I don’t like my sister and I don’t care about her “mental health”

[Hoverfly1]

My sister is an alcoholic, she has lost her children because of it. She just sits in her filthy house all day drinking. She never makes any effort to deal with any of her problems, she denies that she drinks but she very much does, I think all day every day levels of alcoholism. I am sure that this is what the majority of her issues are caused by. She says she has bad anxiety and depression so can’t do anything for herself. She won’t even leave her house to go to the shop and will make out mum fetch anything she needs (my mum won’t buy her alcohol though and she clearly manages to get out the house for that).

She constantly phones me and my mum day and night about the most ridiculous things when she is drunk. Arguments she has had with her ex partner or things that have happened years ago, she once called me relentlessly in the middle of the night to tell me all her problems were my fault because I once pushed her off a swing when we were kids (I did do this when I was about 7).

If she doesn’t get enough attention from us because we are both busy (dm is 63 still works full time and my sisters children also live with her full time so she has a huge amount on her plate already, I am a single parent with a full time job) she will start sending us photos of self harm or threatening to kill herself, she has also harmed herself and phoned ambulances a lot in the past which means my mother will have to go and pick her up from hospital at all times of the night.

She once told me she had cancer and was going to die, which I never believed but she would message me about it every day telling me about the drs appointments she had been too. Once it became clear no one believed her she just deleted all the messages she’s sent about it and denied she had ever said it, then accused me of making things up and “gaslighting” her. she has also made up having dementia and pregnancies and miscarriages as well.

Todays she sent me a message first thing the morning implying she had been sexually assaulted. When I ignored it because I was driving she immediately followed it up with self harm photos. When i asked her where she was she said she had gone to stay with friends for a few days and been out drinking with them, despite the fact that she hasn’t bothered to walk down the street to see her own children for months because she of her “anxiety”. At that moment I just realised I don’t care anymore. I don’t like her as a person and I’m sick of being manipulated by her. I told her she was selfish and manipulative and asked her not to contact me again. I also suffer from depression and anxiety which I take medication for and I find the way she behaves very hard to deal with. I think this makes it harder for me to feel sorry for her though because I HAVE to deal with my problems there so no one to step in and help me if I don’t want to get out of bed one day. I can’t understand why she doesn’t want to help herself a little bit, I’m starting to thinks she actually likes living like this.

I know this makes me a bad person because she obviously does have issues but I honestly don’t want to ever see her or talk to her again I know other people will judge me for it, i also know she will have shared the message I sent to her with a lot of people who will think I’m being horrible, she will very likely harm herself in some way because of it I’m scared she will actually do something serious.

How are you supposed to deal with someone like this without making things worse for them!?

I think you have reached empathy fatigue and your cup is empty. It’s ok. You can’t fix your sister, she can’t fix herself. It sounds a lot like an untreated personality disorder if I’m being honest, self medicated with alcohol and self harm to the point of addiction.

If it were you, you would have someone to take over raising your DC and help you, your DM would do the same for you as she is for your sister. If your DM didn’t exist or couldn’t, then the DC would go into care.

I do not think anyone chooses to live like your sister does, ever. I think she is crying out for help but your DM’s best isn’t enough and you are under too much life pressure to do anything and your best wouldn’t be enough either. If the NHS provided decent MH care, your sister’s life might have been very different.

I feel truly sad for you both and your DM.

There is no medication for Borderline Personality Disorder. The only treatment is residential (months in a psychiatric ward) and the beds are as rare as hens teeth. Even patients with multiple suicide attempts can’t get in. So drinking, self-harm, children taken into care often don’t meet the threshold. The NHS is crap rn for these patients.

Residential is NOT the only treatment option - it is totally dependent on the severity and in fact most people are treated successfully in the community. Please don’t spread outdated and incorrect information.

How awful for everyone involved.

Your sister, as you already know, is a very unwell lady. All I can hear in all the dramas is "help help help" (that's what she's really saying)

But you can't help. Not really. Nobody can really ever help anyone when it comes to this level of mental illness - it HAS to start with her, she must take that first step. But it sounds like she really can't. It's so sad.

But whilst she's in this terrible pit of hell , you must preserve your own health and wellbeing and as should your parents etc. only offer what you can actually safely give without harming your ownselves. The drunken phonecalls and messages are probably best ignored and answered the same way everytime, e.g "hi sis,sounds like you're feeling poorly. Get some rest. Happy to have a chat when you're sober " (that's if you are )

Distance yourself until some change has occured (proper mental health input, some sobriety talk ) I know this sounds so cynical, but once people are this far gone with MH/addiction it can be very hard to ever recover.
I think there's like an invisible line and once they kind of 'go under' with multiple suicide attempts and frequent hospital admissions it's a point of more or less no return. (Although not impossible) But it's very hard to then leave that shit behind when the terrible history is clocking up so well. The less shit,the easier to get up again.

