How to help MIL

[Crunchyontheoutside]

My mother in law seems to be having a kind of breakdown and my husband and his sister don't know how best to help.

She had an abusive childhood & has always had some (undiagnosed, untreated) mental health issues but over the past few years it's been getting worse. She's been trying to care for her mother who is developing dementia, and who continues to be physically & verbally abusive to her. She hasn't told social services about the past or ongoing abuse, even when she has ended up in hospital as a result.

She hasn't worked for years, now appears incapable of it, and has problems paying bills (rent, food, heating etc) but had been paying to see a private counsellor for a few months before she had to stop because she couldn't afford it. She's been calling up my sister in law every week, with hours long anxious "rantings" & has developed an anxious stutter. She doesn't always seem to remember what she's said and won't refer to the issues in other conversations.

My SIL wants to start paying for counselling to continue and while I'm not against that, I feel she should (also/instead) be in contact with local mental health services / social services. However, MIL is resistant to that, doesn't want to see her GP about it etc. She has a fear of mental health services, mostly due to a fear of racism, fear of being sectioned, fear of inappropriate treatment etc. I sympathise with that but I'm worried that counselling alone isn't going to cut it here.

To top it off, we're overseas so it's all falling on my SIL who is struggling to cope. They had difficult childhoods themselves, due to MIL's erratic behaviour, & have both had counselling to help them. This latest escalation is causing them a lot of anxiety both for her, and for themselves.

So.... What should they do? Would contacting local mental health services on her behalf be a terrible idea? Or even possible?

Oh your poor MIL........it's small wonder she's in a state if she's trying to look after her mother with dementia and being physically and verbally abused. This isn't fair on your MIL and it isn't fair on her mother either, as she they both need support. Do you mean her mother has physically assaulted her so badly she's needed hospital treatment?

I don't really understand why your SIL doesn't realise that this situation can't continue. I totally agree that counselling isn't going to cut it - it seems your MIL has become mentally ill - the origins may be her childhood trauma but I suspect the biggest factor is struggling to care for her mother without any support. People with dementia can be very challenging and it's small wonder your MIL is in such a state.

SO I think your DH and his sister need to act together on this (ok you're overseas but they can communicate on Skype or phone) The first port of call has to be the GP (and I think your SIL should go with your MIL) I know she doesn't want to go, but I think she has to be coerced if necessary for her own good. The whole situation needs to be explained and a request made for a referral to Adult Services or the CMHT to get your MIL's mother assessed and some support put in as a matter of urgency. Hopefully the GP will see the state your MIL is in without her having to say very much - but if not, then your SIL needs to be honest and say how worried you all are about her mother, and again the GP should be able to refer her to the CMHT for an assessment. GPs are able to diagnose depression and anxiety but if the mental illness is more complex it needs a referral to a consultant psychiatrist for diagnosis and treatment.

Your SIL will have to be prepared to be assertive because MH services are in serious decline on a nationwide basis - a very small % of the NHS spend is on mental illness as opposed to physical illness.

Is it possible for your DH to travel to the UK (I assume that's where your relatives are) to support his sister in this difficult situation.

The only way to access the community mental health team is via the gp. Your sister in law should visit the GP and discuss it with them as she will also be classed as a carer and entitled to her own support even if your mil doesn't accept services. Then it is a question of capacity, if your mil has the capacity to make the decision at this time about not engaging with mental health services then there is a little people can do tbh but that may change overtime and you may help increase her understanding which may help (eg GP or similar explaining about how and when people may be sectioned and when not). Your sil should raise all the concerns with the GP incl about the mum with dementia as that may be way in, to offer mil support as cater for her mum and also needs reporting as her mum is a vulnerable adult.
Sorry, long post but essentially your sil needs to go to the GP of your mil and tell them what's happening.

Also...so lovely to see a post in the active section that actually wants to help mil not just complain about them. Good for you and extra thanks for reminding me that mumsnet is here for people who care as well as those who want to rant

Thanks both. You're both thinking along the same lines as me. We're in Australia so can't really get back to the UK. We talk to SIL on Skype once or twice a week and to MIL about once a week/fortnight but SIL's the one left dealing with it all face to face, especially due to the time difference.

Yes nananina MIL has ended up in a&e twice (once on Xmas day) after being attacked by her mother. I think social services have advised that she needs more care and ought to go into a care home (they don't know about the abuse) but she doesn't want to go and MIL doesn't want to make her go.

SIL and my husband have tried so hard to get back on an even keel and they find it difficult to be dragged back into the family "dysfunction" but obviously want to help their mum as much as they can - although she switches between wanting them to support her more & not taking the support they offer.

I'll try to get DH to persuade SIL to go to GP with MIL - maybe framing it as getting support for themselves as carers might help.

Thanks again.