An observational study of how staff organise daily activities in child and adolescent psychiatric inpatient care

Background Inpatient care within child and adolescent mental health services (CAMHS) is provided in highly structured, safety-focused settings for young people with severe mental health conditions. In Sweden, minors receiving compulsory psychiatric care have had a statutory right to daily activities since 2020. However, national inspections have identified shortcomings in care environments and organisational conditions. This study aimed to explore how staff organise and enact daily activities for minors receiving compulsory care in inpatient CAMHS in Sweden. Methods A qualitative observational design was used. Data were generated through 160 h of participant observation, evenly distributed across four Swedish inpatient CAMHS units, and through informal interviews with staff. Observations focused on how staff organised and facilitated daily activities involving minors receiving compulsory care. Data were analysed using qualitative content analysis. Results Findings revealed a tension between institutional control and staff efforts to enable meaningful daily activities. Three themes were identified: Control in tension with daily activities , Institutional work at a distance from minors’ interests , and Cultivating engagement through activities . Safety, routines, and boundary-setting often took precedence over activities. Regulation of peer relationships shaped whether and how staff facilitated shared activities. Competing demands and limited organisational support restricted opportunities to identify and respond to minors’ interests, while responsibility for initiating activities was often placed on minors. At times, staff fostered engagement by exploring interests, being available, participating, and creating opportunities for social connection. These enabling practices were less prominent than those centred on control and institutional demands. Access to activities varied with staff availability, competing priorities, and individual staff initiative. Conclusions Daily activities were organised through unit routines, staff initiatives, and available resources, without a distinct approach for minors receiving compulsory care. Similar activity provision in compulsory and voluntary care may not ensure equal opportunities for participation, given the greater restrictions of compulsory care. Realising the statutory right requires organisational structures, clear responsibilities, and integration of activities into unit routines and cultures, alongside staff engagement. Clinical trial number Not applicable. This qualitative observational study was not a clinical trial.