‘A free position in midfield' – a qualitative study of faith-based social work with people who use drugs in Sweden

ABSTRACT

Many faith-based organisations (FBOs) provide social work services to marginalised groups in need of care such as people who use drugs (PWUD), but little is known about how diaconal or faith-based social work with PWUD is carried out and how staff view their work. The aim of this study was to explore how social work with PWUD within FBOs in Sweden is conducted. This study is based on semi-structured qualitative interviews with 14 employees at a range of churches in Sweden. The empirical material was analysed with qualitative textual analysis. FBO staff channeled a personal calling to offer services through their organisations and found PWUD be in need mainly of emergency support. Staff engaged in boundary work such as differentiating between activities conducted at the church premises or on the streets. Staff accompanied clients to meetings with publicly funded welfare services to the benefit of the clients, and they appreciated their free role compared to social services staff. FBOs mainly act as stabilisers in relation to official public welfare services. The role of prophetic diaconal work aiming at social justice was limited and clients’ emergency needs were in focus, which indicates that FBOs in Sweden mainly complement welfare state services.

ABSTRACT

Många diakonala organisationer (FBOs) utövar socialt arbete riktat mot marginaliserade grupper såsom personer som använder narkotika, men vi vet lite om hur diakonalt eller trosbaserat social arbete med denna grupp genomförs och hur personal ser på sitt arbete. Syftet med den här studien var att utforska hur socialt arbete med missbruk och beroende inom diakonala organisationer bedrivs. Studien är baserad på semistrukturerade kvalitativa intervjuer med 14 anställda vid olika kyrkor i Sverige. Det empiriska materialet analyserades med hjälp av kvalitativ textanalys. Personalen kanaliserar ett personligt kall genom att erbjuda sociala insatser via organisationerna och de ansåg att personer med missbruk framför allt behöver akuthjälp. Personalen ägnade sig åt gränsdragningsarbete som att skilja mellan aktiviteter genomförda i kyrkan eller på gatunivå. Personal följde med klienter till möten med socialtjänst för att bistå klienterna och de såg fördelar med den mer fria rollen jämfört med socialtjänstpersonalen. Organisationerna agerar framför allt som stabiliserande i relation till offentliga sociala välfärdsinsatser. Profetiskt diakonalt arbete med fokus på social rättvisa var begränsat och klienternas nödhjälpsbehov var i fokus, vilket indikerar att organisationerna mestadels kompletterar det sociala välfärdssystemet i Sverige.

KEYWORDS:

• Faith-based social work
• diaconal work
• social work practice
• people who use drugs

NYCKELORD:

• trosbaserat socialt arbete
• diakonalt arbete
• socialt arbete med missbruk
• personer som använder narkotika

Introduction

The social welfare services that faith-based organisations (FBOs) conduct in relation to publicly governed and funded services have represented a field of growing research interest since the 1990s, particularly in the United States where such organisations are an important part of civic life (Bielefeld & Cleveland, 2013), but also in Europe (Beaumont & Cloke, 2012; Fridolfsson & Elander, 2012; Romanillos et al., 2012). Faith-based social work differs between European countries on several points and is influenced by religious and historic context and welfare state policies. Overall, the differences are based on the composition between publicly financed social welfare services and privately financed voluntary services, in which the latter may have either a secular or religious profile (Fridolfsson & Elander, 2012). Notable examples of FBO social work are the Catholic Church’s Caritas in Germany and Spain and the Salvation Army in the Netherlands and the United Kingdom (Elander et al., 2012). The development of neoliberal economic policies within social welfare states in Europe has shaped the relationship between FBOs and the state. FBOs are often described as a complement to publicly funded welfare state services in the Nordic countries (Fridolfsson & Elander, 2012; Romanillos et al., 2012). Neoliberal policies, such as new public management, have often resulted in reduced public service provision in social welfare states (Abramovitz, 2012). When the welfare state devolves responsibility to solve social problems to the individual citizen, FBOs may fill a gap in welfare services provision. However, FBOs may struggle to meet requirements for government contracts and might transform into more secular organisations (Bielefeld & Cleveland, 2013). In such cases, these organisations may be accused of being co-opted by neoliberal objectives. However, as argued by Williams (2015), faith-based organisations can resist policies that reduce welfare services by (1) providing services to people whom the state has chosen to withdraw services to, (2) staff resistance to regressive aspects of neoliberal policy and (3) engaging in political campaigning and presenting opposing perspectives on pressing issues and building coalitions with other organisations.

