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.

Smallereveryday
Very few posts seem to be annoyed at the ops sister coming to the UK and taking resources.

Most posts I've read are from people who know it's not likely to be the rose tinted handed on a plate she imagines.
It's bloody tough out there. That's reality.

So I am incredulous at this hostility against a Britain national!

Yes me too.

As a previously tax paying and resident UK national who has fallen ill whilst working/living abroad I'm shocked that people don't think its normal for her immediate family to be concerned and want to help her. Because even with some benefits they will still be supporting her.

OP: check the latest rules but when we were affected by this returning British residents did not need a qualifying period for NHS treatment. One of my DC is currently living/working abroad and the advice still held for him when I checked less than a year ago.

Housing benefit etc is another issue - not sure what the situation is with that as we never needed to check it.

Why does she have no insurance though?

Why does she have no insurance though?

In the US? With an existing condition she quite possibly can't get it or if she can it would be too expensive for someone in and out of work.

There is European style state backed insurance system which covers all conditions.

Lifeandbeans, yes there have been I think only 3-4 posts saying resources shouldn't go towards my sister - they made me a bit angry as if we don't have enough to deal with. I do realise things are very tough out there...it is more my mother who has her head in the sand about things here. She has to hold out hope.

Diddl she has no insurance because she doesn't have a job.

Things in the US are even tougher than they are here. No NHS and when you're poor you tend to have to live in dangerous neighbourhoods with lots of gun crime. My sister was raped at gunpoint a few years ago and her mental health seems to have spiralled downwards since then. The police weren't really interested.

No, she wouldn't be. The mental health service in the UK is a disgraceful state of affairs. I always speak highly of the NHS but, in they don't treat mental health seriously enough. People are only getting help if they attempt suicide if they are lucky.

"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."

It doesn't matter what country she lives in then.

If you have decent health insurance in the US then it is far better for the mentally ill who actually want to get better. No healthcare system can help people who don't want to get better though.

I think you need to think of yourself op. Yes, the idea sounds a perfect solution, but...although you say she has lived/worked here before, it would still be a terrific change socially for her. If you are unfamiliar with the culture in addition to having mh problems it could be very destabilising.
My late brother was bipolar. There is very little help beyond medication. It appeared to me that because of lack of money mh is dealt with on a 'fire brigade principal' in that mh services will only step in if things have gone badly wrong, like attempted suicide. Once they get things back to almost normal they have to move on to someone else who desparately needs their help. There is little or no ongoing care - just keep taking the pills and go away essentially.
The other thing would be the effect on you. Have you lived with your sister for any length of time? (Like, how well do you really know her?) You will essentially become her carer. It is no fun having a manic bi polar person in your house and then actually worrying whether they are even safe to leave alone, and whether you will actually still have a complete house to come back to. We could never leave my brother alone in our house for example, because of his behaviour. No need for detail but he inadvertently caused damage. As a teenager, before being diagnosed, he was living with me and I had to ask him to leave because he was filling the house with random drug smoking people he had met while I was out at work (yeah, come back to my place for a smoke!).
Lastly, social services/mh services are very pressed, and they will always lean on family to do everything. She will become YOUR responsibility, not theirs. Think very carefully, your life will certainly be one of high stress if you go down this route.

"Diddl she has no insurance because she doesn't have a job."

So there is no provision for her other than to pay full whack???

Incredible.

Please urge your sister to find out which health care benefits she is entitled to in her state. Under the Affordable Care Act, Medicaid was expanded in most states. Other programs may be available as well.

BTW, pre-existing conditions must be covered by health insurance companies under the ACA, despite Trump & co's best efforts to change this. Hopefully, the ACA regulations will continue to hold.

Don’t listen to the posters saying, ‘Keep her in the US’. They are either clueless or they blatantly do not have your sister’s best interests at heart.Things are not great in the UK, and I don’t know what her chances are of getting social housing, especially in the short-term, but they are likely to be much better than the Wild West situation in the US.

