The compulsory-care regime at Sweden's special state-run residential homes for young people is a testing one for the residents and staff alike, a University of Gothenburg thesis shows. Instead of the individualized care that these "Sis homes", as they are called, are intended to provide, solitary confinement and control are often the order of the day
The Swedish National Board of Institutional Care (Sis) runs special residential homes for young people with extensive substance abuse and psychosocial problems. Compulsory care and treatment are provided under the terms of the Swedish Care of Young Persons (Special Provisions) Act, which grants coercive means to keep the young clients, or provide care for them, in solitary lockup. Sis are also responsible for the execution of sentences for young people 15-17 years according to the Law on Young Offenders.
Both the "Sis homes" and the aforesaid coercive means have been repeatedly criticized by Swedish child rights organizations and the United Nations. A new thesis in health and care sciences at Sahlgrenska Academy, University of Gothenburg, provides research evidence for these criticisms.
Obstacles to relationships and care
In the four studies composing her thesis, Kajsa Nolbeck explored and analyzed the care environment at Sis's special youth homes. She collected questionnaire and register data; conducted a microethnographic participant observation study at two homes; carried out a photovoice study (a method that is often better at capturing youth participants than interview studies) at three homes; and held focus-group discussions with the staff.
The results indicate organizational shortcomings and perceptions of the youth homes and clients as potentially dangerous and risky. The mixture of target groups at Sis homes, the emphasis on security in the physical care environment, and the staff's access to coercive means amount to impediments to care and treatment.
"Risk management and security procedures and devices constantly get in the way of trusting relationships between the young people and staff," Nolbeck says.
The young clients describe how they alternate between, first, resisting the control measures, which often leads to further restraints and incarceration, and second, adjusting to the care environment and, through their behavior, engaging in negotiation.
This adjustment may confer freedoms, such as being allowed to go outdoors, perform a particular activity or gain access to their own mobile telephone for a while. But adjusting is especially difficult for young people with major psychosocial difficulties.
Heavy emphasis on security
"The clients find it difficult to display the behavior that the institution demands of them, and then the trusting relationship between them and the staff, which could lead to change, fails to arise. It becomes available only to those clients who, so to speak, 'behave themselves'."
Nolbeck describes how efforts to build relationships are impeded, interrupted or subjected to conditions with an excessively one-sided emphasis on security and control. This creates an ethical dilemma for the staff, who are left alone to deal with the contradiction between security and care in their day-to-day work and dealings with the young residents.
"Staff feel they often have to manage difficulties by imposing collective solutions and measures that are seen as punishments by the clients, such as being locked up again," Nolbeck says.
"Strategies like that have been shown in previous research to be ineffective and very often harmful to the young people, and my thesis shows the same."
Title: Confinement and Caring, On sociomaterial practices in secured institutions for youths
