Elin talked about sex abuse by a mental health nurse - no one reported

24-year-old Elin has been told by doctors that she is one of their most difficult patients. But there are causes for her mental ill health that psychiatry aside from.

Elin has autism and becomes ill with anorexia when she is 13 years old. After an elderly man has raped her, she develops post-traumatic stress syndrome, ptsd, with such severe anxiety that eating disorder care sends her to the pediatric and adolescent psychiatry at Sachska Children's Hospital in Stockholm.

- I had post-traumatic stress syndrome when I came to BUP. But I had even worse ptsd when I got out of there, says Elin.

According to the records from the BUP, which Mission Review has taken part in, she is put in a belt bed when she gets anxiety attacks and tries to hurt herself.

But according to Elin, more things happen there, which she then carried with her as deep trauma.

- There was a staff that I was in dependence on. After all, I was isolated in the room. He sat close to me, hugged and would touch me. He closed the door on us and I couldn't get a chance to come out, she says.

When Assignment Review investigates what happened to Elin during the care period, it turns out that from 2017 onwards, she tells several adults in adult psychiatry that the mental health nurse at BUP exposed her to sexual abuse four years earlier, 2013.

- Some time he said "yes, but it is good if I sit here with Elin, because she does not get belted when I work". But it was just because I was so incredibly afraid of him all the time. It was not about not having anxiety when he was there, I had more anxiety when he was there, says Elin.

The care has an obligation to investigate and report information on suspected abuses to the Inspection for Health and Care, IVO, according to lex Maria. It doesn't happen in Elin's case. A unit head of adult psychiatry calls the unit head at BUP - but no one is acting.

It is only in connection with SVT and adult psychiatry examining Elin's care that those responsible at BUP report the suspicions against the nurse to the police and IVO, spring 2019.

- We have things to learn, we need to be much better at catching signals, no matter how they come. The signal that came in 2017 did not arrive in the way we usually take it via, deviations, says Göran Rydén, Head of Operations at Child and Adolescent Psychiatry in Stockholm.

Does it matter?

- No, I agree.

You were informed that someone who has been a patient with you, a child, has told about sexual abuse by staff. After all, it's extremely serious.

- Seen like this in retrospect, I can agree that we would of course have acted even then, early.

In an internal investigation BUP made of the suspicions against the mental health nurse, which Assignment review has taken note of, it says that already in 2013 several employees reported to the unit manager about the man's approach to Elin. The unit manager called the mental health nurse a "clarifying call", the man then chose to retire and quit his job.

But when BUP finally makes an IVO report, they omit important information from their own investigations - including observations about the mental health nurse from 2013 and the information that came in 2017. Instead, BUP states that they only found out the suspicions in March 2019.

- Yes, we may need to investigate ourselves if we have been too deficient in how we describe it, says Göran Rydén, Head of Operations.

If you had acted when you first got information about this nurse, then maybe nothing more could have happened?

- It is very difficult to say but it is possible.

It's a pretty straightforward causal relationship anyway?

- It is based on how much you had knowledge about 2013.

There is, after all, information in your own investigation that this male nurse has sat with her in her lap in the bed of the room and told other staff to leave. It is not normal. It was also reported to the unit manager and the operations manager and it was ignored?

- And if we could have been quicker in, we could also have prevented things from happening.

Elin testifies to Assignment review that the man continues to call her when he quits BUP. She says he later raped her after she was printed.

- What I thought would be the end was only the beginning of something even worse. Then he knew I had an addiction to alcohol, and my weaknesses because he had nurtured me. In doing so, he exercised the power he had on me, and that led to several abuses.

There is now a police investigation in progress, the suspected mental health nurse rejects to the Assignment Review that he should have exposed Elin to sexual abuse.

But whether the mental health care provider is released or dropped out, or the police investigation is closed down, it has no bearing on what legal responsibility the care has for patients who report abuse.

In Elin's case, healthcare has breached its obligations under the Patient Act and the Health Care Act, says Annika Åkerberg, a lawyer at the human rights organization Civil rights defenders.

- They do not respect the patient's need for safety and security. The thing to remember when dealing with forced care is that you cannot leave the ward and risk being locked in with the perpetrator. Whether something is proven or not, it is always the patient's story that must be the starting point for what the caregiver then does.

Elin feels that the care has failed her.

- I feel they do not realize how much it affects one's life. How much is needed for me to be able to maintain a life now without going through everything that has happened.