I also seriously doubt there would be any time period where she wouldn’t be eligible for (free at the point of delivery) treatment while she ‘re-establishes residence’. She just needs to say she’s come to live in the UK for good. It might depend on the NHS trust but I’d take my chances if I were you. The US is like a highly developed and a developing country rolled into one. The poverty and utter lack of care for those at the bottom of the social scale is unbelievable.

I work in a mh hospital. It is not massively unusual for us to discharge a patient to present as homeless at the council offices with a bag of 7 days worth of medication in their hand. Things are not as awful here as in the US but they are pretty fucking bad.

However, on balance it seems to me your sister has more chance of recovery and care here than there. In her favour is that she has you! You need to get specialist advice from people who know what your sister's rights would be, rather than people guessing or assuming.

I would want to bring her here if she was my sister. I'd be prepared for it to be a bloody horrible battle (and it will be- resources are so stretched and it is so so hard to get people the help they need) but I'd do it. If you can house and support her even temporarily that's a start.

Good luck to you both. I hope she gets the help she needs.

In the uS her options for insurance are

1. through an employer. This typically only comes with full-time employment. Any interruption in employment means she loses her healthcare u less she pays for it herself which will be impossibly expensive.
2. buying on the private market. This is relatively new and may be going away. The plans she could possibly afford will only cover a bare minimum and that will not include any extensive mental health coverage.

As a single adult she is entitled to very few types of aid u less she gets a formal disability declaration. That declaration is extremely difficult to get.

Your sister has no chance if she stays in the US. It's not surprising to see whole families homeless in tents by the side of the road in the US now. I think it's gotten particularly bad in states where rent has gone out of control.

You need to consider a couple things:

1. I doubt she would come to the UK because she isn't logical and she probably won't want to be separated from her drugs.

1. She will be better off in the UK but you're going to have to shoulder her as a burden unless you just get your mum to deal with it.

Is your mum fine with leaving her there? I think you're going to have to put this on your mum to deal with. It's her child and if her husband doesn't want to deal with her then she's going to have to make some hard decisions. While your mum is alive, it's not your responsibility imo.

To give context on the insurance expense. The last time my husband changed jobs he got the forms for continuing his insurance as is standard. Just for him it would have been $1800 a month. We didn’t have to pay that because I carry him on my better insurance anyway. That $1800 gives you coverage for about 80% of medical costs, you still have to pay the remaining 20%. Prescriptions are extra. Some are cheap. Others are incredibly expensive. My daughter broke her arm last year and needed it surgically repaired. That cost us $3500. Her assorted asthma medications cost us $85 a month. Each visit to the allergist is $117 and those are required 4 times a year plus for every flare up.

My parents purchased insurance privately for a few years. There only options was a high deductible plan and every year the first $5000 of individual medical expenses incurred were out of pocket.

Minimum wage varies by state? But $10 is common. At 40 hours a week, the most a minimum wage worker could gross a month is $1600. Taxes and social security contributions will be taken out of that for a smaller net. I don’t know how high those are at that level. Some states have subsidized insurance available for purchase by low-income workers, but it is still a big chunk of income and there are additional expenses for actually using it.

All of this is to say that I can’t fathom she would be worse off coming to live near you.. I’ve had friends move to the US because they have better access to health care here than in England, but those are people with high paying corporate jobs.

So she's driven your dad in to the ground and you'll be next.

I'd leave her to it tbh. Drugs and alcohol abuse don't indicate she'll be able to recover and you will end up being responsible for her.

I would talk to the local council first about the reality of social housing. I suspect she will fall foul of the residency period but even if she presents as homeless, I think they would be entitled to judge that she is intentionally homeless, and not their responsibility. I cant imagine what kind of private landlord would be prepared to take her on - or social landlord, if it comes to that.
You should be able to get advice from your own local council.

