Delaktighet under tvång : Om ungdomars erfarenheter i barn- och ungdomspsykiatrisk slutenvård

Sammanfattning: Akademisk avhandling för filosofie doktorsexamen i pedagogik, framlagd vid Örebro universitet 2008.AbstractEngström, Karin (2008): Delaktighet under tvång. Om ungdomars erfarenheter i barn- och ungdomspsykiatrisk slutenvård (Participation under coercion. On young people’s experiences in child and adolescent psychiatric inpatient care). Örebro Studies in Education 22, 245 pp. The aim of the dissertation is to study young people’s experiences of participation under coercion in child and adolescent psychiatric inpatient care and to discuss these in relationship to the potential senses of participation and the conditions applying to encounters in care. It takes as its theoretical point of departure Gadamer’s texts on medical encounters, von Wright’s texts on participation as an intersubjective phenomenon that is related to the creation of meaning and Buber’s texts on interhuman encounters. The dissertation is based on two empirical studies. The first consisted of interviews with 21 young people in the 14-18 age group who were patients in child and adolescent psychiatric inpatient care; ten of them involuntarily, eleven voluntarily admitted. The interviews dealt with the following areas: coercion, participation, meaning and encounters in care. The second study involved an analysis of the ambitions of the health care system with regard to participation and encounters with patients as expressed in the legal regulations applying to the health and medical services and the guidelines on professional ethics for different categories of staff. Analysis of the empirical material was based on a hermeneutic approach.The young people’s experiences of their care revealed that they rarely have any knowledge of the legal conditions that apply or about their rights, irrespective of whether they are voluntary or committed patients. One recurrent experience is lack of clarity about the reason for the treatment and what it is intended to do. Despite these shortcomings in their participation, some of the young people view their treatment as important and at times even lifesaving. Analysis of the ambitions of the health care system shows that the focus in the current regulations is placed on the self-determination and autonomy of the patients. There is rarely any description of the importance of a dialogue or of collaboration with the patient. Analysis of the material as a whole reveals that three senses can be attributed to participation in the care situation studied: participation as a right, participation as involvement and participation as meaning. The dissertation discusses how participation in these three senses can find expression in encounters between young people and staff. If participation is to be possible, a relation and an interhuman encounter is required which is characterised by truth, frankness and lack of pretence. This shows how important it is for young people undergoing coercive treatment to be able to meet individuals who can see and acknowledge them as subjects with an entitlement to participate. This can offer possibilities for the creation of meaning in treatment that has not always been sought but which can still be experienced as meaningful.Keywords: participation, involvement, interhuman, encounters, young people,coercive care.Karin Engström, Department of Education,Örebro University, SE-701 82 Örebro, Sweden, [email protected]