Adolescents in compulsory care represent a particularly vulnerable group. The content of compulsory care and the restrictions on freedom that young people are subjected to are topics that are rarely addressed in either societal debates or within the education of social workers. The purpose of this study is to attempt to interpret and understand how compulsory care affects adolescents from a power and control perspective, in order to highlight their vulnerability. The study is based on a thematic analysis of the adolescents' own narratives in the book "Växa mot förändring," published by the National Board of Institutional Care in 2023. We have employed Goffman's theory of total institutions to analyze the adolescents' experiences of compulsory care. The results indicate that the adolescents' experiences are both negative and positive in nature. Overall, the findings suggest that the adolescents' experiences are highly negative from a power- and control perspective. Emotions such as anger and hopelessness are commonly present. Additionally, the results show that the adolescents adapt to the conditions of the institution in various ways. Several narratives contain aspects of institutionalization and a fear of coping independently. These experiences can be connected to Goffman's theory of total institutions. The results emphasize the vulnerability of the adolescents and highlight the need for their voices to be heard in order to increase knowledge in the field.

Drug abuse often correlates with a criminal career. Compulsory care of addicts aims to motivate the individual to come to terms with their addiction. However, crime can be part of the lifestyle that the addict gets involved in. This essay examines how the preventive treatment at the State Board of Institutions in Sweden works to prevent relapse for both addiction and crime. The issues also concern collaboration in addition to treatment work. The material was gathered through qualitative semi-structured interviews with five people in the treatment staff at one of the State Department Board's LVM homes. The analysis was a thematic analysis and the collection of material resulted in three themes: "treatment work", "lack of knowledge among staff" and "collaboration". The informants believe that the treatment work has a good effect through the social bonds that are created between the client and treatment staff, but also so called “treatment conversations”. Clients are perceived to have high motivation during the time for LVM, but this often decreases after LVM completion. The result of the study shows that there is a lack of knowledge among treatment staff, mainly regarding crime prevention and psychiatry. Collaboration is perceived to work deficient, and informants highlight shortcomings in the provision of information between the actors involved. The results are subsequently attributed to social bond theory, the age-graded theory of informal social control, routine activity theory and to previous research on addiction and crime. The results are intended to be used instrumentally in order to improve the treatment work at the Swedish National Board of Institutional Care, which in turn improves prevention for both substance abuse and crime.

Bakgrund När en person vårdas under psykiatrisk tvångsvård begränsas individens rätt till självbestämmande. Patienter som omfattas av tvångsvård har ofta komplexa psykiatriska tillstånd som kräver särskild omsorg för att skydda både patienten själv och andra från potentiell skada. Denna typ av vård kan vara nödvändig för personer som för tillfället inte äger beslutskompetens. Tidigare forskning pekar på att patienters erfarenheter av ofrivillig sjukhusvistelse bör beaktas och utforskas för att förbättra vårdpraxis. Syfte Att beskriva patienters upplevelser av tvångsvård inom psykiatrisk vård. Metod En systematisk litteraturöversikt genomfördes. Data samlades in genom Cinahl complete och PubMed. Urvalet bestod av elva kvalitativa och kvantitativa vetenskapliga originalartiklar publicerade mellan år 2009–2024. Materialet tematiserades och därefter diskuterades resultatet i relation till begreppet autonomi enligt Beauchamp och Childress definition. Resultat Resultatet består av tre teman: Upplevd brist på autonomi, upplevd tvångsvård kan ändra attityden, och upplevelser av vårdrelation. Patienter i psykiatrisk tvångsvård upplever ofta en brist på autonomi, vilket främst förknippas med otillräcklig information och negativa erfarenheter av tvångsåtgärder. Många känner sig ignorerade och missförstådda av vårdpersonalen. De som utsätts för flera olika tvångsåtgärder eller har dåliga erfarenheter tenderar att utveckla en negativ syn på psykiatrin Sammanfattning Det framkom att patienter inom tvångsvård oftast upplever negativa effekter, såsom förlust av autonomi och bristande kommunikation. Dessa känslor av obehag tenderade att inte bemötas tillräckligt. För att undvika sådana negativa upplevelser behöver organisatoriska brister åtgärdas genom ökad kunskap och medvetenhet. / Background When a person is under psychiatric involuntary care, the individual's right to self-determination is restricted. Patients subject to involuntary care often have complex psychiatric conditions that require special attention to protect both the patient themselves and others from potential harm. This type of care may be necessary for individuals who currently lack decision-making capacity. Previous research indicates that patients' experiences of involuntary hospitalization should be considered and explored to improve care practices. Aim To describe patients' experiences of involuntary treatment within psychiatric treatment. Method A systematic literature review was conducted. Data was collected through Cinahl Complete and PubMed. The selection consisted of eleven qualitative and quantitative scientific original articles published between 2009 and 2024. The material was thematized, and then the results were discussed in relation to the theory of autonomy according to Beauchamp and Childress' definition. Results The results consist of three themes: Perceived lack of autonomy, experienced compulsory care can change the attitude and experiences of the care relationship. Patients in psychiatric involuntary care often experience a lack of autonomy, primarily associated with insufficient information and negative experiences of coercive measures. Many feel ignored and misunderstood by staff. Those who are subjected to multiple coercive measures or have poor experiences tend to develop a negative view of psychiatry. Summary It emerged that patients in involuntary treatment usually experience negative effects, such as loss of autonomy and inadequate communication. These feelings of discomfort tended not to be adequately addressed. To avoid such negative experiences, organizational deficiencies need to be addressed through increased knowledge and awareness.