Anyway, good luck. It sounds like it's been very very tough for you. You have the right to a life outside of this.

I hope your poor sister finds peace one day. It's a terrible way to live.

YANBU!!!

So, you think the OP’s sister who has an assigned cpn is being treated successfully by her community MHT? The description of her life was bleak and all too common.

The current state of the NHS is not outdated or incorrect, the severity threshold for patients to get the residential care they need, and would have had before the # beds were massively cut for personality disorders has as a result gotten far too high and thousands are literally slipping through the cracks.

@SummerFeverVenice i was responding to your post, which stated that ‘the only treatment is residential’. That is incorrect.

For sure, the closure of therapeutic communities was absolutely a scandal and a HUGE loss, and, in my view, was an incredibly short sighted and purely financial and political decision. It certainly had nothing to do with what was best for this group of people. For those most severely impacted, it was the only option likely to be successful.

But to say that the residential model is the ONLY successful model of treatment for personality disorder is incorrect and not at all supported by evidence. For those with mild to medium severity, long term community based therapies are effective. Those with the most severe symptoms are failed by the lack of residential places. The NHS has always failed this group of people and are still far from meeting the complex needs of the client group (of which I am a part of). It’s a postcode lottery, which is cruel and unacceptable. Some areas have very good personality disorder provision, going right from self-referred primary care level up to high intensity acute. Other areas have almost nothing. It’s not good enough.

But this is all largely irrelevant because the OPs sister would not be suitable for ANY of these treatments in her current state - residential or otherwise. And not just because of the alcoholism, but because she is not ready to take any ownership of her own recovery. She probably doesn’t even accept she needs to do anything differently at all. She is not engaging with any services or offers of support, for her alcoholism or otherwise.

Which is why I advised the OP to put herself first.

Sorry, I did not expect to be taken so literally since I was responding to the facts of these particular circumstances. The OP’s sister is quite obviously not being treated successfully in the community despite being under the continuous care of one for years. Her chaotic life and extreme mood swings attest to the fact. The only treatment beyond this, is residential and sadly although she should be offered it, the severity threshold has been raised to the stratosphere imho, letting down many like her.

Thank you for expanding on and agreeing on the dire state of the care available for her.

But this is all largely irrelevant because the OPs sister would not be suitable for ANY of these treatments in her current state - residential or otherwise. And not just because of the alcoholism, but because she is not ready to take any ownership of her own recovery.
I disagree massively with this. She is too ill to take ownership of her recovery. This is just the latest jargon to justify the lack of care. It is the usual pillar to post- they won’t take alcohol dependent patients for residential PD treatment, and the addiction centres won’t take patients with personality disorders that are unstable. She can’t get treatment for either while she is suffering from both.

I also advised the OP that it’s ok that she has decided put herself first- her cup is empty she has nothing to give and a lot on her plate. Her sister needs professional care so there is literally nothing OP can do to help her sister. I said that to alleviate some of the guilt her OP was evoking. It’s the NHS that is letting the whole family down.

@SummerFeverVenice that was badly worded on my part - it sounded like I thought she had a choice to move into recovery or not.

Because right now, you are correct that it is NOT a choice - she is too unwell like you said and she’s caught in a terrifying and devastating cyclone trap of using alcohol to help her cope with the BPD, which then makes her unable to engage or think or weigh up consequences, or do anything really.

So right now she’s just being ‘held’ by services, and like you said, bounced from one to another like a ball in a machine.

A decent care coordinator would be prioritising simply establishing and building a RELATIONSHIP with her (OP says she doesn’t attend appointments). Much of the difficulties of BPD are in relationships and interestingly it is through modelling HEALTHY relationships (even if wi thy therapists, services) that a lot of restorative progress can be made. Only once a relationship has been established could the care coordinator start to move conversation on to what she sees her future to be, goal setting, baby steps but nothing will happen with out that relationship.

Sadly, she’s probably already been written off as a ‘non engager’ - so no one is bothering to try. She’s less bother if she doesn’t attend after all. Less work, less hassle. Services are quick to write ‘DNA’ and then discharge, but they very rarely pause to wonder WHY the person cannot engage and maybe do something to help that.

https://www.beamconsultancy.co.uk
This consultancy service has done excellent work with particularly complex cases like the OPs sister - but the NHS Trust would have to agree to make that referral - and if there’s one thing medical professionals hate, it’s having to admit they have run out of ideas and aren’t sure what to do.

