Mental Health Issues, Need Advice

[Sushipaws]

Ok, my sister has an eating disorder and it's just got worse over the years. The last 6 months have been hell and I no longer think she is a fit mother. I believe she will try and kill herself if her child is taken away from her. I don't know what to do, I think she needs to be sectioned but I don't know how any of this works and if I could look after her child.

If anyone works in mental health of has experience of this please give me some advice.

can you explain why you think she is sectionable and if she is being treated at all - does she have a care plan or community psychiatric nurse or mental health social worker?

I don't understand why you think her child has to be taken away in order for her to be treated - can you describe what is going on?

For the last year she has claimed to be in pain all the time. She said it's around her pelvic area, but she has been tested for everything and the doctors think it's in her head. She's on some serious pain killers that make her look like a junkie. She calls up NHS 24 all the time saying she's in pain and they sometimes come round and give her a morphine injection. However she still manages to cook dinner for her alcoholic bf and occationally go to gym classes. The other night she called the police because she couldn't find her child, he was actually staying at my mum's house. She set her bed on fire because she took her hairdryer to bed as she was cold. She flooded her house as she decided to have a bath late at night then went to bed leaving the taps on. She lies all the time to everyone and worst of all she doesn't feed her child.
She is seeing an Eating Disorder specialist was thinks there is nothing wrong with her because she goes in and tells them lies. She is also going to cognative theropy, but she doesn't tell us when the appointments are so she keeps missing them.
The doctors at our local surgery don't want anything to do with her because they think she just wants pain killers and she's making up the pain. She is so rude to them, no wonder they don't want to deal with her.
She says she wishes she could go to sleep and not wake up or that life is too hard.
I do believe she would self harm for attension.

Sounds like she has lots of problems - is there any one person with overall responsibility for her care, like a consultant psychiatrist? You could ask social services to do an assessment of her and her child's needs if they haven't done so already - and maybe someone from community mental health could assess her too, but that usually happens via the GP.

Do you know how she got referred to the eating disorder specialist and the cognitive therapist, was it through the GP?

She's needs a referral to the local social services department for support for her and her child. She has a complex set of problems that could be indicative of a few things, an eating disoreder, extreme health anxiety, maybe even munchausens syndrome.

On the surface it reads like she has borderline personality disoreder which is v v difficult to live with both for her and her family. People with this sometimes don't feel they're real which is why they behave the way they do, to actually convince themselves they exist. However I don't want to suggest a definitve diagnosis, I'm not a psychiatrist, I'm an RMN of 10 years.

She needs a comprehensive assessment by the primary care mental health team. It sounds like she's at risk to herself if not others inadvertently which are the crteria for being sectioned under the MHA but the GP, a psychiatrist and an approved social worker need to agree on this.

she is putting herself and her child at physical risk by what she is doing.. going to bed with the hairdryer, flooding the house.. also do her meds affect her? if she is getting morphine injections, that is pretty hardcore
surely if she is that unsafe and not getting the help, a section something to look further into? can the GP advise?

Of course, she could actually be in pain for real and perhaps too drugged up to function properly - I can't imagine morphine injections being administered to someone who is blatantly faking it, do the health services usually reward that sort of behaviour?

She does look like she's in pain, she is so emaciated and worn out looking I don't know what to believe.
One of the many doctors she's dealt with said that her problems are pychological and she may feel the pain but it's caused by her mental health issues.
There is one doctor who is better but she says there's not much she can do without my sisters approval.
I would call social services but I'm scared they say she is unfit to look after her child and take him away or give him to his father (a very evil man). I don't know enough about the system, I've been told that if they think a child is at risk they won't even give him to a family member in case they give him back to the mother.
I fully believe she will try and kill herself if she doesn't have her child, he is the only thing stopping her from loosing it all together.
She just can't stand food and he copies her, so when she does give him food he doesn't eat it, she gets angry and frustrated and shouts at him for not eating which just makes him worse. When he's with me or my mum he eats with a little encouragement, if the smallest thing upsets him he refusses. He is 5 and wets the bed every night, he naps every day because he doesn't have any energy and he is so thin, you can see through his skin.
I want to help my nephew but I love my sister too much to risk taking her only rock away.
What is a community phychiatric nurse, can they visit every day and administer pain relief? I think if someone else had her medication she wouldn't take too many and loose the plot.

Community psychiatric nurses can visit every day and bring medication, they have teams called 'home treatment/crisis intervention' or something like that - your sister would need to be referred via her GP if she isn't already in that system. Everything starts with the GP, or as you say, you could approach social services.

It all sounds so sad and worrying, from your side of the story your sister needs lots of help and support to care for her son and if she is not willing to ask for that then somebody else will have to arrange it, just for his sake if nothing else. The school must have noticed how unwell and unhappy your nephew is - on balance it might be best to trust social services to do what they say they do: support families to stay together. Ask them to assess the situation and make yourself available to help if at all possible. Could he spend some time with you?

I think in this case your primary concern must be for your poor nephew I would ring the NSPCC and see what they have to say. Your sister is an adult and has the choice to do something about her life (and I say this as a former anorexic, knowing how difficult those choices are) but her son has no choice. If you think your sister is a suicide risk if SS took your nephew into care - which would surely be a last resort - then there are crisis teams to deal with this.

