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Increasing mental ill-health among youth and young people sent back and forth between different welfare state actors have been subjects of concern in Sweden in recent years. These young people are often labelled as having ‘complex needs’, with a placement as the social services’ possible intervention. What do young people stress as positive as well as negative experiences with placements? How can the concept ‘complex needs’ be understood in relation to placements? Semi-structured interviews were made in 2018, in two municipalities, with 9 young people between 15-22 years. They have received support from social services and psychiatric care, often related to substance abuse. The young people’s history is often a long-term process of different forms of placements, both in families as well as in residential care. Too short-term interventions may lead to discontinuity in care. Residential care is often perceived of as more storage than treatment and care. Implications are that the young person’s placement need to be more carefully monitored. Treatment introduced at the placement need to be better coordinated and evaluated jointly by social services and psychiatric care. It is important that professionals have more interventions to suggest and are working proactively to avoid future placements.

The aim of this integrative review is to investigate research of social work practices for adolescents and young adults with complex needs. The research questions are: What are the major themes in studies of practices for young people with complex needs? How do studies suggest that complex needs can be met in ways that are beneficial for young people? A young person with complex needs is in this review defined as an adolescent or young adult who, due to mental ill-health in combination with different types of social vulnerabilities, is receiving assistance from multiple welfare services. Searches were conducted in seven databases. These searches resulted in a sample of 1677 records, published 2007-2016, which in the screening process were reduced to 24 publications, all peer-reviewed articles. The participants in the studies in the articles consisted of young people, parents and professionals from mainly Anglo-Saxon countries. The articles were analyzed with qualitative summative content analysis. Three empirically generated themes were found in studies of work practices targeting young people with complex needs: collaboration-, relationship- and empowerment-oriented practices. In conclusion, the practices contain a wide variety of features, but with the joint aim of acknowledging young people's needs. The results can be used by practitioners and policymakers to further the development of services for youth with mental ill-health and social vulnerabilities, who use multiple welfare services.

The objective of this paper is to further the understanding of young people's experiences of out-of-home care (OHC). The focus will be on the tension between negative and positive experiences of OHC, refracted through the concept of liminality. The study is based on semi-structured interviews with 10 young people aged 15–22 (7 women, 3 men) with long-term contact with social services and psychiatric care. OHC can be experienced as a liminal space in both a negative and a positive sense. It is negative when perceived as containment rather than meaningful treatment. It can also be a negative experience when connected to fear, a lack of influence, and uncertainty in terms of being in between the social services and psychiatric care. It is positive when it is perceived as a turning point that enables positive change. It is then connected to feelings of meaningfulness, being respected, hope, and empowerment. The young people participating in the study also connect their experiences of OHC to a context of greater austerity in the welfare state. They reflect upon the benfits of OHC in terms of costs for society, but also the costs for the young person if the OHC is not perceived as meaningful support leading towards positive change. The participants have complex, interrelated needs and problems, and they also experience institutional gaps between psychiatric care and social services. It is important to overcome these gaps, so that young people are not located in ‘in-between spaces’ in terms of service provision. 

The paper uses the concept of recognition to investigate how young people labelled as having ‘complex needs’ experience their encounters with welfare state actors. Semi-structured interviews were held in 2018 with 14 young people, aged 15–22 years, in two Swedish municipalities. The participants have received multiple, long-term interventions from social services and psychiatric care. Research questions are: What aspects in the encounters between welfare state actors and young people may contribute to complexity in their life situations? How can Honneth’s concept of recognition illuminate this complexity? Aspects that have contributed to complexity in young people’s life situations are related to acts of dismissal. These dismissals by welfare state actors are interpreted as forms of disrespect as regards affection, rights or solidarity. Barriers to recognition are also related to the participants’ young age and position as children, and what this implies in a particular society. Our findings show that the difficulties young people face in their encounters with welfare state actors are partly due to the high level of specialization which contributes to an increased organizational complexity. Implications include that, when encountering young people in complex life situations, welfare state actors need to consider the importance of recognition as regards affection, rights, and solidarity. Recognition is central to achieving a positive outcome in working with young people in complex life situations and is expressed in social interactions. Therefore, building relationships needs to be more highly prioritized in welfare state organizations. young people in complex life situations and is expressed in social interactions. Therefore, building relationships needs to be more highly prioritized in welfare state organizations.

