<p>Unfortunately , private counseling costs$$. Without money (and even with good health insurance, mental therapy is not well covered), a family needs to start looking at all of the community and government services available. The physical is really the first step for the young man, and really for the entire family. it would be easier to get him to take a physical if it is something everyone is doing. When there is something wrong with a person, he often gets nasty about anyone implying that something is wrong with him, so things need to be started with a lot of tact. Somehow communicate to the physician, hopefully a family one, that a drug screen should be given along with the other blood tests that can cause mood disorders. If the problem includes substance abuse, there are a number of free or relatively inexpensive treatment options. It would be a worthwhile investment to get a counselor, really any counselor to gently talk him through to the programs. The OP should check for any kind of program that can start the steps to some sort of therapy, whether it is substance abuse, educational, occupational, medical, psychiatric. If there are teaching hospitals, check out what they have, investigate offerings and ideas from local colleges. This is not going to be easy, and will take a lot of research and then personally checking out the possibilities. The brother is not likely to cooperate in being paraded around everywhere, so the ducks should be in a row when the big step of involving him has to be taken. Conyat is right about working through the public sector, there just may be some resources available. Also there are support groups for just about everything. They are usually free and the parents in them often have a wealth of ideas, (like the parents at CC), If you can kind of match up his symptoms to a disorder, even unconfirmed, attending the meetings, getting on the websites can be valuable and inexpensive. I was on the verge of looking for something through this route when I came upon the psychiatrist that has been so effective and is working with me at just the right pace for me. For a young man who is not likely to go to college for a while, this might be where the college money should be invested if there is any.</p>