Question:

I have a sister suffering from borderline personality disorder and alcoholism (dual diagnosis). I am her only relative now. She was an intelligent articulate woman but she is now a homeless person living on the street. I cannot get help for her. No agencies will take her and provide therapy because she is aggressive.

She wanders the streets at nights, walks in front of cars, is violent to people (even the police) and she still remains on the streets. She is also suffering gastritis. I am concerned she will kill someone soon by either drinking and driving while disqualified or with the knife she normally carries (she carried it before she was homeless).

Society has a right to feel safe and she should be institutionalised for her sake and her safety. I know that mental institutions don't exist anymore per se, however, there must be a nice place for her to live where she will be cared for in peace. Any advice you can give would be appreciated as I am at my wit's end.

Answer:

From what you write, I am not surprised to hear you feel at your wit's end regarding your sister's situation. Borderline personality disorder is often a highly distressing condition, both for the person affected and for those who care about them.

Symptoms include deep feelings of insecurity and a fragile sense of self and one's place in the world; persistent impulsive behaviour; confused, contradictory feelings; and often self-harm too. These symptoms also make it difficult for those affected to relate to other people, even family and friends. Because the symptoms are often perceived simply as "bad behaviour", it can be a problematic condition to get diagnosed and receive appropriate treatment for.

Some states now have specialist treatment centres for people affected by borderline personality disorder, and there are also psychiatrists and other clinicians who specialise in treating it. This primarily involves psychological therapy, although medication may be helpful for a while to manage other symptoms such as depression or anxiety.

One of the hardest things for family and friends to deal with is when someone is unwell but refuses treatment and help. It is important therefore that — once you have done all you reasonably can to help — you are able to get on with your own life without feelings of guilt. While still caring for your sister, you shouldn't let the illness spoil your life and peace-of-mind too.

While mental health acts vary from state to state, it is generally the case that someone can only be treated involuntarily if their health or safety, or that of others, is at risk. If your sister can be violent towards others or herself when unwell, it may be a good idea to discuss with a local GP or mental health service what could be done to help her in these circumstances.

For further information about borderline personality disorder, see the factsheet and podcast at www.sane.org. You can also call the SANE helpline on 1800 18 SANE (7263) for information and advice on this and other topics related to mental illness.