The National Board of Institutional Care’s special residential homes for young people – shortcomings in state compulsory care of children and youths

The Swedish NAO considers that the National Board of Institutional Care is not fulfilling the objectives of the operations at residential homes for young people. The agency cannot offer a place to all youth who need one, and care is not adequately adapted to the personal circumstances and individual needs of the youth. SNAO considers that the Government has, so far, not exercised management in the issues that are most crucial to attain appropriate care and treatment for all young people placed in the special residential homes. For example, the National Board of Institutional Care’s remit and target group need to be clarified. At present, the agency’s instructions do not stipulate clearly enough the care and treatment to be administered in its special residential homes. In addition, the legislation is unclear as to which individuals are to be placed in special residential homes for young people, particularly in terms of the boundaries between the Act concerning Support and Service for Persons with Certain Functional Impairments (LSS), and the Compulsory Psychiatric Care Act (LPT). If the Government’s intention is for the National Board of Institutional Care to care for young people who have extensive psychiatric problems and/or who need habilitative interventions, the agency must be given means that it currently lacks. For example, constant access to psychiatric expertise and staff with habilitative skills.

At present, the National Board of Institutional Care cannot influence which young people are to be admitted to its care, or when they are to be discharged, as these decisions are essentially made by the Administrative Court or social services through the Social Welfare Committee. Furthermore, there are no requirements for the people making decisions on compulsory care to possess knowledge about vulnerable young people and social work, except for the individual’s social worker, who is the rapporteur in the decision. SNAO’s assessment is that the regulations for admission to and discharge from special residential homes for young people need to be adjusted. Partly to achieve a more professional procedure where experts participate, at some stage, in the placement decision. Partly to attain national uniformity in terms of which young people are to be placed in such special residential homes. This can also help to improve due process for the individuals concerned.

SNAO assesses that the agency has not ensured that adopted guidelines and other policy documents on how the operations are to be run are followed and take effect in the daily work of the residential homes. Lack of follow-up and monitoring leads to inconsistent quality of care and treatment between the special residential homes for young people, while the minimum level of the care and treatment provided is too low.

SNAO also assesses that the treatment activities pursued within the care of young people by the National Board of Institutional Care today is unstructured and vulnerable. Both the daily work conducted in the various wards of the residential homes, and the organisation of the agency management in terms of responsibility, implementation and follow-up of treatments, need to be improved and structured. This is needed to ensure that operations can maintain high and consistent quality. The programme activities at the special residential homes are vulnerable as many of the homes lack a sufficient number of trained programme managers. Also, the staff conducting the programmes do so for a relatively small part of their working hours, which risks reducing quality in treatment.

In addition, SNAO considers that staff recruitment, as well as efforts to retain appropriate and skilled staff, do not function well enough. Neither does the National Board of Institutional Care ensure that staff possess the right competence to conduct care and treatment. This applies to established competence requirements and requisite skills development, but also to the inherent normative approach needed that focuses on care, good relationships and a healing everyday environment – around the clock, every day of the week.