Do I let my uBPD sister stay with me? Or 2 other options?

[Our abuse recovery guide]

Hi BPD Family,

I'm learning lots here, however am really uncertain about what, if anything, to do now about my sister - uBPD, 50s, now also seems paranoid and delusional - who is on the verge of homelessness. I've got 3 options (below) in mind.

Here are what seem like the key points:
- As always, she doesn’t see her role in creating her current predicament, but it’s no longer “just” uBPD (see below).
- She doesn’t work but receives some sort of monthly check.
- I helped her with a some hotel nights recently but am not covering any more expenses — and she did respect that boundary.  Confession: I allowed a subsequent loophole when she pleaded/demanded my assistance in booking some additional hotel nights on my credit card (she has none) with next-day cash reimbursement from her.
- In addition to the longtime uBPD, she also now believes that a specific person is hacking/taking over her mind and body and phone, killed one of her beloved cats, and that a chip was implanted in her brain. It seems extremely important to her that I believe this.  She threatened suicide 2x over the last few weeks but then said that the “hacker” made the threats.
- Despite the paranoia and delusions, I’m starting to think that it’s still the uBPD that’s her biggest obstacle.  She has pursed low income housing with a local agency and says there are “no options” right now, but I wonder if she has the skills to manage the process.
- She says she has PTSD and I suspect it’s true. That’s the one mental health challenge she’ll admit to having.  She did have childhood trauma, but I think her terrible life management skills have brought her additional trauma over the past few years.
- Seems like she’s at breaking point now, and she admits to feeling very scared and lost.
- She saw a Psychiatrist for a while during the last year “for PTSD” and she seemed to really respect him, however in the past few days she called him again and he told her the chip isn’t real, so I’m not sure if she still trusts him.
- I don’t think she has any insurance, and our mom and I don’t have additional funds or extra room to house her.
- Yesterday was a nightmare, as I tried help her deal with the fact that two local hotels rejected her (while I was at work, finding 20-30 new “help!” “urgent!” texts from her between meetings, as I was literally shaking for hours.) It’s just too much, and I keep bursting into tears. So this morning I told her that I would be 100% unavailable today—and she actually (surprisingly) respected that boundary.

Anyhow, sorry this is so long, but now she’s spent all of her $ for this month, and she has two more nights at a hotel, so as of Friday morning she has no place to stay. I’m both fed up and increasingly worrying that falling into homelessness could push her into an even worse mental place.

So I’m wondering about 3 options:

Option A:  I agree to her request to stay with me “for a while” with her (3!) cats, with conditions. I live in a small (600 sf) 1 BR apartment and this seems like a horrible idea to me, but this is what she wants of course.  I think I couldn't handle more than, say, 5 days, but then most likely we'd be back to the same place.

Option B: I say no to her request to stay with me — perhaps simply “I’m afraid that’s not an option.” As much as I don't like Option A at all this one seems terrible too.

Option C:  If the Psychiatrist she saw is available, perhaps our mom and I can convince her to go see him on Friday and agree to whatever he recommends, with our support, emphasizing that she’s out of shelter options and really needs intensive support and care "for PTSD." The Dr. previously said he could get her into a hospital bed if she’d agree. I suppose it's a long shot, but I'm wondering if it's worth a try at this point.

Thanks again for listening, if anyone has read this far!  I’d be so grateful for any thoughts.  

[help4sis]

Hi BPD Family,

I'm learning lots here, however am really uncertain about what, if anything, to do now about my sister - uBPD, 50s, now also seems paranoid and delusional - who is on the verge of homelessness. I've got 3 options (below) in mind.

Here are what seem like the key points:
- As always, she doesn’t see her role in creating her current predicament, but it’s no longer “just” uBPD (see below).
- She doesn’t work but receives some sort of monthly check.
- I helped her with a some hotel nights recently but am not covering any more expenses — and she did respect that boundary.  Confession: I allowed a subsequent loophole when she pleaded/demanded my assistance in booking some additional hotel nights on my credit card (she has none) with next-day cash reimbursement from her.
- In addition to the longtime uBPD, she also now believes that a specific person is hacking/taking over her mind and body and phone, killed one of her beloved cats, and that a chip was implanted in her brain. It seems extremely important to her that I believe this.  She threatened suicide 2x over the last few weeks but then said that the “hacker” made the threats.
- Despite the paranoia and delusions, I’m starting to think that it’s still the uBPD that’s her biggest obstacle.  She has pursed low income housing with a local agency and says there are “no options” right now, but I wonder if she has the skills to manage the process.
- She says she has PTSD and I suspect it’s true. That’s the one mental health challenge she’ll admit to having.  She did have childhood trauma, but I think her terrible life management skills have brought her additional trauma over the past few years.
- Seems like she’s at breaking point now, and she admits to feeling very scared and lost.
- She saw a Psychiatrist for a while during the last year “for PTSD” and she seemed to really respect him, however in the past few days she called him again and he told her the chip isn’t real, so I’m not sure if she still trusts him.
- I don’t think she has any insurance, and our mom and I don’t have additional funds or extra room to house her.
- Yesterday was a nightmare, as I tried help her deal with the fact that two local hotels rejected her (while I was at work, finding 20-30 new “help!” “urgent!” texts from her between meetings, as I was literally shaking for hours.) It’s just too much, and I keep bursting into tears. So this morning I told her that I would be 100% unavailable today—and she actually (surprisingly) respected that boundary.