I do think it would be easier for you to help your sister - or help her to find help - if she were living in the UK. You can't do anything for her while she's in the US and there is no doubt that it's worse to be poor and sick in the US than in the UK. However I think you need to accept that it's unlikely she'll come back, be immediately offered her own place and be magically cured of her mental health problems by the NHS. If she moves in with you, you will be able to help her access help - whether you can persuade her to take up what is available is another matter. The idea her preferred option is to stay with your dad and for him to continue taking care of her does not bode well. Whether you can persuade her to stop drinking and smoking or learn to tolerate it while she is living with you remains to be seen. You can find out what help is available for her, but you need to ask yourself what you will do if she refuses to help herself and then refuses to move out of your house. A large part of the problem is your sister herself - and that remains the same whichever continent she is living on.

I have bipolar. Last year I was manic, slipping in and out of psychosis and my lovely GP struggled to get me any kind of psychiatrist appointment until I was exceptionally unwell. I kept going back, she kept emailing and writing letters but no response.

I have just got to the top of a 22 month waiting list for psychology treatment. I have been on the waiting list for a CPN for a long time after the old one retired.

Mental health services are very patchy, but time and time again on support groups I hear the same story. I have a friend who waited a year to get specialist trauma therapy for PTSD and then got to the top of the list and they told her she was too traumatised for treatment!

Add in an alcohol and drugs problem and she could end up bouncing between systems, psychiatry saying no treatment until she is clean and drug and alcohol saying she needs psychiatric support.

Of course the benefit is that all treatment and meds are free (Scotland).

Is she able to work to support herself at all?

What about the limited provision for disability and medical care in the USA? I know it does exist but don't know the system.

I would still rather be in the UK with bipolar than be someone without insurance in the USA with the same condition.

People have said she could study here, but she would be highly unlikely to qualify for any kind of student funding either.

Which state does she live in?

Medicaid covers people on low incomes in most states.

There are also highly subsidized ACA policies for those on low incomes.

Any hospital that accepts Medicaid is also obliged to provide free or low cost insurance to those on low incomes.

There are also free and low cost clinics.

At this stage her best option would be to get help from a social worker - they are very helpful in applying for benefits, housing and healthcare.

@methusalahsmum

If she was truly manic and she tripped up to A&E, she would be admitted, probably detained under the MHA. Christ resources are scarce but they are not that scarce.
In my experience sadly men are discharged homeless way way more often and it’s relatively infrequent for women. I’m not saying she would get a flat and lots of benefits, but she would most likely have some stuff put in place for her.

However, the OP seems to be avoiding questions about her bipolar symptoms. It sounds like she has had a lot of trauma. It sounds terrible but I think unfortunately it’s true- when they find out about her history of trauma she will end up with a personality disorder diagnosis and help will be less forthcoming.

Unfortunately there is a hierarchy by diagnosis- people with bipolar type I are more likely to receive good services and support compared to someone with a personality disorder/ substance misuse.

Bear in mind I speak for services I have worked in around the north and can’t speak for everywhere. But if you turn up to A&E with elated mood and flight of ideas in a manic state they cannot send you home!

Hi OP,

Do think this through very carefully- it sounds like it will be very stressful and demanding for you and your Mum if your sister does return to the UK.

Can she even afford to engage with treatment in the USA? Is she refusing it or is it just inaccessible for her? She would be entitled to help over here if she chooses to engage with it but she would need to be engaged with mental health services and/or a GP just to claim ESA in the first instance.

Treatment may well be free in the UK, but that's not saying much when there's not a lot of it about.

Drug & alcohol services are up to their necks with people who want to get clean, and psych services are very, very patchy. The care isn't up to comparison with Europe and the US standards.

OP, I suspect DSis wouldn't get treatment in any case - she doesn't want to get clean so D&A won't let her in & psych won't touch addicts.

Being ill or an addict doesn't get you the key to a council flat either - addiction certainly doesn't. Or housing benefit, because no landlord would rent to her.