Response to interpellation 2022/23:229 on deficiencies within the operations of Sis
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns deficiencies and lack of space within Sis. M considers it concerning that children are not receiving care 1 and that the municipalities can influence the availability of places 1. M argues that new forms must be found to meet the needs 2 and that a more unified approach is needed for high-quality psychiatric care 3. M emphasizes that discounted places can be financially difficult for small municipalities 4 and that more balanced alternatives need to be looked at 4. S considers it urgent to have a proper investment in Sis 5 and that the state must execute decisions on confinement 5. S advocates that solitary work should not be allowed 5 and argues that it is tragic when a lack of resources prevents placement in a closed environment.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! Gustaf Lantz has asked me what measures I intend to take to address the lack of space and the poor conditions within Sis's operations.
It is very concerning that children and young people do not receive the care and treatment they are entitled to. It is important that children and young people who are assessed to need youth care, residential youth care, and substance abuse care are given that opportunity and that they receive the protection and support needed against violence, threats of violence, sexual abuse, and drugs.
The State Board of Institutional Care, Sis, is in a strained situation with a shortage of space for the youths who are placed according to the Act (1990:52) on Special Provisions for the Care of Young People, LVU. In recent years, the authority has received several large financial supplements to enable quality and capacity improvements in the authority's operations.
Sis has an obligation to receive the youths and clients that the municipalities decide shall be placed within Sis. The authority has no discharge right. According to Sis, many of the youths currently cared for within Sis are finished with treatment and should proceed to other social interventions, but in many cases the municipalities have difficulties finding other suitable placements. The municipalities therefore have an opportunity to influence the availability of places within Sis by ensuring that the youths who are finished with treatment are offered placement in more open forms.
According to the Tidö Agreement, the responsibility for the most heavily criminal young people shall be moved from the municipalities to the Prison and Probation Service. Special youth prisons shall be established with the Prison and Probation Service as the principal. The new special youth prisons shall replace the departments at special youth homes that Sis currently manages and where sentences of closed youth care are served.
It is a difficult balance for Sis to allocate a place as soon as possible while at the same time the place should be adapted to the young person's needs. Sis has recently decided to temporarily pause some of the quality initiatives that Sis has implemented in recent years, including smaller group sizes in several girls' departments. I intend to follow up to ensure that the initiatives are resumed as soon as the placement situation allows. It is very important to continue the special initiative on the care of girls.
I welcome the Health and Social Care Inspectorate's, IVO's, report on the government mandate regarding the reinforced inspection of SIS's special youth homes that care for girls. These are very serious matters, and I react strongly to the deficiencies and poor conditions that are reported.
In the authority's regulatory letter for 2023, Sis has received a new goal and a number of reporting requirements aimed at addressing the quality deficiencies that have been noted. Sis has previously been tasked with developing its violence prevention work, which has a particular focus on those children and young people who run a high risk of being subjected to physical interventions from staff.
The government has made several initiatives to better meet girls' needs. Several girls' wards have received reinforced staffing and smaller group sizes, which has both created a better care environment and reduced the number of separations.
The Government has also tasked the National Board for Medical and Social Evaluation to carry out a preliminary study aimed at evaluating alternative methods to coercive measures within Sis's operations, psychiatric compulsory care, and forensic psychiatric care. The assignment aims to strengthen legal certainty and the quality of care for children and young people who are cared for under coercion and to reduce the number of isolations.
The quality of the operations must, of course, be maintained even during the strained situation that currently prevails. I will intensify and densify the dialogue with Sis to monitor how the authority works with its mandate and ensure that the development is moving in the right direction and that the authority has the support it needs.
Gustaf Lantz (S)
Mr. Speaker! I thank the Minister for the answer.
I read a report in Svenska Dagbladet some time ago about Alexander Ojanne, safety councillor in Stockholm. He sounded alarmed and worried and described how Stockholm decides on the placement of persons who have a certain behavior in gang environments. Stockholm has made the assessment that these persons must be locked up. They must be removed from streets and squares, because otherwise, other people risk being exposed to their often violent crime, a distressing crime that leaves marks for the rest of one's life. But these persons cannot be placed, because no one can take them in. Sis is full; there is a shortage of places.
If society judges that a person should be locked up, it is a central task for the state to carry this out. It ultimately concerns the trust in the entire state and the common good. It is also about ensuring that the people who are to be given care also receive care and a chance to leave a criminal path. It is also about ensuring that those who have self-harming behaviors and who have suffered badly in life are taken care of.
That is why I felt upset and despondent for a moment when I read the report.
