When Thyra, whose real name is something else, was 16 years old, anorexia took a firm hold on her life.

During forced care at the child psychiatry at Östra sjukhuset in Gothenburg, she was repeatedly strapped down by her hands and feet to be tube-fed via a rubber tube in her nose down to her stomach. 

- It is an extremely large intervention in personal integrity and it is experienced as both frightening and humiliating, says the lawyer Anna Nilsson, who researches forced care at Lund University.

Another team in Norway

In Norway, children under the age of 16 are not belted.

In Iceland, they stopped using belts in the 1930s.

In Sweden it is legal, but it should be seen as a last resort, when "other measures are not sufficient", according to the law on compulsory psychiatric care. 

Last year, roughly 140 children were in compulsory care in Swedish anorexia care.

The National Board of Health and Welfare has no reliable figures on how often children are put in seat belts, the reporting from the regions is insufficient.

Decision on repetitive belting

Thyra is today 18 years old and is now being cared for in adult psychiatry.

In child psychiatry, she was belted 34 times over two months.

Assignment review can show how the care at a treatment conference, decided that Thyra should be put in a belt at every tube feeding.

Making such a decision in advance is illegal, according to lawyer Anna Nilsson. 

- The requirements must be met in each individual case.

We can never accept idleness.

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"Presupposes that individual decisions have been made" - hears Johan Sandelin, chief physician at Sahlgrenska University Hospital.

Photo: SVT

In her diary from her time in hospital, Thyra writes about how she experienced the belting as traumatic.

“All these scenes are constantly replaying in my head.

I will never be whole again.”

Thyra's records show that before the belting decision, she participated voluntarily in the tube feeding on several occasions, or was held down by staff. 

"Importance of a care plan"

Johan Sandelin, chief physician at Sahlgrenska University Hospital, is not familiar with Thyra's case, but Task Review is referred to him for questions.

He sees no problem with the belting decision at the treatment conference. 

- It is important that you have a care plan where you anticipate certain expected situations and how to act, says Sandelin, who assumes that formal belting decisions are made on each occasion. 

Belting or restraint

An alternative to belting in anorexia care is restraint.

A method advocated by chief physician Ulf Wallin in the region of Skåne.

- I feel that it is often much gentler to be restrained by people than by belts.

If it gets violent, it can be uncomfortable, but holding a child to calm it down also requires some training.

Anne-Line Solberg, responsible for the Eating Disorders Center for Children and Young People at Sahlgrenska University Hospital, believes, unlike Ulf Wallin, that there are situations where restraint risks harming the patients and that there are children who have trauma from physical violence and abuse. 

- To then have four, five adults so physically close holding you, it can be retraumatizing for some patients.

Thyra wants the care to change

Thyra is aware that the care she has received has saved her life, but wants to see a change when it comes to seat belts.

- It needs to be reduced a lot and not taken up as often as it has been and really for no reason, when you have wanted to eat yourself.