Sister having a mental breakdown – what else can we do? Advice desperately needed.

[sausagepastapot]

The situation is such a mess and I didn't want to leave anything out so I have used AI to help me write this post. please don't shoot me down for this, I'm utterly exhausted with the situation and trying every avenue I can for help, and I know mumsnet can be a great source of support from people that have lived experience. So, please be kind in your replies. I would b very appreciative of any advice or signposting. Thank you in advance.

I'm looking for advice from anyone who has been through something similar, either personally or supporting a family member.We're in the South East for context.

DSis is going through what I can only describe as a complete mental breakdown, and as a family we're struggling to know what else to do.

A bit of background: she went through a divorce last year, subsequently got a new partner and moved a considerable distance away from the family. She absolutely hated living so far away and eventually moved back in with our parents.

Unfortunately, things have deteriorated massively over the last three months. She's having panic attacks, talking about suicide, cannot function normally and is nowhere near well enough to work. On a good day she can just about manage to make a simple meal, interact a little with her DD and do a small amount of exercise.

Her daughter is with her around half the week, so we're also trying to make sure she's supported and that my sister isn't overwhelmed by parenting responsibilities while she's so unwell.

In terms of treatment, she's currently:

• Having weekly CBT therapy.
• Taking 10mg Prozac (fluoxetine).
• Taking 15mg mirtazapine.
• Seeing a private psychiatrist occasionally (around £300 per appointment).
• GP is useless.

She's not taking any other medication. We're also looking into private residential treatment/therapy facilities to see whether a more intensive approach might help.

As a family, we're throwing absolutely everything we can at this:

• Regular walks and gentle exercise.
• Reiki and massages.
• Looking after her DD to give her breathing space.
• Talking, listening and being there whenever she needs us.
• Doing little things like her hair and generally trying to get her feeling like herself again.
• Her DP is involved, although his approach is sometimes more tough love than perhaps she needs right now.

The problem is that three months on, we're not seeing any meaningful improvement.

Our mum and dad are also struggling. They're trying to accommodate everything, but they're arguing about things like the increased household bills and even the milk! They're both stressed, exhausted and, I think, a little in denial about just how serious the situation is.

I feel like we're all firefighting rather than actually getting her better.

So I'm really looking for advice:

1. Has anyone experienced something similar? What actually helped?
2. Are there particular private treatment facilities, intensive therapy programmes or specialists in the South East that you'd recommend? Between London and Newbury ideally.
3. Is residential treatment worth considering, or could it potentially make things worse?
4. Are there therapies or approaches we're overlooking?
5. How do you support someone who is so unwell that they can barely function, without making them feel pressured to get better?
6. Has anyone had experience with Prozac and mirtazapine together? Did you find medication made a difference, and how long did it take?
7. How do you support the wider family, particularly parents who are struggling to cope themselves?

I know there isn't a magic fix, and I appreciate recovery takes time, but watching someone you love deteriorate like this is absolutely heartbreaking.
We love her, we're trying everything we can think of, and we just want to get her well again.

I'm particularly interested in hearing from anyone who has navigated the mental health system, used private psychiatric services or found a treatment approach that genuinely made a difference.

Thank you. And, look, sorry about the AI, I cannot face typing it all out myself, and have disabilities of my own- but it has basically said all I wanted this post to cover. Thank you for reading, and thanks if you can offer any advice.

1. priority is her child.

this should be at the front and centre

Would she give you permission to speak to her psychiatrist?

Can you condense it?

Has she been signed off work?

I think the meds might need a review. I believe 15mg Mirtrazipine is quite low.

DBT (a type of CBT) is sometimes recommended for women who might be neurodivergent (not saying this is your sister but some of her behaviour sounds a bit erratic so it’s a possibility). It’s more effective then CBT in such cases.

If the GP is useless I'd get her seen by someone else.