Sweden is one of the most secularised countries in the world in terms of traditional church-oriented religion (Tomasson, 2002), but the churches’ diaconal institutions are important actors in the Swedish social welfare state. Historically, diaconal work in Sweden has been directed at ‘the poor’ within an evangelising context. Today, social work in religious settings in Sweden is often focused on specific groups such as homeless people, people who currently use drugs, women engaged in prostitution, and victims of sexual abuse (Hollmer & Bodin, 2018; Rudolfsson & Tidefors, 2013). The Church of Sweden and several other Christian churches in Sweden engage in professional and voluntary social work with groups such as people who use drugs (PWUD), who face socioeconomic marginalisation, homelessness, physical and mental health problems, and stigmatisation.

Social work with marginalised groups in FBOs entails several dilemmas in how the work is carried out. These dilemmas relate to symbolic boundary work that staff engage in as they carry out social work in religious settings. Symbolic boundaries appear especially when there are overlaps between different organisations, as exemplified by the relationship between faith-based and publicly financed social work. Boundary work entails demarcation in relation to other actors, but also concern bridging of boundaries, in a process where objects, people and practices are categorised (Lamont & Molnár, 2002). Professionals may engage in boundary work by drawing up boundaries, maintaining them, crossing or bridging boundaries, or use boundary objects to mediate between organisations. Attention to boundary work is a conduit to knowledge about social work, since it may guide how services view their own role, which strategies are undertaken or not, and how target groups are defined. For example, FBO staff may have a more traditional social worker role, but they are not always bound by the bureaucratic demands on publicly funded social work services. In cases where FBO staff act as ombudsmen for clients toward social services and psychiatric services, they conduct boundary work toward these services in terms of establishing a bridge between PWUD and welfare services. Dilemmas may relate to the degree of openness toward marginalised groups and services provided to them. For example, congregations may strive for openness toward PWUD, but those who engage in illegal activities such as drug dealing or who have severe substance use and mental health problems may make other church visitors hesitant to attend services. This entails boundary work in terms of categorising church visitors as those who are included in the general congregation and those who visit the church to access diaconal services. As such, attention to boundary making can further new knowledge about how a range of actors use boundary work strategies in social processes that differentiates between types of social work, types of clients to work with, and how to conduct that work.

The aim of this study was to explore how social work with people who use drugs within faith-based organisations in Sweden is conducted. The study was guided by the following questions: (1) What motivates staff in FBOs to provide services to marginalised PWUD? (2) Which strategies are used by FBO staff to offer help and care to PWUD? and (3) How does the work relate to other social welfare services in terms of bridges and boundaries?