@Rinoachicken
Very well written, I strongly concur

I didn't know this, thanks for sharing.

My mother was on a mix of several anti-depressants/anti-psychotics prescribed decades ago, that she should not have been drinking on. She clung to them, but could not seem to get any sort of talking therapy because she refused to stop drinking. She was under addiction services but used them simply to rant at.

I know of at least 3 cases where people are substance abusers and have severe mental health difficulties. The NHS won't treat their mental health difficulties until they come off alcohol (and drugs too in one case), the situation can be utterly unbearable - these substance abusers are self-medicating their mental health problems.
One has severe OCD - alcohol dulls the voices so he can get through the night - there is no help for him within the NHS - he cannot tolerate his mental illness without alcohol and they will not medicate his OCD if he is drinking. His behaviour has become more and more problematic - police have had to be called several times - he abuses his mum in many ways and she cares for him deeply but in the current situation they face - there is no help and it is destroying their lives.

I have a sibling with addiction issues and a severe mental illness. I've just cut contact because of the abuse.

And the NHS services for alcohol dependency are woefully inadequate - sil's therapist declared she was no longer an alcoholic and didn't need their help anymore - the reality was they kept cancelling and rearranging therapy sessions so sil could not attend - that coupled with their strategy to shame the addict into giving up - well you can see why this particular charity (who charged the NHS) was doing more harm than good. We raised complaints and were met with GDPR restrictions - we got around those, lies from the GP surgery, the therapist provision was incredibly dysfunctional - how they ever actually help anyone is beyond me.

@faroutnow our GP was useless. They wrote her off as difficult. She was difficult, but many patients are, in different ways.

A small detail, but my dad was upset to receive a very crass condolence card from the surgery, almost immediately, scrawled in big childish handwriting. 'We are here for you'. Oh yeah?

They gave a known addict heaps of codeine, with little monitoring, kept her on psychiatric drugs for years with no medicine reviews, misdiagnosed her alcoholic neuropathy as carpal tunnel syndrome and sent her off with suppositories for what we now know was clearly cirrhosis.

As a family, we were powerless. We were never consulted, we hit a brick wall in whatever we tried to do. I still know that no one can make an alcoholic stop drinking, but the care simply wasn't there.

I am thinking about going nc with dsis over something much more trivial than what you are experiencing OP. I think you owe it to your children to go nc with her because they need their mum to be mentally healthy and she's bringing you down...

No judgement here, it sounds like hell. Some people just can't be helped. As long as she continues drinking, you are limited in what you can do for her.

If you need to step back to preserve your sanity, that's absolutely what you must do. You have kids depending on you.

Remember what they say on planes 'fit your own oxygen mask before helping others'....

They have to reach rock bottom before they do anything, have no one to rely on or help only then will they do something to help themselves

You are not 'a bad person'. My younger brother is an alcoholic. On the face of things successful, but has health issues, marriage issues and (in my opinion) needs a full psychiatric assessment. He ruined mother's day this year (catatonic at my parents' house) and my birthday (apparently suicidal, although his wife wouldn't call an ambulance). He sometimes makes horrible comments via phone, text or social media. I have simply stepped back this year. I don't have to take it and neither do you - you can't save someone who doesn't want to change.

Suggest some counselling options for her? Or NHS services. Sorry for you. Good luck - and stay strong!

OP, you cannot help your sister. She wants to have someone to blame, and as long as you allow yourself to be in that role, she will use it. My ex was like this. I felt so guilty about all his problems, but they were all always my fault until the day I threw him out. Afterwards, he realised it was the kick up the arse that he needed. Until another woman took him in and thought she could change him...
You're not a bad person. It's really hard not to believe that when you see someone you've loved suffering, but never tell yourself anything different.

I’m sorry you’re going through this, I had the exact same thing with my sister. I went no contact 2 years ago and then 6 months ago she committed suicide and I’m more broken than I ever was when I had to endure what she put us through when she was here.

Her attention seeking is bordering on harassment/abuse. Let her get on with it.

As the daughter of an alcoholic, it does NOT make you a bad person. You don’t deserve to be treated incredibly poorly by anyone - especially not family members. I’m glad her children are safe with your mum.

There is nothing wrong with you setting these boundaries, in fact for your own sanity you have clearly done the right thing. X