Families at the Center

On families, friction, and...sports gambling?

Last week, I had the privilege of attending the Georgetown Thrive Center’s inaugural Family Mental Health Summit: a gathering of thoughtful, passionate leaders and innovators working to reimagine mental health systems for children and families across the country. The event was co-hosted by Luminary Impact Fund and facilitated by The Holding Co.

This isn’t a recap or a formal report. (For that, I’d suggest poking around the Thrive Center’s website and signing up for their newsletter). Rather, these are just a few reflections sparked by the experience of being in the room with such an extraordinary group of people. I’m grateful to be a small part of it, and even more hopeful about what’s possible when we center families in the work ahead.

Beyond Individualism

Alexis de Tocqueville famously observed that American-style democracy naturally elevates the individual, not the clan or the tribe, as the core unit of society. But that framework seems to be shifting, across the political spectrum. We seem to be arriving at a collective consensus about the limitations of building policy and programs focused primarily on the individual as the key driver of change.

The question remains, what will replace the individual? The discussion at the summit offered a clear answer: put families at the center. It is a powerful idea and a potentially unifying one, because it reflects how most Americans already feel: 96% of Americans consider their family "extremely" or "very important" to them, a figure that has remained remarkably stable over the past two decades.

Dr. Matt Biel, a child psychiatrist and founding director of the Thrive Center, put it best:

“For anything to happen at the community level, it must happen at the family level first. Families are microcosms of communities and they make up communities. Families are the smallest unit of action and intervention in a social species.”

Family-Centered Users in an Individual-Centered System

As one participant at the summit said (as I would learn later, paraphrasing influential pediatrician/analyst DW Winnicott), “there is no such thing as just a baby,” meaning that there is always someone else there when the baby gets care.

This concept reflects the core idea of family-centered mental health: that individuals don’t thrive in isolation, but within the context of their closest relationships.

The problem, of course, is that our systems do not follow this logic. Virtually every part of the healthcare system is built around the individual. Services are billed to individual patients. Electronic Health Records are assigned to single individuals. Clinical notes, diagnoses, and treatment plans all focus on one person at a time, even when that person is part of a deeply interconnected family system.

This idea—that health is an individual matter, experienced and addressed in isolation—may be administratively convenient, but it does not reflect the reality of how people live or suffer or want to heal.

This disconnect was a recurring theme at the conference. Presenters and participants in table discussions continually returned to a simple and powerful insight: mental health challenges rarely exist in isolation, and neither should our responses. As a summit organizer put it, “families thrive or tank together,” and yet our systems continue to treat people as if they are navigating life and health alone.

One model that surfaced repeatedly as a promising exception was dyadic care, a clinical approach that treats mother and baby as a single unit of care. Rather than splitting their health into two separate files, providers trained in dyadic care understand the emotional and developmental interdependence between them: how a new mother’s postpartum stress affects her infant’s stress regulation or a baby’s sleep or feeding difficulties can exacerbate maternal anxiety. With the dyadic approach care is delivered to the mom and baby together, within their relationship.

And it works. Dyadic care improves outcomes for both mother and child. It leads to stronger attachment, healthier development, and more stable mental health for the entire unit.

This approach may seem obvious in early childhood, where the mutual dependence of caregiver and infant is undeniable. But the insight has broader implications. As participants at the summit asked: Why stop with mom and baby? Why not design systems that support families in crisis instead of as individual patients? What would it look like to build services, billing codes, and care models around small groups of people who are morally, emotionally, legally and practically responsible for one another?

The answers are complicated, of course. But the example of dyadic care shows that it is possible, and one big takeaway from the summit was that when we design for families, we often get better health.

There’s a quote that makes the rounds from time to time, often attributed to author Glennon Doyle, sometimes Hillary Clinton, and others too: “There is no such thing as other people’s children.” Systems that truly center families take that a step further, recognizing that there’s really no such thing as other families either. Sooner or later, we all find ourselves on the receiving end of care, not just as patients, but as parents, partners, siblings, or children.

Ultimately, neither thriving nor healing is meant to be a solo act.

Friction-Busting

My second big takeaway from the summit was about the idea of friction.

We all know that part of the problem is resources. Public mental health systems have been chronically underfunded for years. Everyone at the summit understood that we need more, but we also know that more probably isn’t coming anytime soon. So, we have to do better with what we have, which starts with redesigning systems around families and eliminating the unnecessary friction that wears them down.

As one parent put it, in most care systems, “the burden of linking and stitching together care falls almost entirely on the parents.” Another called it “a system of animosity,” shaped by the endless hoops families must jump through just to get basic help for their kids. The irony, of course, is that the very systems that ostensibly exist to ease stress and burden often end up creating even more of it.

At our table, someone summed it up simply: if we did nothing else, we should use our collective knowledge and resources to ruthlessly seek out and eliminate friction in the systems families rely on. That, by itself, would be a worthy goal for this group.

This got me thinking about something else. Better family mental health isn’t just about eliminating friction. The problem, as I see it, is that friction is misaligned. The biggest challenge for families is that the things that should be easy are hard, and the things that should be hard are easy.

We all experience this. The things we know are harmful—like pornography, toxic comparison, ideological echo chambers, mindless distraction, and other finely tuned dopamine loops—are seamlessly and instantly accessible. Meanwhile, the things that truly matter—accessing care, building connections, and finding time to rest and just be—are harder than ever.

That’s what makes the effort to reduce friction so urgent. Yes, families are tired, but also fighting an entire ecosystem pulling them in the wrong directions. Our ultimate goal should not just bet to eliminate friction, but to rebalance it: reduce it where it obstructs what’s good, and increase it where it enables what’s harmful.

Of course, that second part is incredibly hard. The currency of our current economy is attention, and there’s no incentive for companies to willingly forego their share of it. We probably don’t have the regulatory tools or political appetite to build meaningful friction into those systems, yet. But we should keep talking about it.

For now, we should focus instead on what we can control: making the good things radically easier to access. For an unlikely example of how, consider what could be considered a prime example of misaligned friction, something that is far too easy to access, with potentially devastating consequences: sports gambling.

Family Systems, by Fan Duel?

Sports gambling dominates through a ruthlessly efficient two-part strategy: make it easy, and make it everywhere. Entire sportsbooks now live in our phones, algorithmically optimized to lure users into placing more bets. Gambling is fully embedded in sports culture, from betting lines on-screen to luxury boxes sponsored by gaming apps. The industry latched onto the last remnants of the monoculture (sports) and became part of the cultural fabric. The results speak for themselves: record revenues and exponential growth.

What if we reverse-engineered that playbook and applied it to family mental health? What would it take to make peer support as accessible as a same-game parlay? What if care and connection were baked into our everyday experiences, available everywhere families are?

The group gathered at the summit is already on its way by explicitly working to embed family mental health principles and access into the systems that most directly touch families: schools, health care, community organizations, even the home. That’s an essential start.

We also need a parallel effort to strive for cultural ubiquity. With sports gambling, the omnipresent sports part is as important as the sticky gambling part, because sports are culturally infused into our daily lives. The lesson is that scaling works best when latched onto something already woven into people’s identities and routines.

How do we build a world where the language, expectations, and tools of emotional well-being are part of the atmosphere? How do we make mental wellness a norm that is woven into our social fabric, reflected in media, in workplaces, in sports, in faith communities, and in the products we design and the policies we adopt?

We may not be able to make harmful things harder to access anytime soon. But we can design a world where the things that matter most aren’t hidden behind complexity, stigma, or mind-numbing bureaucracy. We can learn from what works, and use those lessons to build something better.