Mental ill-health among young people has increased in the past decades in Sweden as well as in other western countries. When mental ill-health is connected with social vulnerability such as difficulties in completing education, unemployment or substance abuse you may be considered to have “complex needs”. This paper presents findings from a project (2016-2018) in two municipalities. The data consists of semi-structured interviews from two sub studies. One with 13 young persons (15-25 years) who have been or are recipients of long-term support from social services as well as psychiatric care, and one with 24 professionals from social services and psychiatric care. The aim is to investigate young people’s and professionals’ experiences of work practices aiming at increased well-being for young people labelled as having complex needs. The research questions are: What barriers for work practices for sustainable support are there from the young people’s perspective? How to overcome work practice barriers for giving sustainable support, from the professionals’ perspective? The questions are reflected in three themes; empowerment, relationships and collaboration. Barriers mentioned by the young people are high employee turnover as well as too many professionals involved in activities. Professionals might have their own ideas about what should be done, not taking the wishes of the young person into consideration to a satisfying level. In collaboration between different organizations, the professionals consider it important with at least one person who has the influence in several of them. To take the young person seriously as well as staying on in difficult times are considered important. We argue that the expression complex needs, when used as a way to categorize young people, may obscure that the problem also lies with highly specialized and complex welfare state organizations.  They do not always succeed in catering for the interconnected needs of their clients.

This paper presents findings from a Swedish interview study from 2016-2017 with 20 professionals working with young people, who suffer from a combination of mental ill-health and social vulnerability. They have been recipients of long-term support from multiple welfare service actors with the aim of promoting the young people’s wellbeing. The aim of the study is to investigate professionals’ experiences of work practices aiming at increased wellbeing for this group of young people. Mental ill-health among young people has increased in the past decades in Sweden as well as in many other western countries. Mental ill-health has also been connected with social vulnerability such as difficulties in completing education, unemployment, out-of-home care or substance abuse. This group of young people are sometimes referred to as youth with complex needs. Complex needs is a concept used to categorize people that have multiple interconnected needs that span medical and social issues, people that are considered as especially disadvantaged, or presenting challenges to welfare services. Categorizations of people and needs are prerequisites for legal, bureaucratic and professional systems within the welfare state. Welfare organizations construct knowledge and strategies regarding specific target groups according to these categorizations. In the paper we argue that the expression complex needs, when used as a way to categorize young people, not necessarily take into consideration that the problem instead may be the complex organizations that young people meet. These organizations may not always succeed in catering for the needs of young people.

This paper concerns preconditions for the well-being of young people with mental ill-health combined with social vulnerabilities, also referred to as youth with complex needs. Research questions are: What barriers to sustainable work practices for young people labelled as having complex needs do professionals encounter? What do professionals identify as possible ways to overcome these barriers? Sustainable work practices are reflected in three themes: empowerment, relationships and collaboration. The findings are based on semi-structured interviews with 24 professionals, 3 men and 21 women, working in psychiatric care and the social services in two Swedish municipalities in 2016 and 2017. Major barriers are lack of continuity and co-ordination in staff and support, and fragmentation of work practices. As a consequence of the increased specialization of human service organizations, young people have to interact with many different professionals which could cause disparate interventions. Possible ways mentioned to overcome these barriers are supported through good interactional skills, using keyworkers as well therapeutic alliances, wrap-around services and case management. Complexity is linked to organizations and work practices rather than to young people. An often dysfunctional service delivery system in organizations with rigid boundaries may also affect professionals’ aim for sustainable support.

This thesis explores the increasing medicalization of society, the process whereby social phenomenon are transformed into medical problems. Alike the general tendency of neu- ropsychiatric diagnoses, the number of people with ADHD (Attention Deficit Hyperactiv- ity Disorder) has increased and expanded from a boys’ diagnosis to include both adult men and women. Studies on the latter category is however scarce. The objective of the thesis is to contribute with a micro sociological and critical perspective on the effects of the biomedicalization process, by focusing women's experience of getting and living with ADHD. The empirical material consists of narrative interviews with sixteen women, diagnosed with ADHD in adulthood. The participants, age 20 to 50, were enrolled via Swedish NGO:s in 2010 and 2013.

