To think my mentally ill sister would be better off in the UK?

[Catslovepies]

Name changed for this as its outing.

My sister and I are dual US/UK citizens. I live in England and she lives in the US. She suffers from bipolar disorder and has been unable to hold down a job. She has no health insurance and our father has been supporting her - however this cannot continue as he is elderly and going broke. If she stays in the US they could both end up homeless.

AIBU to think that she would be better off in the UK? She could get treatment, a small council flat (in the northwest near me), benefits, and support to return to work - couldn't she?

I have no experience with the benefit system or mental health provision as I haven't needed either of these - I am very fortunate to have a good job and good mental health. So it is difficult for me to advise her. I know under austerity there have been a lot of cutbacks but if she came over and stayed with me for a while would there be help available to her? I cannot support her indefinitely but I can provide temporary housing and food. Thank you to anyone who can advise, we are pretty desperate.

A private rental wont have her! No way and she'll be waiting years for a council place.
If shes as bad as what you say OP can you really cope with housing her for years on end? You need to think about yourself as well. She wont be seen as priority if shes living with you.

With BiPolar she will be entitled to PIP after 2 yrs

This is not true, this will depend on how her condition affects her, it has nothing to do with the actual condition and she might be able to apply for PIP (personal independence payment) but if she get refused it may take up to another 2 years to actually get it. ESA is the same if she get refused.

Waiting lists for mental health services are long in a lot of areas. I have heard people waiting up to 18 months/2 years.

I would probably say, you would be looking to support her for up to 2 years, I am unsure if she could get a council house straight away but if not and she has to live with you, then you would have to evict her as she would not be considered at risk. This will also depend on the stock of houses your area has.

Can she not go for welfare in the States? From what I know it is tough and you have to hire a lawyer etc, but given what you said her chances might be the same with disability benefits in both countries if she is not engaging with anyone from the medical community.

You will also find that she will probably have to pay for medication on the UK as well

I know this sounds horrible cats but I think if you push for this you could end up responsible for your sister who you say is a drug user and alcoholic. If you were very close I would say go for it, but as it is I think this could put an enormous strain on you and your immediate family and it would take a while for the state support she needs to kick in. Certainly in terms of housing as a single person she would not be a high priority.

OP do you live alone?
If not you would also have to factor in how having her move in would affect the others in your life.

You will also find that she will probably have to pay for medication on the UK as well

Sorry should also say, but it wont come close to being as expensive in the States

I used to work for a mental health charity. I'm a bit out of date with what provision is available, but I'd suggest getting in touch with Rethink, MIND and possibly citizen's advice bureau to advise on what's likely to happen if she comes back.

The benefits system is being slashed and made harder for disabled people - as Disabled People Against the Cuts are constantly pointing out, but you're probably right that she's better of here than in the US.

My DS moved back to the UK against all our advice with bipolar. He was a UK citizen and had lived in the UK until he was 15.
We had treatment all sorted in this country. He had care and supervision and medication etc
When he got back to the UK he couldn't even get his NI number. He had no money as he couldn't work without that. He had trouble getting into a GP. Eventually he saw a psychiatric nurse who discharged him. He killed himself as I was booking a flight to go to him. There was absolutely no support for him.

It's very possible that ESA and PIP would not accept her claims for disability benefits as they are particularly unfair to mental health sufferers.

Coming up against this for the first time will be a massive eye opener to how brutal the UK is for disabled people.

As long as we can show we are making the UK our permanent home (which we will be) we were told that we and our US born kids will be covered.

This is the advice we were given as well - a returning UK national intending to stay permanently is covered.

I agree with PPs. However bad MH service is here (and its woeful) its much worse if you are poor or uninsured in the US.

Housing is another issue though. A single, potentially unemployed adult is going to struggle with housing unless you can house her and get her into some form of employment (if well enough).

Hang on though, if she's smoking pot every day and doesn't actually want to get help, what will moving here achieve?

If she won't engage she won't engage and there is nothing you can do, as sad as it is.

I have a sister with bipolar disorder. I have no experience of the US healthcare system but I can describe what it has been like for my family. For years, we provided all the support my sister needed and despite asking for help none was ever forthcoming because my sister would not engage with MH services. If a person does not engage they will get NO help as services are so stretched. Eventually things reached crisis point and she was sectioned at which point things did start to happen but it still took years and a lot of fighting on our behalf.
Likely what will happen is that your sister will need to live with you and you will become her primary carer. Being a carer for someone with bipolar who does not was treatment is hard. I avoid having my sister stay with me because she has been violent to in the past and as a result I suffer from PTSD.

@Mummaofmytribe
That’s so awful for you. I am very sorry

What does your sister think about this idea? Do you think she would agree? If this was to work, she would really need to want to make a new life here.

There is actually a good Age UK fact sheet about this - designed for older people who, as other posters said, moved back to the UK after years of living abroad. Of course you are going to have to read it realising that there are different benefits for someone under state pensionable age but it explains the difference between ordinarily and habitual resident which is important:

www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs25_returning_from_abroad_fcs.pdf

I only know of this one but possibly mental health charities such as Mind have done something similar.

I do feel for you in this really difficult position. It could work but it will take time and you and your mother are going to have to give your sister a huge amount of support.

