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My 48 year sister has been practically non functional for the last 10 years.     In January she attempted suicide for the third time.  The prior two times she was discharged after a short stay and then sent home with my mother who provided room and board and countless other forms of financial support.   My mother continued this enablement even when my sister refused to attend treatment.  Five years ago her second suicide attempt ended with a fire in her condo for which she was convicted on several arson related charges.    She continued to live my mother after that and  last spring managed to get a job and move out.   At the same time my mother was diagnosed with alzheimers and I moved my mom to an assisted living facility in January.  Two days after my mothers move  my sister overdosed on wellbutrin and survived after a three day stay in the ICU.  Since then she has been admitted three times for short stays.  She is discharged, goes home, immediately decompensates and I have to call crisis again.  The last time was  yesterday.  The state of New JErsey refuses to committ her for longer term treatment because she is "voluntary".  I live three hours away and am also managing my mothers care and finances and keeping my sister's 20 year old twin daughter's apprised of what's going on.  (They are both in college out of state.)   They don't understand why the system refuses to provide my sister with any type of therapuetic care and neither do I.   I don't see any other way I can help my sister but everyone is looking to me to keep things together and I'm losing it.  I have a full time demanding job and a child at home and I can't continue at this pace.   I already see a therapist and try to practice good self care with a good diet and exercise but honestly I am beyond what any reasonable person can be expected to do.  Frustrated, hopeless and exhausted :(

That's so much to have on your plate...

I know your nieces are young, yet they are adults, and your sister is their mother. Have you thought about transitioning things so that they keep tabs on their mother, even from afar? I was an only child,  and my mother started getting really bad (a severe breakdown) my senior year of high school when I was 17. I moved 50 miles away on my 18th birthday and kept tabs from afar.  Sometimes there's no choice but to grow up faster. 

Your sister is sick, but she's also making these choices. You have your nuclear family to take care of, and then your mother. That's a lot regardless of other adults.  Taking care of you means that you are both healthier for yourself and also for for child and your mother.

It doesn't sound like there's anything else you can do for your sister; the system, flawed as it is, will have to step in, with the involvement of her daughters if they are willing. Her needs sound never-ending and they will deplete your energy to attend to yourself and son, and your mother to whatever extent you want to help her. Maybe it would help to talk with the therapist, to help accept your limits? - if they really understand all you have taken on, they can help you decide what limits you have to set to live a happy and healthy life with your son. You sound like such a caring responsible person and its so easy to be smothered with those commitments.