I think you are absolutely correct in the way you see this hospitalization playing out, with the first and second outcomes you've outlined above. Even if she's admitted, as you foresee, that will be only a stop-gap measure and not a guarantee of any permanent solution. They will only keep her there for so long. Then she will come out, resume her typical pattern or cycle of behavior, including non-compliance with treatment, and you, your mom and sister will all re-live this yet again. The only difference - and it's an important one - is that she now has a much better paper trail of documentation of her condition. Once a person has been admitted, it will be easier to get admitted the next time. There will be a next time. And there will be a next time after that. Being an inpatient will allow staff to sbegin getting to really know her. The physicians' and nurses' notes in her hospital chart will much better reflect the seriousness of her level of mental disturbance than notes made by a pdoc after a 45 minute interview. So, as you say, this is a good thing. But, as you also say - and I agree - it's not the beginning of the kind of comprehensive solution one would wish for.

I'll be the last person to say there is anything easy about your family predicament. (I have a brother much like your sister.) Even if your mother took your advice and "gave the ultimatum," your mother is not going to follow through with a firm, consistent approach. And you already know that, yourself. A lot of this is beyond your capacity to influence, no matter how sensible your insights and recommendations may be.

Do you live in this household yourself? Are you living with your mother?

I can totally grasp that this is heartbreaking with no easy solution. My brother goes in and out of homelessness, in and out of jail, in and out of substance abuse rehab programs, and in and out of psych in-patient facilities. He used to move in and out of my parents' home. Now they're deceased. He has lived sporatically with either my sister or myself. Trust me! I am more than a little familiar with what you are trying to cope with.

I do think it may be even worse with a female who is mentally disturbed because of the greater potential for her to be targeted on the street by men who will sexually exploit her and physically abuse her. This is why, in most communities, it is generally easier for single women to access shelters than it is for single men. Just about any homeless 30 year old woman can find a man who will take her in, which is usually not a good thing. Men who pick up homeless women are not the nicest guys in the world. She's apt to end up raped and beaten. I'm sorry to paint such a grim picture. I know the realities, so don't think I underestimate the awful quandary you are in. You can't solve this. And there is no government, social or medical entity that is going to step up and take over with a good solution.

You can advise your mother all you like. I don't doubt that you give her sensible advise. In the end, your mother is probably going to let your sister move in and out of where your mother is living - without applying any firm, consistent expectations that she will expect your sister to conform to. And - you know - that's your mother's right . . . whether you approve or not.

I hate to be pessimistic about your sister's future, but I am. And you are right to worry about your mother's safety. On one occasion, after not getting drug/booze money from my mother, who was home alone, my brother picked up a broom and ran around the ouside of the house smashing windows.

Years later, I financed my brother moving to where I had relocated . . . a region that has a lower cost of living. I helped him in every way humanly possible. I assisted him to connect with every form of social support available in my community. It so happens that there is a more help in my city than in a lot of places . . . and I happen to know more than the average person about that help because of my years working here in healthcare. For awhile, it seemed like this was greatly benefitting my brother. Then it fell apart. He was in and out of jail. Then my brother wasn't speaking to me. Now I don't even know where he is. For all I know, he may be living inside a warm apartment 2 miles down the road from me. When driving around town, I look at homeless men on the street to see if one of them might be him. I hope he is alright . . . or, at least, has a bed to sleep in at night.

Mainly, I concentrate on living my own life. I asked if you if you were living with your mother. If you are, then you will be a direct observer of all that goes on between your mother and your sister. A lot of it will be dysfunctional and stressful for you to witness. It might be healthy for you to not be living in that house. If you do have an apartment of your own, you might have to distance yourself a bit, mentally, from a situation that may never respond much to your best efforts to be a good influence.