När en socialsekreterare ska handlägga ärenden enligt Lag om Vård av Missbrukare i vissa fall (LVM) behöver denne ta ställning utifrån många olika perspektiv. Syftet med denna studie är att ge kunskap om hur socialsekreterare upplever handläggning av LVM-ärenden samt vilka erfarenheter de har av en sådan process. Undersökningens material grundar sig på kvalitativa semistrukturerade intervjuer med sex socialsekreterare som alla har arbetat med LVM-handläggning. För att kunna tolka och analysera materialet användes gräsrotsbyråkrati, makt, etik i socialt arbete och handlingsutrymme som teoretisk referensram. Resultatet indikerar att socialsekreterarna upplever både för- och nackdelar i arbetet med lagstiftningen. De upplever handläggningen av LVM-ärenden likt ett dilemma. Socialsekreterarna anser att lagen är nödvändig då de i avsaknad av den skulle känna en stor maktlöshet av att inte kunna ingripa i allvarliga situationer där klienten riskerar att avlida eller skada sig själv och andra till följd av sitt missbruk. De anser även att tillämpningen av lagen medför inskränkningar i den enskilda klientens integritet och att klienten i mötet med socialtjänsten riskerar att bli kränkt utan noga eftertanke från socialsekreterarens sida. Resultatet visar även på att socialsekreterarna så långt som det är möjligt respekterar klientens autonomi men att autonomin vid fråga om liv och död måste förbises. / When a social secretary has to investigate a client due to the Law on Care of Addicts in certain cases (LVM) he or she need to do so with consideration to many different perspectives. The purpose of this study is to provide knowledge about how social workers perceive handling LVM cases and also to find out what their experiences are when it comes to managing cases of this kind. The study is based on qualitative semi-structured interviews with six social secretaries who have all worked with LVM management. To interpret and analyze the material a theory about street-level bureaucrats, power, ethics in social work and “handlingsutrymme” were used as theoretical framework. The results seem to indicate that there are, according to the social secretaries, advantages as well as disadvantages to this approach. They experience the process of LVM as a bit of a dilemma. The social secretaries believe that the law is necessary for them so that they can act if needs be, in serious situations when clients are in danger and even risks death because of the addiction. They also believe that the law and the application of the same include quite a large restriction for the integrity of the client and that there is a risk for the client to be violated if the social worker does not show careful consideration on his/hers side. The result also show that the social secretaries wants to, as far as possible, show that they respect their clients’ autonomy. Although, this must be disregarded in a matter of life and death.