The thesis resides on four analytical themes: biomedicalization, pharmaceuticalizaton, functionality and gender. It shows how diagnostics evokes processes that involve learning and using a biomedical terminology to describe and understand oneself. ADHD is, in general, depicted as diffuse, expansionary, masculine and deviant sociability and cognitiv- ity. Unlike depression and anxiety, described as temporary and unwanted illnesses, the ADHD-diagnosis embraces the whole personality. Hence, the women find it difficult to identifying and separating ADHD from the self. Furthermore, categorizations of oneself as a ‘woman with ADHD’ imply constructions of individual and collective identity that has ideological implications, i.e. the individual narratives are related to grand narratives. These contradictory grand narratives bring about ideological dilemmas that are handled rhetorically in the women's everyday life. The masculine connotation of ADHD, for ex- ample, render the women experiencing themselves as transgressing not only femininity but also ADHD-personhood. Additionally, as social actions are attributed to the ‘ADHD brain’, the brain is portrayed as a pathological deviant and dysfunctional object for phar- maceutical intervention. Nevertheless, this discourse is also contested by the women by pointing to 1) positive aspects of the ‘ADHD-brain’ in everyday life, or 2) gender inequal- ities and demands of the late-modern society. Concluding, the women in this study are not only victims of their bodies or societal norms, but also agents negotiating– adapting and opposing to – expectations of how to be an ideal citizen or woman.

The aim of this paper, based on data from two Swedish interview studies conducted in 2010-2013 and 2015, is to critically investigate constructions of motherhood among women who identify themselves as having neuropsychiatric disabilities. The data, based on a selection of participants in the above mentioned interview studies include participants who identify themselves as women, who are parents to children under the age of majority, and who identify themselves as being a person with a neuropsychiatric disability. In the paper the women’s struggles of being perceived of, by others and by themselves, as "good mothers" are highlighted. To be a ‘good mother’ are by the women in the study constructed as abilities to organize the daily life of the family, organize and do household chores, keep track of the children’s activities, as well as the ability to clean and present a tidy and respectable home. Against these normative images of motherhood, where a ‘normal woman’ is positioned as someone who has an ability to organize the daily life of the family and present a respectable and tidy home, women in the studies position themselves as ‘deviant moms’. When they explain their lack of ability to organize and clean as being an effect of them having a cognitive, neuropsychiatric disability, they position themselves within a bio medicalizing discourse, where a certain way to ‘do mothering’ is constructed as a disability and a pathological deviation from normative motherhood. However, they also resist to be positioned as deviant and ‘bad mothers’ by positioning themselves within a norm critical resistance discourse that problematize gendered power relations, and notions of normative femininity connected to images of motherhood. 

The aim of this chapter is to explore Motherhood ideology from the perspective of mothers with a neuropsychiatric diagnosis. The analysis draws on interviews with Swedish mothers with the diagnosis ADHD (Attention Deficit Hyperactivity Disorder) and is informed by the theoretical concepts able-mindedness and responsibility. The interviewed mothers experience pressure to comply with what they perceive of as gendered expectations on mothers to possess specific cognitive abilities. Keeping the order, plan and organize family life are described as cognitive abilities that are more connected to motherhood than fatherhood. Experienced difficulties with this type of cognitive abilities are framed by a diagnostic discourse and turned into objects for pharmaceutical treatment. A gender equality discourse is however also used to resist or renegotiate ascribed gendered responsibilities in parenting and gendered norms of cognitive prowess.

In social work discourse, youth with mental ill-health in combination with social vulnerability are more frequently referred to as “youth with complex needs”. The aim of this paper, based on two interview studies, one with professionals in psychiatric care and social work, and one with youth (age 15-25 years), is to critically investigate how "complex needs" is used as a way to categorize youth. Youth with complex needs are by professionals in the study constructed as recipients of long-term but less successful support from social work services and psychiatric care. They are also, from the perspective of professionals, described as a category that in various ways present challenges for welfare services. Categorizations of people and needs are prerequisites for legal, bureaucratic and professional systems within the welfare state. Welfare organizations construct knowledge and strategies regarding specific target groups according to these categorizations. In the paper we discuss whether there is a risk that a categorization such as complex needs is used in a way that individualize problems, thereby obscuring problems that are related to complex organizations and care systems that cater for the needs of young people in less effective ways.

Title: Young people with complex needs. An interview study with professionals in psychiatric care and social work

Theoretical background: Mental ill-health in youth has increased the past decade, in Sweden as well as in other countries. The most common diagnoses being depression, anxiety, and/or neuropsychiatric diagnoses such as Attention Deficit Hyperactivity Disorder or Autism Spectrum Disorder. Mental ill-health is often accompanied by social vulnerabilities, as for example difficulties in completing education, unemployment and substance abuse. Thus this is a group of young people who often need support from both social work services and psychiatric care. Young people with mental ill-health with multiple and interconnected needs are in social work discourse more frequently referred to as having “complex needs”. 

Categorizations of people and needs are prerequisites for legal, bureaucratic and professional systems within the welfare state who construct knowledge and strategies regarding specific target groups based on such categorizations. The aim of this study is to, on a local level, critically investigate how the target group youth with complex needs is constructed, and how these constructions inform policy and work practices among professionals in psychiatric care and social work.