Did something trigger this episode do you know? - I'm not asking for details but may be helpful to know if something has happened or if your sister has a history of mental illness.

fluoxetine dose doesn't seem high enough to me (my DD was at 40mg at her highest)

Get bloods done, especially vitamin D, B12, folate and ferritin. The GP can do this, just take her and say you want to rule out any physical causes of her lethargy/tiredness.

Are the medications helping at all and how long has she been on this combination? Are two being tried because one on its own didn't help or is she transitioning from one to the other? Mirtazipine can be sedating so if she's finding her days are too impacted it's worth discussing this with her prescriber.

CBT isn't always the right approach. Is she seeing a Clinical Psychologist?

It would be best to go through her psychiatrist as they would be able to refer on to other appropriate support whether that is inpatient treatment, therapist, clinical psychologist. If you have the funds available then Inpatient treatment might be helpful but it is very expensive. I was covered by private medical insurance for my 28 night stay otherwise it would have cost about £20k and that was four years ago.

I think an increase in meds would be a good start, I’ve no experience of private residential units but have been sectioned and that’s not very helpful, however private facilities have therapy I imagine so I would look towards that if you can afford it, it’s very pricey.
When was her last psych appointment? I had them every two weeks when I was really unwell.

The medication doses are low / starter doses : is she taking it strictly and on a daily basis? Are you clear on when she started the meds? The SSRI can take 12 weeks to have full therapeutic effect. At the very least GP (another GP at the practice) can review those meds.

can’t help with the other questions sorry 😔

Adding to this, my local Boots now does various tests (ferritin, vit D, etc) for £7.99. You can buy a full set of tests for under £100.

DN is absolutely priority for us all too, my parents are totally there for her and we are all helping out. shes at mine now playing with my daughter having a right laugh. shes absolutely fine and cared for and supported. thank you though, you are quite right

I will ask her tomorrow, good shout thank you. It's just so so expensive and I think we may need to be saving funds for a more in depth option such as inpatient or day patient at a local facility. so far, her psychiatrist seems to be a little bit disinterested but we're not getting full information tbh as my DSis forgets

she is self employed, living rent free at our parents, she's not working, not entitled to any benefits as she is sitting on the proceeds of the house sale from the divorce

She’s need to be staying with you until your sister is in a much much better place

Wheee the heck is her DP in all this?? Is he the father of your niece?

Gosh your poor parents must be struggling under the weight of this responsibility. Have you thought of involving social services in terms of safeguarding your niece and getting some support for your parents? They're not just there to remove children.

thank you, I will look into DBT. never heard of it myself. and yes I agree that all her meds are low which is why I am annoyed with the lack of interest and action from her psychiatrist! they are making her like a zombie right now and she is worse on them than she was off them.

Is she under the mental health team? It certainly sounds as if she should be. And she should have access to an NHS psychiatrist who can have an oversight of her care. If you're not happy with her treatment, make a complaint to PALS on her behalf. I had to do this for my son and it proved very effective.

There are charities that can help you make the complaint.

www.theadvocacypeople.org.uk/

as far as I know it is mostly down to the divorce. she was attacked as a teen which has had a lasting impact on her anxiety and self view and caused low level anxiety and mild depression on and off for decades. But this is next level, shes totally zombified for want of a better word. I totally agree about getting her seen by another gp. I am going to see her again tomorrow so I will suggest we speak to a different gp. Thank you.

Her current psychiatrist is a private one? So all her meds you pay for?

She’s divorced
but she is in a new relationship. How long has she been with the DP?

thank you, I will ask if shes had bloods lately. great idea. shes only been on mirtaz for 7 days, shes been on 10mg prozac for about 8 weeks now? the psychiatrist gave the option of upping the prozac to 20mg or adding the mirtaz, she wasn't sure, and is struggling to make decisions, so she chose the mirtaz which is why this is her current script.

I also think she needs to see a CP, she isn't' I will add this to her list tomorrow of things to look into. thank you very much.