Legitimering av tvångsvård. Klienter och deras socialsekreterare om LVM

Sammanfattning: The aim of this dissertation was to examine the legitimacy and the legitimizing of compulsory care for substance abusers according to LVM. For this purpose I have conducted, recorded and transcribed qualitative interviews with 80 clients – taken into such care in spring 2006 – and their social welfare officers when the clients were in compulsory care and then again about six months after its termination. Five research questions were posed: (1) How do the social welfare officers justify and explain their decisions to initiate or apply for compulsory care according to LVM? (2) Do the targeted clients consider the decision justified when it was made, when the care is implemented, and some time after its termination? (3) To what extent do social welfare officers and clients reach agreement about alternative placement during the care period (27 § LVM), and about measures to improve the social situation after its termination, which the social services are supposed to work actively for (30 § LVM)? (4) Which are the consequences of these agreements and measures in the clients’ own opinion – especially for their housing situation? (5) What overall conclusions can be drawn about the legitimacy of the act (LVM)? Theories on accounts, last resorts and discretion were used in the analysis, which was both quantitative and qualitative and refined through analytic induction. The social workers primarily justified their decisions as necessary to save their clients’ life; other accounts were to protect them or to discipline them. The clients’ attitude to coercion proved to be highly changeable over time. Some of them retained an unbroken negative attitude to their coercion and compulsory care, while others gradually accepted it. The crucial factor for the clients’ swing to a positive view of the compulsory care was the subjective benefit they ascribed to compulsory care, either during their stay in the LVM home or in the time after that, but the degree of participation in the planning and the decision also seems to have played a part. The question of the legitimacy of LVM should also be answered on the basis of the outcome of the measures that the clients actually receive or do not receive after discharge from compulsory care. At the follow-up at least six months later the housing situation was slightly better than in the time immediately before being taken into care, while five clients at this time were once again forcibly taken into care and a further five were in prison. But even though at least a year had passed since they were originally taken into an LVM home, the majority of the rest of the clients still lacked a home of their own or a sublet flat. LVM gives the possibility of taking measures against the individual’s express will, but the act is legitimated with the claim that compulsory care is nevertheless in the client’s interest since it is assumed to lead to an improvement in the client’s social situation. My dissertation shows, however, that this result is often not achieved. Although the clients often give some kind of retrospective consent, generally speaking their social situation is not improved. If the demand for evidence-based social work is to be taken seriously, this means that the legitimacy of LVM must be seriously questioned.