Diaconal work in Sweden

Sweden is a social welfare state with a comprehensive social security system that provides relatively good access to social support for marginalised groups, although discretionary power exercised by street-level bureaucrats extensively guides accessibility to social assistance (Panican & Ulmestig, 2016). Diaconal institutions provided social work long before the Swedish welfare state expanded during the late 1940s and onwards, although the balance between state and Church responsibility in welfare has at times been debated (Leis-Peters, 2014). In the year 2000, the Lutheran Church of Sweden was separated from the state and was subsequently defined as a ‘faith community’ comparable to other religions (Gustafsson, 2003). Deacons within the Swedish Church must have a bachelor’s degree with a major in psychology, social work, nursing, medicine or public health or must have completed education as a social worker or nurse, as well as education in pastoral theology. Eligible persons are admitted as deacon candidates in a local diocese and then they study pastoral theology for one year at a Church of Sweden training institute (Engel, 2006). Other Christian churches do not have such clear proscriptions and may to a larger extent rely on persons who volunteer to conduct social work (Lundström & Svedberg, 2003). Diaconal work is centred on offering support and comfort to individuals, although there are also examples of more structurally oriented work. The approach that aims at changing social structures through social justice is called prophetic or political diaconal work in the Church of Sweden, in which deacons take on the role as ‘voice carriers’ for marginalised persons (röstbärare in Swedish) (Hollmer & Bodin, 2018).

Diaconal work might complement or replace governmental welfare services, and in terms of replacement, this may involve services seen as needed, but not provided by public welfare institutions (Fridolfsson & Elander, 2012; Hollmer & Bodin, 2018). The Church of Sweden defines two different main focuses for diaconal work; activities aiming at care and the community, and those aiming at change and problem-solving. Diaconal work might combine these two, but there is usually a main focus in the work. Religious social work with PWUD is usually focused on change and problem-solving (such as offering concrete help in contacts with public welfare services), except for cafés for homeless persons that aim to offer a sense of community (Hollmer & Bodin, 2018). While the Church of Sweden recommends that each parish or congregation should have at least one employed deacon (The Church of Sweden, 2015), other Christian churches may have a ‘head of social work’ and rely more extensively on voluntary workers. In Sweden, some secularised FBOs engage in providing for individuals’ emergency needs, such as The City Mission that offers temporary accommodation and social spaces for homeless people and takes on the role of ‘stabilizer’ when it fills a gap left by publicly funded welfare services (Lundström & Svedberg, 2003).

Understanding faith-based social work

Bäckström (2009) discusses three different views on diaconal work that relate to views on Church and society, and which lead to different methods in diaconal work. The first is a holistic view of society where diaconal work is a part of the total welfare provision in society. This view prioritises marginalised groups in society and focuses on social projects. The social-caritative work is a goal in itself and not a means to achieve other goals, such as evangelisation. The second approach is based on the Bible and confession. Care of the other is spiritually motivated and the diaconal work is evangelising and a means to spread a certain view on faith. The perspective is based on tradition, and worship and devotion are important aspects. The third represents a holistic view of the parish in which diaconal work emanates from worship or the altar. The work is both a goal in itself and a means to achieve other goals, resulting in a combination of a vertical faith dimension and a horizontal social dimension in the work carried out. These perspectives can lead to different methods and the perspectives to some extent differ in relation to gender and generation cohort among individual deacons. For example, older deacons may tend to view their work as relating strongly to a curative dimension within healthcare, while younger deacons may view the role of diaconal work as being active in social issues and outreach (Bäckström, 2009).

Faith-based social work today is often located within what Williams calls geographies of postsecularity, defined as ‘the particular sites, spaces and practices where diverse religious, humanist and secular voices come together in a dialogic manner’ (Williams, 2015, p. 192). Within these spaces of care, social work is directed at categories such as homeless people, asylum seekers, victims of trafficking and women in prostitution, with faith-based social work conducted in the nexus between marginalised individuals and the publicly funded social welfare system.

Methods

We employed a qualitative approach consisting of semi-structured in-depth interviews with 14 employees at a range of Christian churches and parishes in Scania County in the south of Sweden. The interviews were conducted between June 2019 and February 2021 and were carried out in two waves due to the Covid-19 pandemic. The churches represent both the Church of Sweden and non-denominational churches within the Christian faith, in total ten different faith-based organisations. All interviewees were conducting social work specifically with persons experiencing problems with drug use and homelessness, within a faith-based organisation. As such, the persons that the staff meet commonly experience addiction problems, mental health issues, long-term homelessness, and social marginalisation.

