From the U.S.: My older sister is 65 years old and has suffered from mental illness virtually her whole life.  She has received various diagnoses: bi-polar, major depressive disorder, and borderline personality disorder..  Despite this, she got a master’s degree, was a CPA, raised two children and almost completed her PhD.  Our relationship has always been complicated – my childhood memories are of her being very mean to me and nice to our little sister.  She is able to present one face to most people and a very different one to others.    (I realize that my memories are biased.).  But, I have resorted to blocking her phone to protect myself from receiving what I perceive as insincere and manipulative text message/phone calls

My sister has attempted suicide multiple times (once with her children in the car).  The most recent attempt resulted in her being placed in an assisted living center for the past two years.  Despite a tremendous amount of family support (financial and emotional), plus regular doctor, psychiatrist and counselor visits, she is not making apparent progress.  That having been said, if you talk to her on the phone, she sounds like she did 10 years ago – bright, interested in what is going on, etc.  My niece has told her mother she won’t bring the grandsons to see her unless she showers, puts on clean clothes, and meets them at the front.  She doesn’t (can’t? won’t?) do this.  She lies in bed all day, getting up only for meals, doctor or counselor appointments.

My niece has tried to get her to go to an outpatient facility, but my sister absolutely refuses to go, saying she doesn’t like group counseling.  I am pretty far down the food chain as far as decisions about her care goes.  But, I am taking care of our 94 year old mother who is very involved, so I hear about the issues, from both her and my niece.  Plus, it is just awful to think of my sister lying in that bed for the next 20 years.

My niece and nephew lost their father recently, and my nephew lives about 3 hours away, so my niece needs her mother!  My sister’s meds have been changed a couple of times and her counselor comes to see her every week.  We are at our wits end.  How do you help someone who will not help themselves?

This is heart-breaking for everyone who loves your sister, I’m sure. Sadly, the answer to your question is that you can’t help someone who refuses good help. Her refusal is part of the illness which makes a circular dilemma: Her failure to engage in treatment contributes to the maintenance of the illness. Her illness makes it unlikely she will engage in treatment. This is what severe and persistent mental illness looks like. The ray of light in this situation is that your sister is safe and cared for in the facility. It’s unlikely a suicide attempt there will be successful.

My best advice to you at this point is to let her counselors and other people who support her do their jobs. It is far more useful for you to focus on the people in the family who need your love and support. Visits with a family therapist may help everyone come to some peace with your sister’s decisions and may alleviate any guilt they are experiencing about not being able to influence her to get active in her treatment. It’s normal to experience this as a kind of grieving. A therapist may give you and others in the family some guidance about how best to help your elderly mother deal with her feelings about her daughter’s illness.

If there is a chapter of NAMI (National Alliance on Mental Illness) in your area, I urge you to attend some meetings to see what they have to offer. Often they provide support groups and informational meetings for family members that are very helpful. Here’s the website. The website has useful information about mental illness and the effects on both the individual and their family members on it. There is also an online discussion group. As is the case with any grassroots organization, the quality of local programs depends on who is leading the group at the time and how involved the members are willing to be. But do give it a chance.

There are also forums here at PsychCentral that may be helpful. People from all over the world who have similar issues provide each other with information and support. Click on the “Find Help” tab on the home page.

I wish you well.
Dr. Marie