In this dissertation, I explore a quite unique legal situation, namely administrative court hearings relating to coercive interventions: the Care of Young Persons Act (LVU), Care of Abusers (Special Provisions) Act (LVM), and the Compulsory Psychiatric Care Act (LPT). There are three central participatory roles in the court hearings: The official party is the authority who files the application for coercive intervention – either a chief psychiatrist or a social welfare board (typically represented by a social worker or sometimes a lawyer assisted by a social worker), whereas the citizen party is the person about whom the application is brought. The citizen party is represented by a legal representative. The professionals represent two different logics: therapeutic and judicial. The purpose of this dissertation has been to study the tension between therapeutic and judicial logic in court hearings relating to compulsory care. With theoretical concepts from Scott (1995) and Wetherell & Potter (1998), it is possible to say that the therapeutic and judicial logics are built up by institutional elements that are communicated through interpretative repertoires. Three questions are central: 1. How do professional participators handle the different role expectations embedded in therapeutic and judicial logic? In this case, I am particularly interested in role conflicts faced by social workers and psychiatrists. 2. How do different institutional elements (regulative, normative/cognitive) play out in the court hearings? 3. To what extent can these court hearings be considered a scrutinizing order of discourse, where the arguments of official party are subjected to critical examination? In my analysis I am inspired by both critical discourse analysis and organizational theory, more precisely, new institutionalism. These two perspectives provide useful insights and make it possible to combine the micro- and macro levels in the analysis. Data for the analysis consist of 43 court hearings and 31 interviews, gathered from two different county administrative courts in Sweden. All written documents used and produced by the courts are also part of our data. The dissertation consists of five studies that indicate that the court hearings hardly can be described as a scrutinising order of discourse. In spite of this, the court constantly finds that the legal criteria for coercive intervention are satisfied. Neither the official party nor the legal representative argue according to a judicial logic. Instead, therapeutic logic dominates the order of discourse. When the arguments for compulsory care are therapeutic, they are not explicitly related to the criteria in the law. In my interpretation, the reason why the conflict between therapeutic and judicial logic is not realised can be found in the existence of a logic of normalisation. This ideological logic of normalisation can be found in most of the institutions in the Swedish society and are built on the idea of traditional welfare norms.

Den här intervjubaserade kvalitativa studien syftar till att utforska den professionskunskap som socialarbetare upplever att de har och använder i sitt dagliga arbete inom barnavårdsutredningar i Sverige. Ordet "professionskunskap" avgränsas i studien som den kunskap, de erfarenheter, de verktyg och upplevelsen av handlingsutrymme som socialarbetare använder i beslutsprocessen kring tvångsomhändertaganden. Det empiriska materialet består av åtta semistrukturerade intervjuer med socialarbetare som syftade till att samla in socialarbetarnas subjektiva syn på och åsikter kring sin professionskunskap. Det empiriska materialet tematiserades och analyserades genom Michael Lipskys teori "Street-level bureaucracy" och narrativ teori. Även om professionskunskap kan anses vara individbaserad visar studien på vissa gemensamma mönster. En av uppsatsens slutsatser är att den professionella kunskapen som socialarbetaren har uttrycks genom ett utbyte av erfarenhetsbaserad kunskap som är knuten till det utmanande ställning som socialarbetarna har som gräsrotsbyråkrater. Ett annat resultat är att för att behärska denna komplicerade position måste socialarbetarna hantera sina känslor i samband med sitt arbete genom att regelbundet utbyta kunskaper och erfarenheter i en narrativ miljö. Sammanfattningsvis indikerar uppsatsen att ett konstant utbyte av erfarenheter skapar den ultimata grunden för professionskunskap. / This interview based qualitative study aims to explore the professional knowledge that social workers experience that they have and use in their daily work in authority based child care in Sweden. The word “professional knowledge” is defined in the report as what “knowledge”, “experiences”, “instruments” and sense of “action space” the social workers include in the process of decision making regarding compulsory care. The empirical material was collected through eight semi-structured interviews with social workers with the purpose to gather their subjective views and opinions regarding their professional knowledge. Then, the empirical material was thematically categorized and analysed through Michael Lipsky's theory “Street-level bureaucracy” and narrative theory. The study finds that professional knowledge is a constant exchange of self-perceived experiences and that it is somewhat tied to the individual social work but also that there are some basic common observations to be made. One of the conclusions of the essay is that the professional knowledge that the social worker possesses is expressed through a development of experience which is tied to the challenging position the social workers have as street-level bureaucrats. Another finding is that in order to master this complicated position the social workers have to manage the emotions connected to their work through exchanging experience-based knowledge on a regular basis. In summary, the essay suggests that a constant exchange of experiences creates the ultimate basis for professional knowledge.

