500.com
The best psychiatrists & counsellors: the complete list
Click on the individual names to be directed to more detailed profiles of each adviser on The Spear’s 500 website. The table is ordered by ranking and then alphabetically by surname.
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