Most of the interviewees were deacons but some had other titles such as priest, pastor, deacon assistant, counsellor, and head of social work, depending on their religious affiliation, organisation, and educational background. Nine of the interviewees were female and five male, and their average age was 51 years, with a range between 30 and 60. All the interviewees worked in urban settings in four of the most populous cities in Scania. Although drug use problems occur in rural areas of the county, we found that this type of social work in religious settings is centred in the larger cities, mainly due to the concentration of homeless persons and dedicated services located there.

The interview guide was semi-structured to allow for a focused conversation about the interviewees’ practices and attitudes and contained sections about personal background, work experience with marginalised PWUD, views on diaconal work, and perceptions on drug use problems. Interviewees were recruited through a strategic and purposive sampling approach (Morse, 2010), aiming to reach a broad group of staff members in terms of Christian church or denomination, location, age and gender. Initially, a priest acted as a facilitator, but we also used websites of different churches and congregations for contact information, and subsequently a snowball sampling approach where we asked interviewees to suggest persons that might be suitable to interview.

Since the period of fieldwork coincided with the Covid-19 pandemic we found it to be a risk to the interviewees to meet face to face. Physical distancing requirements thus meant that all but two of the interviews were conducted via telephone and Zoom (cf. Archibald et al., 2019). The two face-to-face interviews were conducted at the authors’ university workplace and at a church. Our assessment is that the telephone and digital interviews were suitable and efficient, and the interviewees spoke in detail and at length about their work. Most interviews lasted for around one hour, with a duration between 51 and 92 minutes. The interviews were recorded and transcribed verbatim by a research assistant and checked for accuracy by the first author.

Our approach to analysing the empirical material is based on qualitative textual analysis. This means that our aim in analysis has been to interpret meaning from the empirical material consisting of transcribed interview data (Kvale & Brinkmann, 2009). Coding was carried out in a three-step process. The first step consisted of a reading by the first author of the transcribed interviews, with the aim of obtaining a holistic view of the material. In the following step, the material was categorised by coding aspects of the data that focused on work practices among the interviewees in a coding guided by how they described what they did and their actions in relation to PWUD. These categories were then assessed by the second author in terms of validity and representativeness in the material, and subsequently significant themes were identified jointly. In the third step, quotations that represented the identified themes were chosen to present the analysis as excerpt-commentary units that focused on specific analytical points. The interview excerpts were translated from Swedish into English by the first author and then checked by a professional proofreader to ensure that the meaning of the quotations was retained.

The study was approved by the Swedish Ethical Review Authority (Dnr. 2019-06509). All interviewees gave informed oral consent to take part in the study. To ensure the anonymity of the interviewees we have anonymised their faith-based association and organisations.

Results

The analysis of the interviews resulted in three overarching themes. The first concerns the personal motivations to offer services among staff at the FBOs and the actual work they carry out. The second theme discusses boundary work by the FBO staff. The final theme concerns how staff acted in relation to publicly funded welfare services.

A personal calling in a religious organisational context

Religious social work is undertaken in a setting that is influenced on the macro level by changes in society and political decisions impacting on social welfare provisions, on the meso level by the aims and goals set by the churches and parishes as organisational institutions, and on the micro level by what individual FBO staff see in their everyday work and personal lives. An important focus among the interviewees was to be able to offer help and support to persons who are in a marginalised position in society. The notions of ‘extending a hand’ and ‘reaching out’ were commonly brought up as important activities. The activity of identifying social marginalisation was associated with an individual calling among the interviewees, as exemplified by a female deacon:

I usually say that when you are a deacon there are three things that shape the results. Firstly, you have a description of your tasks given to you by your workplace, and you also have certain needs that you see in the parish, and another thing is what I as a human being feel strongly about, the gifts I have. Those three things usually work together and result in the diaconal work in the parish. But I would also say, a bit far out perhaps, that it is God’s acts of love, you receive the love of God and you want to give back. / … / and not just sit on the pew so to speak, but to do something that reciprocates. (Participant 2, female)