Anyhow, sorry this is so long, but now she’s spent all of her $ for this month, and she has two more nights at a hotel, so as of Friday morning she has no place to stay. I’m both fed up and increasingly worrying that falling into homelessness could push her into an even worse mental place.

So I’m wondering about 3 options:

Option A:  I agree to her request to stay with me “for a while” with her (3!) cats, with conditions. I live in a small (600 sf) 1 BR apartment and this seems like a horrible idea to me, but this is what she wants of course.  I think I couldn't handle more than, say, 5 days, but then most likely we'd be back to the same place.

Option B: I say no to her request to stay with me — perhaps simply “I’m afraid that’s not an option.” As much as I don't like Option A at all this one seems terrible too.

Option C:  If the Psychiatrist she saw is available, perhaps our mom and I can convince her to go see him on Friday and agree to whatever he recommends, with our support, emphasizing that she’s out of shelter options and really needs intensive support and care "for PTSD." The Dr. previously said he could get her into a hospital bed if she’d agree. I suppose it's a long shot, but I'm wondering if it's worth a try at this point.

Thanks again for listening, if anyone has read this far!  I’d be so grateful for any thoughts.  

[Notwendy]

I recall doing water lifeguard training as a teen. One of the lessons was- if someone was drowning-  how to not let them grab on to you because, a frantic person will grab on to you and drag you down with them. It doesn't help anyone if both people are in danger.

Many of the lessons were about how to try help them and also keep yourself safe. While the goal was to learn to help someone- keeping yourself safe was a part of the lessons.

How do you help a person with BPD who has self destructive behaviors without harming yourself? And when is this help actually enabling them, keeping them from the consequences of their own behavior so that they don't learn from them or get the assistance they need due to being unable to manage?

If your sister isn't working but gets income- this is possibly disability income- so she's been evaluated and determined to need it? If this is the case, can she be referred back to social services for something like possible group home or other housing assistance? With her paranoid delusions, it sounds like there's more than BPD going on. She may need to be hospitalized for some other mental health issues.

If she can't work and is on social security disability- she'd be eligible for Medicaid (in the US). If she isn't getting either of them, she may be eligible for them.

You have been focused on short term solutions but this sounds more like a long term situation for your sister. If she's 50 and can't hold a job, then she's likely unable to. If she has a documented mental illness, you are looking at her needing assistance for the long run.

Let's look at your options.

A. Staying with you is not a long term option. Once she's there, how would you get her to leave? It's also enabling her behavior and keeping her from seeking the kind of long term assistance she could need. It's also going to put you in emotional and financial distress. To me this looks like letting the drowning person grab on to you. That's of no use as both of you will go down with this arrangement.

B. Say no, and let her go homeless. This is the natural consequence of her behavior. It also doesn't help her to be homeless and off the radar of social services. I think you would feel uncomfortable with this decision, even though it's a better one that decision A as it doesn't enable her behavior or be possibly emotionally and financially harmful to you.

C. This is the one decision that opens the door to her getting evaluated and possibly qualifying for assistance. I wouldn't just leave it in her hands to follow through. This is a no choice decision for her. No she can't stay with you, no, you won't give her money for a hotel. She goes and you go with her, possibly also speak to the doctor separately. If hospitalization is an option then this could be a good thing for her.

Your sister may also not be legally mentally competent. If she refuses to go for help- you could seek the route for her having a guardian appointed to manage her finances. This might be a family member or the state can appoint one.

If she's legally competent, then option B is her only other choice. You will need to take a stand for not having A as even a possibility. It's not in her best interest and it's not in yours.

[help4sis]

Thank you NotWendy.  This seems very wise - I appreciate your advice and confirmation. 

Turns out Option C is not as clean cut as I might have hoped.  After checking with the Dr., he says he's not sure if he can get her admitted to a hospital - just can't guarantee - so if I take her to the Dr. and he can't get her admitted, then she has no place to stay. 

Well, she has no place to stay no matter what as of tomorrow!  But if I've taken her* to the Dr. - and he does say having me present would help him fully assess the best treatment based on things she may be hiding from him - then if there is no hospital admittance on the horizon, I don't know what she and I would do,  since clearly staying with me is not an option. 

*The Dr. and I are in the same city, two hours from the city where she is, so I would be bringing her here.

Because of this "stuck" place, the Dr. therefore recommends taking her to the emergency room where she is, and hoping for the best.

Taking deep breaths.

[Notwendy]

I agree with going straight to the ER and not near your home area. If you allowed your sister to stay with you, it would be more difficult to ask her to leave after a while than it is to say no and hold that boundary.

I have posted this before as it describes so well this kind of situation with a family member. It's the author's mother but similar to your sister.

https://slate.com/technology/2022/03/mentally-ill-parent-elder-care-boundaries-liz-scheier.html