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.

I would avoid the UK like the plague. This could ONLY be uttered by someone who has no experience of living without the NHS !!

I agree with the statement above!

It's going to be a difficult transition, OP, but I agree that she'll be better off in the UK as there's barely anything available in the US if you're uninsured or fall on hard times. Everything here is based on your ability to pay - and if the money runs out, you're out of luck (except for going to the Emergency Room, where they have to treat you).

Also, there's still much more of a stigma attached to mental illness in the US compared with Europe. It's slowly improving, but even admitting to stress is still viewed negatively.- I don't know anyone here who'd admit to their employer that they were stressed or suffering from depression, for example. They'd be afraid of the consequences for their career.

As PP's have said, the question is whether you can financially and emotionally take on the responsibility of supporting her in the short to mid-term? If you are, you need to set out parameters before she comes over, e.g. you can stay with me for six months, during which time we'll sort out accommodation and get various options in place.

ONE of the reasons it is short of money is because of folk who haven't paid a penny into the pot taking money out.
Your daughter (like my son who is also disabled) hasn’t paid into the system either. British citizens have the right to reside in uk. Once here she will qualify for care, just as your daughter does. You’re right “silly” wasn’t a very good descriptor for your attitude.

Hi again catslovepies. I've just read your updates. Your poor sister. She sounds absolutely traumatised. And it must be such a weight on you.

Re your father; you alluded to her having a difficult past with him I think, do you think that being away from him might actually be a help to her?

I do think on balance she is probably better off here in the UK, if she wants to be here, but as said, realistically much of the burden of her care will fall on you, Basically don't have any expectations of the NHS :(

It can be possible to find low cost private counselling that might help her. There are often local charities that provide this but of course she would have to agree to go. Mind and Rethink are usually very good, but are not everywhere. Some community MH groups and schemes can be helpful. So variable around the country though. Rethink have carers groups to support MH carers specifically so worth looking out for .

I don't know how it works with UC but on ESA you used to be able to work under 16 hours and still claim ESA for illness so perhaps her aiming to work part time might be an idea as TierraJ said. Then ideally spending the other time doing something therapeutic. Gardening therapy can be wonderful.. gives a sense of nurturing and thinking for the long term, and is slow and peaceful. Some places have local charities that provide this. If part time she would even have time free to blow off steam in a manic phase hopefully without affecting her job too much.

I think that perhaps what she needs most is safety and predictability even if she ends up trying to destabilise it, someone who can give her boundaries. Some help to take out the highs and lows, some certainty. It will probably be quite exhausting but people can and do recover from mental illness or at least stabilise, so its not always a lost cause. If only the NHS could do more. Its heartbreaking to hear how many people suffer so badly and get very little help. My DH is really unwell so I understand. I hope you are able to find a resolution.

If she was truly manic and she tripped up to A&E, she would be admitted, probably detained under the MHA

No she wouldn't. I have been manic and also suicidal, everytime, I was given a referral and sent on my way.

I believe, although not sure, you have to be a danger to others.

If you've been out of the country for over, I think a year, you're not entitled to any NHS support until you've been back in work and paying tax for 6 months. As for other support, I don't know but the way the country is right now I doubt she'd have an easy ride getting the support. I used to work for a charity which provided support for homeless and also vulnerable/mentally ill people and it just turned into a nightmare after the Conservatives were voted in. We couldn't even get help for the most vulnerable people who had been on waiting lists for months. Mental health facilities were cut so much they only had a simple walk in clinic where we could send people because nowhere else was accepting anyone or had the funds to help. In the end I quit as it was so heartbreaking to see these people coming to us for help and because of the government we had nowhere really to send them, regardless of whether they wanted mental health care, housing, etc. We continued providing medical healthcare but that was all funded by charitable donations and run by us ourselves. I would imagine she would spend a lot of time living with and being funded by you before she even got a chance at any help.

As of yesterday, there were no adult mental health inpatient beds anywhere in England!!