As this deacon explained, the kinds of services and support offered to PWUD and other marginalised groups are dependent on an organisational context, in which the organisation assesses needs, give tasks to employees and volunteers, but where also a personal ‘calling’ is required to conduct successful work. Since diaconal or faith-based work is broad and can include almost any kind of marginalisation and vulnerability, to focus specifically on PWUD is an active choice made by congregations and their individual employed staff members or volunteers, a focus that not all congregations chose. Although the work conducted was situated in a religious setting, much of it was centred on providing essential services such as food, shelter, hygiene and a space for socialising with other PWUD and staff members. Most of the FBOs offered services at dedicated premises, and some conducted street-level outreach work directed at marginalised persons frequenting public places. The interviewees seldom brought up situations where they engaged in evangelisation and staff did not expect visitors to be particularly religious. Similar to the quotation above in which the deacon described God’s acts of love as ‘a bit far out’, a deacon who conducted street-based work discussed this aspect of not being evangelical:

No, well, of course that is individual, but my approach is that it should be totally unconditional. My function is not to go out and missionize or bash people on the head with God. That’s not how I function as a person at all. I think it’s all about meeting human to human. (Participant 3, male)

This approach to faith-based social work can be interpreted as an aspect of postsecular spaces (Williams, 2015), in which overt religious elements in services are put into the background, and the task of social meetings between people are highlighted as the basis of the work that is conducted. The faith-based work in this study was directed at persons with substance abuse problems and homelessness, and the approach taken was in all cases guided by the notion of openness. As one deacon said about a café service: ‘We have decided that there should be low thresholds and wide gates. Everyone should be welcome here’ (Participant 3, male).

Although prophetic diaconal work was not a significant theme in the interviews, a few interviewees discussed the possibility of a more political role for the churches and congregations. One deacon said that there was an ongoing discussion about this kind of work, but she also mentioned that prophetic diaconal work was underdeveloped:

There is talk that diaconal work should have a prophetic voice and that’s about carrying the voice of the marginalized. We talk about that among colleagues. [That we should] point out social wrongs and that some people become vulnerable because the system is not working. I think we should act more on those issues. (Participant 6, female)

Overall, the FBOs conducted work focused on emergency need services connected to the pressing needs of their target group of PWUD, but also café services that focus on community in a broad sense. In this sense, the FBOs worked with both individual problem-solving and community development (Hollmer & Bodin, 2018).

Establishing boundaries

There were important differences between offering services in the church premises and conducting outreach work on the street level. Most of the organisations chose a combination of these two approaches, although the premises were usually the home base for the services. Services that were provided at the church premises were often located in central parts of the city and located in the vicinity of other official or civil society services directed at PWUD and persons experiencing homelessness. In some cases, the central location of the services led to the gathering of many people with drug use problems, which could result in an increase of illegal activities, mainly drug dealing, near or at the premises. In a few cases, other people living in the area had complained about loitering and nuisance. Some deacons who worked in well-known and extensive services spoke about the issue of drug dealing on the premises. One explained that the staff had to continually explain their rules to visitors:

You sort of have to meet them halfway. I mean, we’re not totally against drugs here, but you have to be a little bit street smart, we also know who keeps on dealing. So, we set up a deal with them that they cannot do it inside the Church, and not outside our premises. It’s totally forbidden there. But since we know that it keeps happening, we say – ‘If you are going to do that you have to leave the Church’s premises’. And it usually works. (Participant 3, male)

All of the services had rules against drug dealing on the Church premises although only some of the services had experienced any extensive problems with illegal activities or nuisance at the premises.