You need proper advice OP. Start with the Citizens Advice website, then try Mind and other mental health charities. She will not just walk into housing, benefits, support.
I agree with a previous poster. A UK psychiatrist might attribute her symptoms to drink and drug abuse. I attended a psychiatric appointment with a person diagnosed with bi polar and the psychiatrist refused to prescribe medication until she stopped drinking.
I don't think it will be easy for any of you.

‘AIBU to think that she would be better off in the UK? ‘

Yes, you are being unreasonable in your thinking.

Apply reason & be practical.

MH resources are severely stretched for those already in need. Likewise, both social services & provision of social housing.

Your sister’s real needs are unknown & what you know of her condition is second or third hand. From what you have said, she is not compliant. Encouraging or bringing her here is a bottomless pit.

Are you &/or your mother ready to become carers for your sister? If you assume that NHS services will be available for your sister without you & your mother becoming involved on regular & routine basis, then you are naive.

Put your love, energy & goodwill into supporting your father as her carer. From what you are told, he is about to go broke. Maybe this is the case or maybe an exaggeration. Maybe this is his way of asking for support.

Again, what you know is what you have been told & is second hand.
Check the situation out for yourself.

Also she refuses to get treatment or do anything to help her situation so it will be very difficult to get everything set up for her even if it is actually possible

If this is the case then adult social care will not be able to help her. You cannot force support onto people unless she is deemed to be a risk to herself or to others then she would be sectioned.

What do you actually expect the UK services to do if your sister unwilling to accept help?

She end up sectioned and I am sure it is the same in the US as well.

I don't think she is smoking every day although I don't know. I think she tries to quit for a while and then goes on benders. She is definitely mentally ill rather than just being a drinker and druggie, trust me on this one.

She needs medication for asthma and she can't get it in the US. This is life threatening and is reason enough for her to come to the UK. She is a skilled and experienced chef and could hopefully get well enough to work although she hasn't been able to lately.

Mummaofmytribe I'm so sorry to hear about your DS.

You will also find that she will probably have to pay for medication on the UK as well

Not as a returning UK national making this her permanent home.

There is no meaningful welfare in the US. Unless you have some form of veterans pension, insurance related benefits you will struggle to get more than a few food stamps and that typically is only for a few months with an expectation that you turn up to do 80hrs a month of unpaid "volunteering" to earn your stamps. Its become worse under Trump.

There are plenty of people here who think that is a good model and that even our appalling levels of support for disability are "too much big state".

I think you have to have been resident in the U.K. for a minimum of 5 years before the council has a duty of care to house you? But it may be different if she has a local connection (you). Check with a solicitor?

I used to work on a psychiatric ward (a few years ago so things may have changed) I remember a few acutely unwell patients who were homeless, the ward worked closely with social services to find them accommodation. But it was temporary accommodation (normally a grotty room with shared facilities). Unless your area has lots of council flats available she could wait years in temporary. Is there any possibility she could stay with you?

How severe is her bipolar? Does she have psychotic symptoms when she's manic? Do you have documentation of her diagnosis? Bipolar sufferers are eligible for the higher band of PIP. Just make sure you have evidence from her doctors so she doesn't get misdiagnosed with EUPD or something over here.

I really hope you manage to get her back to the UK. I think NHS treatment for acute conditions like bipolar is brilliant over here. If she needs an inpatient stay to get her condition under control she should then be able to access ongoing support and treatment in the community.

‘With BiPolar she will be entitled to PIP’

No. She will not be entitled to PIP.

Not as a returning UK national making this her permanent home

Yes she will, as I stated it won't be as expensive as the States, but you still have to pay for medication, unless she manages to get an exempt certificate. She maybe entitled if she is earning under £16k but again this will depend on whether the OP is supporting her in her home and their wages are taken into account

‘Bipolar sufferers are eligible for the higher band of PIP’.

Nope, PIP assessments are not based on the condition(s).

Is your mum happy to have her move in with her and become her carer?

What will be the impact on your mums health. And your sisters mental health if she doesnt get on with your step father.

I totally see what you are saying, however, it's not going to be that easy and may, in the long run not be better. Our services are better, if you cant afford insurance in US. But she would actually have to engage with them.

The likely scenario is that she moves her. Moves in with you or your mum. That person has their health impacted, your sister doesnt engage with services. When the carer can take no more, or maybe even after that she will get a flat or room at a hostel. Still not engage with services. Still not be able to hold a job down, or be paying her bills and get evicted. Or get barely anything in pip or UC, if she gets it.

In general, you are right. She would be better here. But theres no reason to think she will actually engage with the services. And your mum, presuming she moves there, will have her health impacted by it all.

I have to pay for medication, too. I think it's about £8 per prescription. In the US it's often several hundred dollars without a prescription. From what I'm reading she should be eligible for medical care on the NHS straight away.

‘If she needs an inpatient stay to get her condition under control she should then be able to access ongoing support and treatment in the community.’

Really ?
Inpatient stay?

Those with the most severe & enduring mental health problems just about get the ongoing support & community treatments they need. Even with a MH Act section in place.

Mental health diagnosis, treatment & provision of meaningful support is complex & resource intensive.

For MH carers (meaning unpaid, not paid help), it is a labour of ‘love’ that exacts a heavy toll, even when NHS MH provision is good.