You are in a very difficult position and I feel for you, but your sister isn't going to sort her life out from her current position and your nephew will be as messed up as she is - or worse - unless someone intervenes now. Good luck.

Thank you, your right, I do need to do something.

I think I'll try and speak to her GP and talk about a community psychiatric nurse.

I'll be spending allot of time with them over christmas so I can try and talk to my sister about her treatment of her son. I am a bit more positive because she got some results back yesterday and she called me saying that she thinks the pain might be in her head.

However if things don't improve over the christmas period then I will call SS. It's a horrible thing to do to your sister but I feel it might just be at that point.

Thanks to all of you for your help.

To be assessed under the mental health act she will need either her G.P or a section 12 doctor (psychiatrist) and an approved social worker. In some circumstances they will use the next of kin to make an application for a section instead of using a social worker. The G.P will only section in an absolute emergency. A social worker will look at every alternative to detaining a person as it is a huge loss of liberty.

A person is usually only sectioned if
they are a danger to themselves or others. I mean that they have to be actively suicidal or completely neglecting themselves or threatening to kill or harm others because of a mental disorder. Nowadays the mental health services do everything they can to keep people out of hospital, and use the mental health act as a last resort.

Hi Sushi I've just come by this post and wondering how you're getting on. It's struck home with me as I have been in a similar position to you. What a tough time for you all. It sounds like there's a lot of issues for your sister that are going to take some time to sort out.

Does your sister ever talk about what she thinks might help her and her DC? You say you're not sure (because of the system?) if you could look after the child - is this something you'd seriously consider if it came to it? Does your sister know that you may be willing to help out like this?

All the posts are right though, you have to put the DC first. Not an easy situation at all and I really wish you and your sister well.

Hi Whoop,

Thanks for your post and for thinking of us.

I would be more than willing to look after my nephew but my sister hangs onto him and gets suspect if you offer to take him too much. If I say he should come and stay with me for a few days she asks why and if I point out the obvious she goes in a strop and cuts me off all together. It's better to pander to her and then at least I get to take him some of the time. If I fall out with her she never gives in, until she wants something, but even then she'll never say sorry, she'll just make her demands and I give in because I worry. I know it's stupid to give in to her but I'm scared I get cut off and I can't help my nephew.

As I said above I'll be around her lots over the Christmas / New Year period so I'll be able to speak to her about her son and about getting her some help. I also want to talk to her about a rumour I heard, someone told me her bf has been dealing anphetimines, this would explain so much.

Hi Sushi
It sounds like your sister needs someone to carefully talk her through the reality of the situation, and the real risks to her dc, without judging her. It can be really difficult for some people to hear these things from poeple closest to them, especially when there's denial going on.

I guess the main thing is to communicate that you do what you do because you care, and that no-one is activily trying to ruin things for your sister.

Try to find out as much as you can about how good social services are in your area, how up to date they are in terms of family support. There's been a huge change recently in supporting families to stay together, but can be difficult unless social services are really with this.

If the worst comes to the worst and you are able to show that you regularly care for your sister's dc, this should go in your favour, although you'll need to be prepared for showing how you'd deal with difficult situations with your sister. It would be best if you also had your sister's support, so keep working on this, it really sounds like a better alternative than foster care.

The Family Rights Group is quite good (sorry don't know how to link) but should come up on google. Try also to get some support for yourself as a carer, your GP may be able to get some help for you, so you can best help your sister. Really good luck to you.

Hi, I hope you don't mind me posting, but when I read this thread it reminded me of what happened to a cousin. She was diagnised as anorexic although she always insisted she wasn't, and that it was the pain that stopped her eating. For months or even years I think no-one believed her and she was in and out of hospital with malnutrition. Eventually they gave her an MRI scan (I think it was an MRI - sorry, not medical at all) and they found a tumour the size of a lemon tucked behind her spine - it had been missed off any other xray because it was behind her spine. Tragically she died a few weeks later.

I'm sure that this was such a one off, but it does show that medics can easily miss things, and don't always offer all the tests and examinations that they can. I just wanted to tell you this because perhpas this pain is real and can be pin pointed and sorted out - it is a possibility.

Good luck, it sounds like your poor sister her son and your family are going through such a tough time, I hope things get better
x

Absolutely omond. It sounds to me like sushi's sister needs space and time to find out/work through problems, and to find out what the causes are. Pain is pain whether emotional or physical and this needs to be eased. Her DC also needs to be in a safe and supportive environment and it sounds like she has a family willing to support them both. I think if Sushi wants to help, she needs support in doing this.

I think the painkillers are complicating her problems and it sounds as if it is these that might be making her behaviour so odd/risky. Also if she is very thin and taking high dose controlled drugs, they are likely to affect her more than a larger built person - though she has probably built up a tolerance to them now. Anorexia Nervosa itself can lead to behaviour disturbance too. If she says she has been in pain for a long time, all investigations should be done eg an MRI, full set of bloods etc. Complementary therapies like Acupuncture are supposedly good for chronic pain.