“Man Får Inte Supa Ihjäl Sig Enligt Svensk Lagstiftning!”: Svenska socialarbetares tal om bruket av tvångsvård

Abstract

The Swedish handling of drug users includes compulsory treatment (CT) for up to 6 months. Social services play a key role in the decisions about when and for whom CT is used. In this paper the aim is to get an understanding of how social workers reason about the use of CT through looking at the goals they set for their clients and how they are to be reached. Why they reason the way they do is a central question in the analysis as well as in the long term understanding of why Sweden uses CT. The social worker comments are contrasted against three principles central to modern society; the principle of liberty emphazising the autonomy of the individual, the egalitarian principle of social justice linked to paternalism and the utilitarian principle focused on maximizing happiness. The data used in this analysis comes from interviews with social workers and observations of meetings with clients as well as other professionals in 6 municipalities in Sweden. Central goals for the social workers are that the client takes responsibility for her/his life (autonomy) and total rehabilitation (abstinence). However, their possibilities of reaching these goals are limited, and therefore they have modified them (a bearable life for the old and total rehabilitation for the young clients). The means to achieve these goals are ambitious treatment for the young and low threshold interventions for the old, in theory excluding CT for both groups. However, obstacles are identified also for these goals which allows for CT to be an alternative. Financial issues and expectations on social services also play a part in the understanding. Further the analysis shows the importance of the egalitarian principle and a strong paternalism, which minimizes the role of the liberty principle.

Out of the ordinary: Media reports on wet eldercare facilities

“…Homecare workers report on misery and squalor among older care users who live at home and are willing to seek treatment for their alcohol problems (Karlsson & Gunnarsson, 2018). Representatives of social service organisations have argued that for older people with long-term alcohol problems, treatment is usually a waste of money (Palm, 2009). Studies on the everyday reality of wet eldercare facilities associated with problems that could be described in terms of ethical dilemmas -acceptance of trouble and misery being weighed against a higher threshold that excludes people in need of care (Harnett & Jönson, 2018;Lindgren, 2008).…”

”Vi möter de ofrivilliga” – socialsekreterare om äldre personer med missbruksproblem

“…Majoriteten av äldreomsorgens brukare är 80 år och över och kvinnorna är i majoritet (knappt 70 procent). När socialsekreterare inom missbruksvården talar om äldre personer med missbruksproblem ligger gränsen betydligt lägre, under 50 år eller till och med ännu lägre (Palm, 2009;Storbjörk, 2010). Det blir därför oklart vilka grupper av äldre det talas om i olika sammanhang.…”

“…Frågan om tvång eller frivillighet diskuteras ofta i relation till ålder. Palm (2009) har intervjuat socialsekreterare om tvångsvård och hur den används. Som tidigare påpekats är begreppet äldre relativt och när socialsekreterarna i Palms studie talade om äldre var det oklart var gränsen gick, men den låg långt under 65 år som är det huvudsakliga fokuset för vår artikel.…”

‘Wet’ eldercare facilities: three strategies on the use of alcohol and illicit substances

“…In both Sweden and Denmark a positive view has been particularly present in relation to older individuals with a long-standing history of substance use disorder and homelessness (Jönson and Harnett 2019;Thiesen 2007). To provide housing in special eldercare facilities has been suggested as a reasonable harm reduction intervention for this particular group (Palm 2009).…”