Moell Finds 2020 Reform Did Not Reduce Coercion in Youth Psychiatric Care

STOCKHOLM — Sweden's 2020 legislative reform intended to reduce coercion in child and adolescent psychiatric inpatient care did not result in a clear reduction of coercive measures, according to a doctoral thesis from Karolinska Institutet. Analyses of national register data showed no clear decline in such interventions following the law change, which aimed to strengthen children's rights and limit coercive practices.

The research, conducted by Astrid Moell, PhD student at the Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and senior consultant at Region Stockholm's inpatient child and adolescent psychiatric care, examined how coercion is used, how common it is, and what factors influence its application. Two studies within the thesis specifically evaluated the impact of the 2020 legislative amendment. One finding indicated that involuntary medication increased immediately after the reform, while other coercive measures remained unchanged.

"Coercion is often presented as a last resort, but our results suggest that it is a recurring feature of care, even though levels vary greatly between different settings and countries," says Astrid Moell. "This suggests that stricter legislation in itself does not necessarily lead to less coercion," she said.

Formal coercive measures include mechanical restraint or involuntary medication under the Compulsory Psychiatric Care Act, while informal coercion—such as persuasion or pressure to encourage cooperation—is unregulated and often less visible. Interviews with healthcare staff revealed that ward culture, staffing levels, time constraints, and prior experiences significantly shape coercive practices in daily care.

Certain patient characteristics were more frequently associated with coercive interventions, including younger age, male gender, longer treatment durations, and repeated admissions. Some studies noted higher coercion rates among children from ethnic minority backgrounds, though findings were inconsistent and did not establish clear risk profiles.