Dear cats. I feel your pain and am very sympathetic. I have a brother in US, which, like your sister, has MH/ addiction issues. While the US health system is a mess, there is actually quite a lot of MH provision for indigent people, through a combination of state/voluntary/ charity agencies.
Given your description of your sister’s behaviour, and that she would have to live with you for a good while, I am not sure returning to the UK in the situation you describe would be the best choice.
The issue would be to facilitate your father in not being taken advantage of by your sister. Can this be addressed in some way?

you're not entitled to any NHS support until you've been back in work and paying tax for 6 months.
This isn’t correct

I'll be honest, I would prioritise your father's health.

I agree that if she is really at rock bottom and engages, there may be charity provision in the US for her. If she's not engaging, then it really won't improve things for her to be here.

My dh with long term mh problems was assessed as low risk to self by specialist services here and was dead two hours later, so I am somewhat jaundiced at the possibilities really of meaningful help. And I don't blame the staff (although they didn't do a great job).

@sobeyondthehills

I’m sorry for your experience but it’s not true that you have to be a danger to others to be sectioned.

Every manic person I’ve ever seen in A&E has ended up on a mental health ward.

Moanranger, I hope your DB is able to find the help he needs. Its awful being so far away and feeling so powerless, isn't it?

TemporaryPermanent I'm so sorry to hear about your DH.

I spoke to my father yesterday on the phone and he just sounds so weak and depressed. He said he wakes up every morning feeling this heavy weight on him which is my sister's issues and he worries about it constantly. He said he won't give her any more money but I can't see him sticking to that. They don't live together, she lives in a different state and he pays for her to have a nice flat, all bills, food, petrol, etc. She has given him yet another excuse why yet another job has fallen through. He tries to believe everything she says and when I told him she has admitted to me she lies all the time he let out a little moan it was so painful for him to hear. Fortunately he is coming to visit me in August for a few months and I will be able to distract him a bit. Now he just sits and worries and he sounds older and more exhausted every time I speak to him.

It depends really. I have bipolar and have found the help available woefully inadequate. I wouldn't have got through it without family.

If she is a danger to herself the mental health system here is shite. You have to be chopping your own head off in front of the assessors to get any inpatient help. I've seen people seriously harm themselves repeatedly, stabbing themselves etc, but still that isn't enough to section them - in large part because there's a severe lack of beds. In the US you get inpatient stays for merely stating your suicidal. But obviously there's the cost.

Can your dad stop paying your sister and pay you instead? You can take your sister in for a couple weeks and try to help her get a flat (anywhere). Get her a few months in a flat then see if she can get some benefits since then she will be considered a resident? It seems like your dad has money to throw at the problem but the money is going in the wrong direction.

Every manic person I’ve ever seen in A&E has ended up on a mental health ward

I would like to know which area you live in because it sounds like they have good mental health provision. Here that absolutely doesn't happen. When I used go work in a&e myself it used to break my heart at the people we would have to discharge. Manic people, suicidal people, people swallowing sharp objects, throwing themselves in front of cars, stabbing themselves, intentional overdoses. I felt like I was throwing them to the wolves. And that's what it felt like when it was done to me. sobeyondthehills experience is much like my own both professionally and personally, it was the people who were at risk to others who were given inpatient stays.

Also I would try to go at this one problem at a time.

First thing to solve is her impending homelessness, then you can try dealing with the mental health. Perhaps some of her mental health will be helped if she's pulled out of the toxic environment she has made for herself.

Can I suggest contacting local charities and support groups to see what the situation is where you are? As with many things NHS it is a bit of a post code lottery as to what’s available. I think you also need to talk with your DH and mum etc and realistically consider the support you can give her. Could you cope with her lies day in day out? Could you afford funding her long term given the excuses made for not getting a job. The new PIP system is a nightmare, genuinely ill people told they can work when medical proof shows otherwise then you are in a cycle of appeals. Is there an option of giving you dad respite by inviting over for holidays instead?