The Minister represents a party that went to the election on a platform of combating crime and establishing order. I believe that the voters expect that those whom society has identified and said should be cared for also receive the intended care. Therefore, it is important that a proper investment is made in Sis and that these problems are solved fundamentally. It is urgent.
We have also discussed the problems that exist within Sis. In several homes, the legislation has not been adhered to, for example regarding separation.
If we are to seriously address this, it is important that we also pay attention to the working environment. We Social Democrats have recently introduced a follow-up motion in the committee to not allow solo work within Sis. Among the most complex children and young people we have, an employee should have a colleague close at hand. But above all, it is about those in need of care who are behind locked doors. They should be secure in knowing that there are at least two staff members in the care.
What is the Minister for Social Services' position on the proposal in our motion?
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! I thank the member for an urgent interpellation.
This area concerns me greatly and has concerned me for a long time. It was also the first director general I called to the Social Affairs Committee during my first time there in 2017 because I saw that there were extensive problems.
It was a fairly large part of our opposition work to get the previous government to move and make efforts regarding Sis. But there are many governments back in time that have not put the commitment and the force into Sis that they should have. It means that it is a collective responsibility for a member who is, not least, a representative for a former governing party and for me to take this further in a responsible and powerful way.
I also want to say that it is not acceptable for children and young people to have to wait for their care. Just as the member underlined, one has a right to care and treatment, and one should receive care and treatment of high quality. Therefore, it is extremely important that the pauses that have now been made, for example when it concerns special initiatives for girls, last for as short a time as possible, because we know that they have played a major role. There are also connections to the fact that one works in pairs and never has a solo effort.
I follow Sis's activities very closely, and one of the problems is, just like in so many other welfare professions, that there are difficulties in recruiting staff to Sis's operations. That makes this even more complicated. But it is important that the quality of the operations is maintained, even during the acute situation that we are seeing right now.
We have something in Sweden that the municipalities often emphasize, namely municipal self-government. This means that a large part of the treatment chain when it concerns children and young people who are drifting away for various reasons is the municipalities' responsibility. I do not say this in order to in any way push away the state's responsibility, but it becomes a problem when not the entire treatment chain is handled on the way to Sis, which is to be the last part in a treatment chain for these vulnerable children and young people.
Today, the situation is that the number of young people ready to be discharged from Sis is approximately equal to those waiting in line to enter Sis. This also means that the municipalities have a responsibility to be able to receive them. But when I meet with the municipalities and discuss with them, I understand their concerns. They are worried that they are not sufficiently well-prepared and point to the concern that a newly discharged young man who has spent time in criminal environments will be sucked back into criminal activity immediately or at least within a very short time.
This means - it is my conclusion - that we must find new forms. This is something we must do between municipality and state, because it will never work if one blames the other, but we must see these children and young people. Today, children as young as eight-year-olds are placed in Sis because the municipalities do not find forms to meet these young people. So we cannot have that.
Gustaf Lantz (S)
Mr. Speaker! I have also met municipal representatives who are a bit concerned about the answer that the Minister has given. For they see that when children or young people must be placed urgently because there is an imminent risk that the child will harm themselves or others, there are no emergency places. What the Minister describes are places upon discharge. Is that not a bit of mixing apples and oranges? The emergency places are another type, one that must be accessed immediately, and then there are the places where one is treated. That is what I have heard from municipalities. It would be good with a clarification in that part.
It can also be the case that different assessments are made. The Minister is himself of the opinion that there must be an interaction. It can perhaps also become better, that is to say, if the municipality actually does not make the assessment that there is a better intervention than the one that Sis can provide, this is something that must be taken into the equation and see that perhaps it is the case that Sis must be able to offer better treatment.
There is an enormous potential here. For example, it is not possible to decouple the discussion about the Sis-homes from the discussion about youth psychiatry, BUP. What happens to a care contact when a person from, for example, Uppsala is suddenly placed in Boden, when one is to take over the care and the care is to take place within the closed form of the Sis-homes?
I believe there is reason to consider how to facilitate continuous treatment. Both in the previous discussion and in this interpellation debate, I have perceived that the Minister is interested in having an ongoing dialogue. These are difficult questions, and that must be respected. But they are also very important questions, because within Sis are the keys to whether those young people who have fared worst in our society can get a chance, can feel better and can return to good lives, but also the risk that people can be affected by a treatment failure. It can be a failure with people who are in a gang-criminal environment and whom the municipality decides to take into compulsory care and place in a closed environment, but who, when we do not have places, end up in open HVB homes where they go as they please. It is deeply tragic, and it is probably also very provoking for those who suffer from gang crime that society is so toothless in its actions. In the thought, there is an idea of care in a closed environment, but then it does not become so because one does not have the resources.