This dissertation investigates compulsory care of alcohol abusers in Sweden during the years 1940 to 1981. The purposes of the dissertation are twofold: in part to determine the concrete forms which care services for alcohol abusers took during the years focused on, in part to analyze what connections existed between the development of services and conceptions of the reasons for, consequences of and possible solutions to alcohol abuse. One point of departure is that the problem was defined with respect to the interests of influential social actors, and with respect to a very particular view of what a respectable life (free of social problems) was. Among the most influential actors involved in these social services, I argue for a focus not least on so-called “street-level bureaucrats”, with direct influence on the goals and methods of institutional care. The study is thus oriented towards mapping the development of problem definitions and formulation within the praxis of compulsory care in four institutionalized care establishments for alcohol abusers. This development is contrasted to broader trends of institutional and discursive development in the definition of alcohol abuse as a social problem. The legislation regulating compulsory care has constantly been founded upon assumptions of the social damage caused by alcohol abuse. At the level of concepts or discourse the consequences of causes for and solutions to alcohol abuse were initially defined in terms of individual morality, with definitions subsequently developing so as to depart from more medicalized terminology. Towards the end of the period the problem descriptions became focused on societal dysfunctions and reforms as the respective causes of and solutions to societally problematic alcohol abuse. At the level of treatment focused upon in the dissertation, societal explanations of alcohol problems departing from societal dysfunctions as causes thereof, and societal reforms as solutions, have never been fully integrated in care services praxis. This was not the case for the simple reason that these care activities, as such, were developed to deal with individuals rather than with society. Neither did a medicalized perspective come to dominate institutionalized care during the period studied – something which can be explained not least with the fact that the perspective’s expansion was not attended by development of medical treatment methods which were convincing with respect to results of use. On one hand, concretely practiced compulsory care thus long remained dominated by problem definitions departing from inmates’ gender-specific moral qualities. On the other hand, certain elements of a more resource-oriented and societal-reformist perspective can certainly be distinguished in the development of care services, albeit on the special terms associated with service implementation in the field. In conclusion, the historical development of care services for alcohol abusers shows that alcohol abuse need not necessarily, or primarily, be seen as a problem having to do with individuals’ relationship with alcohol. Other definitions of the problem have focused upon individuals’ relationship also to working life, the family, sexual morals, the gender order, or capitalist oppression. The problem has been seen as a workers’ and poverty problem, a problem of families and violence, a medical problem, or a symptom of societal problems. Causes have been sought in the character of individuals, the ways in which they have been raised or not raised, their spiritual life, their metabolism, their genetic material, their socioeconomic environment, gender and family situation. The proposed solutions have included everything from work, organized coffee breaks, medicines, psychotherapy and democracy to piece-rate wages, no wages, collective care, or solitary confinement. Alcohol itself has been a secondary factor in the problem definitions which have let themselves be attached – either via perceived links of cause or of effect – to more overarching social issues. / <p>Sammanfattning på engelska med titeln: The rehab : compulsory care of alcohol abusers in Sweden 1940-1981</p>

Tvångsvården av missbrukare är ett av samhällets sista verktyg för att vårda missbrukare som lever ett väldigt destruktivt och farligt liv. Tvångsvårdslagstiftningen har kritiserats för att vara svårtolkad, och det finns stöd för att lagstiftningen tillämpas olika i landets socialnämnder. Genom att intervjua socialtjänstens enhetschefer om deras tolkning och tillämpning av tvångsvårdslagstiftningen syftar uppsatsen till att belysa skillnader och likheter i tolkning och tillämpning av lagstiftningen samt att bidra med kunskap om vilka faktorer som kan försvåra arbetet. Resultaten visar på att det finns skillnader i hur tvångsvårdslagstiftningen tolkas, vilket även verkar resultera i skillnader i hur lagstiftningen tillämpas. Enhetscheferna verkar vara klämda mellan å ena sidan den lagstiftning och de krav som finns från politikerna, och å andra sidan det behov av individualiserad behandling som finns hos klienterna. Enhetschefernas dubbla kravbild stämmer väl överens med den konfliktsituation som domänteorin beskriver. Lagstiftningen har inte genomgått speciellt stora förändringar sedan den rädde i kraft. En översyn av lagstiftningen föreslås, där behovet av sex månaders vårdtid ifrågasätts och där vikten av att socialtjänsten som ansvarig utförare får komma till tals betonas.

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This study aimed to analyze statements made by professional practitioners and clients in verdicts related to compulsory drug treatment. The statements were examined in order to illustrate their contribution to the social construction of drug addicts. The study also aimed to address the power professionals have over individuals with drug problems. The data consisted of twelve verdicts obtained from administrative courts located in three different geographical areas in Sweden. Based on a qualitative approach we used a critical discourse analysis as a framework for the examination of vocabulary and sentence structures. The findings were further examined through a social constructivist approach and power theories. The results showed how all parties in the verdict can contribute to the social construction of drug addicts through substantial information that is given as well as the use of additional terms and discursive words. Themes and patterns identified within the statements showed how the clients’ life situation were described in terms of homelessness, unemployment, mental illness and crime. The results also showed that the clients were described as either responsible for or victimized by the drugs, a description that has a high impact on how the clients are subsequently perceived. It was also prominent that the professional statements, compared to the client’s, enjoyed higher degrees of credibility. The professional statements were also more often perceived as true due to the choice of words and structures of the sentences. Consequently, we could illustrate how professionals by the authority granted by their job title are given the power to depict and affect the social construction of drug addicts as a group.