Research question: How do professionals in psychiatric care and social work services construct youth with complex needs? And how do these constructions inform policy and work practices among professionals in psychiatric care and social work?

Method: The paper is based on 24 semi-structured interviews from 2016-2017 with professionals in psychiatric care and social work from two municipalities (100 000 and 150 000 inhabitants) in Sweden.

Results:  Youth with complex needs are constructed as recipients of long-term but less successful support from social work services and psychiatric care. Lack of collaboration and lack of flexibility in work practices, and diverging opinions among professionals on the nature of the problem, type of solution, or whether and to what extent the young person’s needs are the responsibility of their organization and profession are described as impediments to sustainable care.

Discussion: In the paper we discuss whether there is a risk that a categorization such as complex needs is used in a way that individualize problems, as social problems are being transformed into medical problems. Biomedical power/knowledge may intersect with other socio-political factors, as in welfare state policies and practices, in a way that reflect and reinforce neoliberal ideology, thereby obscuring that problems experienced by youth are related to societal changes and complex organizations and care systems that cater for the needs of young people in less effective ways.

Social work is a field in which budget and debt counselling are offered, and instruments have been developed to map this type of problem. The aim of this paper is to present a scoping review of validated instruments in budget and debt counselling with over-indebted people. The study's questions are: How do the instruments studied address problems related to over-indebtedness? What assumptions about the causes and remedies of over-indebtedness do the instruments for budget and debt counselling rest on? How can the ways in which these instruments address over-indebtedness be understood as micro-managing this social problem? How may the use of these instruments affect the possibility of budget and debt counsellors taking structural conditions and barriers into account? The study results show that most of the instruments are designed to map resources or problems related to the household economy. Using these instruments, social workers can be seen as part of the governance of citizens through reformatory technology and micro-management of subjects in a financialized society. On the one hand, they can be used to support clients. On the other hand, the instruments can also shift the focus away from structural conditions in society and the consequences of economic inequality. Budget- och skuldr & aring;dgivning & auml;r ett omr & aring;de inom socialt arbete som ska erbjuda st & ouml;d och hj & auml;lp till & ouml;verskuldsatta. Instrument har utvecklats f & ouml;r att anv & auml;ndas av budget- och skuldr & aring;dgivare i kartl & auml;ggningen av denna typ av problem. Syftet med denna artikel & auml;r att presentera en kartl & auml;ggningsstudie (scoping review) av validerade instrument f & ouml;r bruk inom budget- och skuldr & aring;dgivning. Studiens fr & aring;gest & auml;llningar & auml;r: Hur adresserar de studerade instrumenten problem relaterade till & ouml;verskulds & auml;ttning? Vilka implicita antaganden om orsaker till problem som r & ouml;r & ouml;verskulds & auml;ttning och l & ouml;sningar p & aring; dessa problem bygger utformningen av instrumenten p & aring;? Hur kan s & auml;ttet som dessa instrument hanterar & ouml;verskulds & auml;ttning f & ouml;rst & aring;s som mikrostyrning av sociala problem? Och vilka effekter kan bruket av denna typ av instrument f & aring; f & ouml;r budget- och skuldr & aring;dgivares m & ouml;jlighet att beakta strukturella f & ouml;rh & aring;llanden och hinder? Studiens resultat visar att de flesta instrumenten & auml;r utformade f & ouml;r att kartl & auml;gga resurser eller problem relaterade till hush & aring;llsekonomin. Genom att anv & auml;nda dessa instrument kan socialarbetare ses som en del av styrningen av medborgare genom reformatorisk teknik och mikrostyrning i ett finansialiserat samh & auml;lle. & Aring; ena sidan kan de anv & auml;ndas f & ouml;r att st & ouml;dja klienter. & Aring; andra sidan kan instrumenten ocks & aring; flytta fokus bort fr & aring;n samh & auml;lleliga strukturella f & ouml;rh & aring;llanden och konsekvenserna av ekonomisk oj & auml;mlikhet.

This paper uses a neo-institutional perspective to examine possibilities and obstacles for participation in coordinated individual planning (CIP) for people with intellectual disabilities. CIP is a tool for interprofessional and interorganizational coordination with the objective of creating a joint plan for a person needing cohesive care. Participation by the service-user is considered important for effective coordination but involving someone with an intellectual disability may require special adaptations. A thematic analysis of interviews with 17 professionals from different organizations in Sweden reveals that service user participation is considered an important goal by professionals, but also that it is difficult to put into practice. The results indicate that CIP is characterized by tensions and policy-practice decoupling that limit the service-users’ possibilities for participation. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.