I believe, in conclusion, that it is very important that we take a completely new approach, that we are focused on the future in this discussion. We must speak at least as much about these young people as about the Kriminalvårdens mission: Regardless of who will treat them in the future, we must have a solution, and it must exist here and now, and we must address these questions because they are so important. I hope to be able to get some clarifying answers here and that we can continue the discussion even when this interpellation debate is over.
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! Thank you, Member, for what I perceive as a wholehearted commitment to trying to be constructive moving forward.
I also believe that we have a situation that we must solve here and now, and I can assure the members that work is underway to promptly provide these places. Regardless of what the municipalities' readiness looks like regarding receiving the youths who are now ready for discharge, we must provide more places. I know that hectic work is underway to resolve this. We also know that the journey that Sis is on now means that we will get more places in a few months. These are, therefore, long-term places that still do not solve the situation here and now.
But it is clear that there is a certain number of places at Sis, and when fully treated youths are discharged from there, Sis is an authority that has learned to be flexible and that can adapt. It also means that when youths are discharged, there will be places left over that can be filled.
I have traveled around and visited I don't know how many Sis-homes. If the member has not done so, I can recommend it, because it provides a great insight. When I started traveling around in 2017, it was frightening to see the premises I was met with. Some of them are as old as summer cottages from the 50s. Now it is easy to say that it is not the premises that are the most important but the content, and I am the first to agree with that, but the premises still ensure that one can make a differentiation between girls who are at odds, who harm themselves, and those cases where we have severe problems with drugs and those where we have criminal youths. These needs are very different, and it rarely works to place them together. To this, very many of our young NPF diagnoses have been added, which indicates another failure in our society.
The school activities within Sis are not something I want to highlight as a positive part. Not infrequently, these children and young people have failed in school, and within Sis, one sometimes meets young people who unfortunately can neither read nor write and who need a lot of support and help to succeed in life outside. This is incredibly important.
Regarding the example of Uppsala and Boden, it is one of the parts that I have desperately raised to the previous government for several years, namely that we need to review how we can work in a unified way in Sweden. This is an issue where different regions choose to respond to Sis in different ways when it comes to the important psychiatry. This prompts discussions that we need to have in the near future on how we can in a better way be able to provide this important care and a treatment of high quality. Sis has a mandate to do this but is dependent on the regional health and medical care.
Overall, there are many things we need to do, but I can assure the members that it is a journey that has started with full force.
Gustaf Lantz (S)
Mr. Speaker! I thank the Minister again for the answer. There was a passage stating that the government has invested in discounting the Sis places for the municipalities. The situation is now so serious that there may be reason to look at whether it would not be more appropriate to focus the resources on ensuring that Sis has places for those who wish to place.
According to Alexander Ojanne, the major problem is not primarily the municipality's cost for the placement, but that the municipality is denied the right to place in Sis. Now we have an extreme situation with an extreme spiral of violence, and we have many young people in gang environments who are a danger both to others and to themselves. That society cannot offer them a place is our collective responsibility.
I must congratulate the Minister on the election victory, but with this victory comes also the responsibility of being in government. I am happy to help with good advice, but in the end, it is the government that is responsible for making it work.
As I began my speech by saying, this is a central task for the state. Regardless of what one believes the state should deal with or not, I do not think there is any voter who does not think it is the government's responsibility to ensure that those whom society, based on legal paragraphs, has judged should be locked up also shall be, and that they shall receive the care they deserve - the best possible care.
In conclusion: Thank you for a good interpellation debate! I wish you all the best with the work that must be done to resolve the situation.
Statsrådet Camilla Waltersson Grönvall (M)
Mr. Speaker! Many thanks, member, for the debate! If there is anything I can assure you of, it is that I, regardless of whether I am in opposition or in government, take a great responsibility for moving development forward regarding Sis. So it is.
When it comes to the discounted places, it is possible that Stockholm thinks the prices are not a big problem. However, I travel around the country and can assure the member that for small municipalities, a few placements can overturn an entire economy and an entire budget situation. This is important, but that being said, we can see that the discount that both the previous and the current government have had has not entirely achieved the effects that we would wish for.
There are tendencies that responsibility is not taken for all parts of the care chain, and therefore we need to look at alternatives that are more balanced and placement-neutral, in order to achieve a more reasonable outcome. The mere suspicion that, due to discounted Sis-places, one chooses not to handle the entire treatment chain, where HVB is, for example, an important part, is naturally very unfortunate.
Much is needed, and many things are falling into place. I am concerned about the recruitment situation, but we are following Sis very closely and will also continue to support Sis on their journey. But we will also return with more proposals, and I hope it will be in the near future.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.