Expert: Libby Bonner - 2/29/2004

Question
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Followup To
Question -
My sister is 47 years old and was diagnosed with bipolar disorder about 20 years ago. She has been in and out of hospitals in that time. She is also an alcoholic. She doesn't live near me, however, I am very concerned for her. She is currently homeless and has been in and out of jail for two years now. On occasion they stick her in a mental health facility and she get's on track for about a week and then the alcohol kicks in and she's done fo. She refuses to get help for her alcoholism, she is in complete denial about her life, ie: nothing is her fault, it's all been done to her, it's my fault, it's her husband's fault, it's mom's fault, etc., (my sister is/was very smart--she used to be married, had a good life, college degree, etc.) One weekend she went on a drinking binge and never stopped. She lost everything. I speak to her only when she calls. Do you think there's any help for her. She lives in Tampa. I've tried Social Services there, but since I am in Virginia, no one really wants to talk to me. When I can get money to her she usually gets drunk, violent and gets arrested. Any suggestions--my Mom and I are heartbroken--we feel as though we've lost her and we can't get through to her. Thanks.
Answer -
World's toughest question: how to help the very sick, very resistant adult patient who lives elsewhere.

Unless one of you can be in Tampa, and are welcome there tho not living in her house or apt while there, for up to 3 months, or she can make a permanent move to where you are, things will remain pretty difficult, in part because of the length of her illness and because of the dual diagnosis [substance abuse + bipolar disorder.]

Here are my brief thoughts.

1. Pay for some legal help to effect a committment there and/or to appoint a guardian there.  You will need a FL atty, working w/ a local one.  See www.nami.org for info on this and all other kinds of info.  [Or ask Tampa NAMI for an atty name.]

2.  Don't send her money.  Pay for some expense there, like her rent, but never money.  The check goes directly to someone providing her w/ goods or services.

3.  Determine her income and income source/s.  Is she on Soc Sec Disability [SSDI] or what?  Can you help her, get someone to help her, get on SSDI?  Tho might be tough to do w/ alc involved.  Does her income level make her eligible for Medicaid, which would pay for meds?  If not much income and nothing to provide meds, is there a large public hospital in the greater Tampa area that cares for indigent out-patients? - my daughter got meds in this way for awhile.

4.  Did the alcoholism pre-date the bipolar?  Often bipolars self-medicate w/ alcohol or drugs until on meds.

5.  Does she take any meds now?  Has she ever been on meds, and stayed on them, and felt better for awhile?  Until and unless she is stable on meds, alc will remain a problem?

5.  You might try to determine if Tampa has special programs for dual diagnosis pts.

6.  If you or mom would like to be able to speak to her more productively when she is sober and calls, please, please get the book by Wollis called When someone you love has a mental illness.  Very practical and all about communicating.  GET THE BOOK!

7.  To learn a great deal more about mental illness, being mentally ill, helping a family member, try to enroll soon in the free NAMI class [12 sessions] Family to Family.

8.  Her story, sad to say, is a common one - the ill person loses everything [either because spouse doesn't 'get it' or can't take it anymore or leaves to rescue the kids], gets inconsistant care, already has a fallback med in alc or drugs, and those who care live far away.

That she is now homeless and in and out of jail and not medicated and chronically alcoholic - these are not hopeful indicators.  IF one of you is able to go where she is for awhile, are yourself w/ some info about practicalities by attending NAMI where you live. Ask what services exist most everywhere, what to do re the drinking, how to approach the sister, etc.] and then continue WHILE YOU ARE IN TAMPA.  The Tampa folks know whose on first in Tampa, who's good, where the services are, how to get services, whether there is subsidized housing or half-way houses etc etc etc.

It's tough to be bipolar, tough to be an unmedicated bipolar, tough to be a family member....these folks can be hard cases and not easy to love, close up.  Forgive her if you can and try to get to a place [figurative] where you can believe that this is real illness.  No one seeks out the life she now is living.

Write again anytime.  Wish I had a magic wand - it's what's surely needed here.

Good luck

Hi again, thanks so much for the response. Just a few quick notes:
Yes she's been on medication for much of her disease, however, she stops taking it (as do many) or gets drunk and forgets.

She was an alcoholic prior to diagnosis.

Unfortunately, you cannot commit someone in Tampa, Fl, however, I will contact an attorney there and see what can be done. She's been "Baker-acted" about 10 times, and unfortunately, gets better really quick (they keep her about 10 days) leaves the hospital, refuses to get help with her alcoholism (she's been offered in-house substance abuste help, but she won't seek it.

She has income of 1000 per month in alimony. I know it's not enough.

Unfortunately, there's no way I can go to Tampa for an extended period of time.  ALso, she's homeless because she gets kicked out of every place she lives due to her agression and "screaming fits."

She refuses to come here. We are really between a rock and a hard place.

I know it's the disease--I wish she did. I will get the book and contact NAMI. The book sounds like it will be a ton of help.

Thanks again. Don't you have a magic wand?

Answer
Ah, the wand.  How I wish --

[There was a confusing typo in my answer to you, about going to Tampa, should have been "arm" yourself, not "are."]

Here are 3 resources I should have given you originally, but we haven't lost too much time.  Websites:  www.psychlaws.org and www.bazelon.org     And a book by Amador called: I am not sick; I don't need help.  The websites may give you some new ideas and facts re legal matters; the book may suggest new strategies for dealing w/ her....I'm not too hopeful w/ late, chronic alcoholism.  You need the person to be maybe mentally ill but at least sober while trying to do the negotiations he suggests.

Even my virtual wand doesn't dredge up much more.  IF you could get guardianship [have no idea what's involved in any state] and/or become her payee for the alimony, you would have some dandy leverage.    ---In thinking about "dangerous to self or others" it's hard to believe that homelessness is not dangerous to self.  [Her modest income may make her ineligible for Medicaid, which would be her best way to pay for meds.]

And then there is the issue of legal competence - which ties in to the issues above....have no idea what flies in FL.

I am so awfully sorry.  It's terrible to be helpless.

Do please write again if things change or you come up w/ a plan that you want listened to.  DO get involved w/ NAMI, if there is a worthwhile group near you.  It will help heal your hearts even if nothing else changes.