He really, really can't keep giving her money. He has already had to sell his house and move into a small one bedroom flat that he fortunate inherited from his mother. The money from his house sale has mostly all been hoovered up by my sister and now he has a small amount of savings that he just can't keep burning through. He may well need that money for nursing care for himself but also...if he spends every penny now what will my sister have when she's older and physically can't work? She obviously has no plan for that....

Its very hard to figure out how much of my sister's problems are from mental illness, how much from trauma, and how much from laziness and being enabled to do nothing for so long. I think the best case scenario would be for her to realise she can't keep on like this, that my dad is seriously not going to give her any more money, and then she goes out and gets a job. I believe she would be able to get one if she realised she had to. I think so, anyway.

How about between you, your mum, and your dad? If you guys could all try to put a little money together then get her a flat in like the cheapest area possible...? Perhaps one of you could get a loan or cash advance on a credit card or something? Maybe get her a flat in a remote area of Scotland (just because they may have more resources for NHS/social housing)?

It seems like flats are far cheaper in some parts of Scotland than the cheapest parts of the US. It might provide your dad with some relief, just not right away.

This place says it's £275 pcm.
www.rightmove.co.uk/property-to-rent/property-62188632.html

I wouldn't advise someone struggling to recover from problem drug use to rent a cheap flat in Paisley tbh!

Writing it all out it sounds like madness that I would have her come and live with me

You're right, it does. It's clear your father's being stripped bare emotionally and financially by her difficulties, and if you chose to house her (and it is a choice) this would soon be you

I'd be especially mindful of the dubious allegations you've mentioned -how would you feel if the stress of a move worsened her MH and she started to accuse those around you?

As PPs have suggested, personally I'd do everything I could to research support in the US, but I'm afraid there's no way she'd be living with me

If your sister wants to come back to the UK and you and your Mum think you can support her then that is probably the best thing to do. It will be hard and I would advise not having any children until your sister is stable and established in her own place. The other thing to think about is that, from my experience, it is more difficult to access social housing if your family are financially well off. It may well be easier for you to pay rent on a small flat for your sister near you.

As far as being sectioned the criteria are

1. Person has a mental disorder (if your sister isn't known to psych services here that could take time to establish)

AND

1. Person is a risk to their own health, safety or welfare OR the safety of others

Talk to your sister and see what she wants to do as the move could well precipitate a MH crisis, especially if she feels forced into it. Best of luck with it.

I don't think she'd be sectioned or get inpatient care. I would think she could get some mood-stabilising medication though via her GP if she had access to the NHS.

I don't want to pay rent for her (and our mother can't). Partly because that would give her no incentive to help herself. If she was staying with me I know she'd rather have her own place and that provides incentive. Right now my father is enabling her and I don't want to make the mistake of doing the same thing.

If I'm honest I think unless your father is strong enough to say 'no' to your sister, there is no 'can't' about his last bit of savings. They will go to her. He's already lost his home, I can see her making them both homeless.

It's often hard to tell whether people can't or won't hold down a job. The effect is the same. I think it's possible she will get jobs after/just before they're both on the street, but I doubt very much she will keep them. It's just possible, if the right circumstances come together.

I would focus on encouraging your father to make boundaries and stick to them.

Read this OP - someone in a similar situation to your sister except that they both live in the US.

www.dailyrepublic.com/all-dr-news/wires/features/state-national-lifestyle-columnists/my-sister-is-jobless-and-homeless-and-im-not-sure-how-to-help/

The answer given is this:

Dear Lost: It is compassionate of you to take in your sister and her family, but she needs more help than you can give her. The best thing you can do for Jess is to look into local social services that will help her and her husband with mental health counseling, job training and housing. Please contact the National Alliance on Mental Illness (nami.org), the U.S. Dept. of Housing and Urban Development homeless assistance (hud.gov/homeless) and the National Coalition for the Homeless (nationalhomeless.org).