Secure care for young people can cause trauma – but also save lives

After working at residential care and as a social worker, Sofia Enell received funding from SiS, the Swedish National Board of Institutional Care, to study the investigative work conducted with placed young people. Instead, this led to a deep interest in how placement and incarceration affect young people and their families.

Sofia’s research has always moved within the field of child welfare – but at both extremes.

– Partly in the very early interventions aimed at preventing negative development for children and young people. But above all, in the other extreme, the last resort – the secure care institutions, or SiS homes as they are commonly referred to in Sweden.

Those placed in secure care are in compulsory care. They have limited control over their lives and often come from families with few social, economic, and/or cultural resources. Therefore, it is crucial to shed light on this area, Enell argues, particularly from the perspective of the young people’s own experiences.

– At the same time, these are young people who disrupt order, who are extremely challenging, and who can cause considerable harm. I don’t wish to minimise that. But what happens to them when we remove them from the streets and lock them up? That’s what I want to highlight.

Seeing themselves as guilty

In her studies, Enell has seen many examples of how the stay affects the young people. They arrive in a place where they know no one and are met with a multitude of restrictive measures, particularly locked doors and alarms. This, in itself, can be a traumatic experience.

– What I observe is that the young people disconnect from their previous social contexts and tend to blame themselves to a high degree. They say: ‘It was my fault; I’m the one who needs to change.’

This leads to young people wanting to become independent of others, which makes them extremely vulnerable. Sofia recounts the case of one young woman who chose to speak with a priest because the priest had absolute confidentiality. She was struggling with significant mental health issues but avoided seeking healthcare because she felt that staff judged her based on previous records.

– These are very fragile lives, often with very limited social networks and a strong desire for calm and peace. But I also met a boy who said that his life had never been as good as it was then, ten years after his placement.

It is not only the young people who are affected. Placing them in an institution shakes the very concept of what a family is. In many cases, the care has been initiated at the parents’ request, when they could no longer manage the situation. This can result in a wound that never heals – the experience of betraying and being betrayed. As SiS focuses on the young people, they do not have the time or resources to work on family relationships as well, even though they try.

Treatment – but also control and punishment

Recently, there has been a great deal of negative media coverage about the SiS secure care institutions, and Sofia does not shy away from acknowledging the problems.

– They are hybrid institutions. They are meant to provide care, treatment and support, but also to control and punish. This combination constantly obstructs the good intentions we might have for the form of care.

When staff have significant power and oversight is limited, the risk of abuse of power becomes considerable. Physical restraints, sexual assaults, and improper use of restrictive measures are some examples.

Another problem is that the institutions have long been used as a respite solution for other types of care, such as residential care (HVB), foster care, or home-based care offered by social services.

Enell also points out that there is a lack of interest in what happens to young people placed in compulsory care at secure care institutions, which is remarkable considering that this form of care has existed for over 100 years.

The positive sides of the institutions are less often highlighted.

– Some young people would say it saved their lives. They are often in a very critical situation. There has also been considerable investment in education within SiS; many young people have been given a second chance. They also speak of staff who meet them in their very vulnerable state.

What are the alternatives?

In her doctoral thesis, Sofia followed 16 young people over three years.
This was followed by one study focusing on how family relationships are affected by placement, one on children's rights and the treatment they receive, and one on their oral health.

She is currently conducting a study on the use of restrictive measures in secure care and how these measures vary. This includes examining the use of seclusion; physically moving a young person to a secluded room. She also studies the use of body searches; requiring a young person to undress in front of staff, and the use of solitary care; preventing a young person from being with others at the unit.

– We’re seeing a pattern where girls and younger children are subjected to isolation more often, and we are now trying to understand why.

Returning to the other extreme in Sofia’s research – what do children and young people themselves say they want in terms of support?

– Many say, just like the young people in care, ‘Why did no one listen to me earlier? Why did no one see what was happening to me earlier?’ Young people often feel they are screaming out for help and think that everyone should be able to see how badly they are doing, and yet we still miss it.

Drawing on her 15 years of research, Sofia sees secure care as a form of care that society takes for granted – as if we cannot imagine a society without institutional care for young people. She argues that this is dangerous.

– Ultimately, I would like us to rethink and consider other possibilities besides institutional care. What alternatives are there? How else could we do this? That’s probably the ultimate aim of my research. But also to explore how institutional care, when necessary, can become a place for real change.