Four of the ten FBOs conducted extensive street-level outreach work directed at marginalised persons who experience drug abuse, mental health problems and homelessness. This kind of work was conducted as a complement to regular services provided on the church premises. One staff member explained how this work was carried out:

We go out on the town once or twice a week, it depends on time and opportunity. But two persons go out and follow a special route where we meet our guests outside. We meet them on their home turf. And sometimes it's like you miss some guests, you meet them out there, and it is important to them when we say ‘Oh I haven't seen you in a long time, I have missed you’. That you feel that someone has missed you. It means a lot to them. And if they need help and so on and guidance, you have conversations out there instead. (Participant 11, female)

This quotation indicates the perception that it is important to reach out to PWUD who spend a lot of time in public places and who are seen as in need of both emergency needs services and social encouragement. When the participants in the present study crossed the boundary between the Church and the streets, they engaged in boundary work in their actual practices of leaving the church premises, but also in verbal categorisation of spaces as exemplified by terms such as ‘out there’ and ‘on their home turf’. As such, outreach work was a large part of making the diaconal work visible in public spaces for those staff members that used this strategy in their work.

An important part of diaconal work is to assess the needs of different marginalised groups. To give cash, vouchers, clothes or food to PWUD gave rise to the thought that this will increase drug consumption since several basic needs become satisfied. One deacon explained that some clients categorised the deacons as either ‘kind’ or ‘mean’, and that they generally did not give cash to PWUD, but would instead assist with accessing the specific item needed:

Interviewer: Is there some kind of balance within diaconal work or a discussion about that? How much should you help?

Internally among the staff, among the deacons, we have that conversation all the time. We agree most of the time but may have different views sometimes. Some of them [the visitors] jokingly talk about kind deacons and mean deacons. But I think it’s important to set up boundaries and when it comes to drug abusers, we very rarely give out cash. If we do it, it’s under very special circumstances. Sometimes they need help with medicines and then we follow along and help them receive them. Perhaps they need to travel somewhere, to the hospital in [another city]. (Participant 3, male)

This quotation is representative of an overall focus on openness and compassion toward PWUD in the interviews, as well as the more long-term aim of the FBOs to support PWUD in more holistic changes to their marginalised situations. Although everyone was welcome at the services provided, some organisations had age limits and were reluctant to support younger PWUD:

And we also do not want them to be here, the younger ones, to have contact with the older ones and be in this environment. It's not sustainable, so we try, as it were, to push them further, like ‘Go on and take that treatment’ or ‘It's not good for you to be here’. They also know for themselves that it is not a useful environment for them. You also do not want to invite them to too much to spend time with these others who are very much in the game. (Participant 12, female)

This example indicates that although the FBO activities were influenced by a notion that everyone should be welcomed, boundary work in terms of people categorisation was present at the FBOs.

Supporting social services clients

One kind of significant boundary work engaged in by the FBO staff concerned their position between their clients and the publicly funded social services. Most interviewees said that it is positive to be able to offer help and support while not being bound to the strict judicial and bureaucratic demands associated with public official social work. One of the interviewed deacons said the following:

I would say that it’s a really important function to have someone that has a free position in midfield, to use a sports analogy, that we have a free role in society that is not excessively regulated by official authority. Where people can go. I think that’s spot on, and perhaps the most important thing, when we have that role, people dare to contact us. Which can be a start of something that leads to something else (Participant 7, male)

Through their diaconal work, churches and parishes support persons who experience socioeconomic marginalisation and who might receive other services from the health care system and the social services. To some extent, the FBOs provide support to PWUD and homeless persons when they are denied social welfare provisions. Several of the organisations distributed food packages and provided free or cheap food and clothing, and deacons in the Church of Sweden helped individuals to seek funding for food, medicines, and other needs. Staff also described that the social services sometimes advised clients who had been denied help to go to the church organisations for food packages, which has also been identified in other FBO settings in Sweden (Fridolfsson & Elander, 2012).

In their relationship with other welfare actors, staff acted as guides that linked or mediated between individuals in need and relevant public welfare actors. One interviewee explained that the organisation had several members with an immigrant background, which was seen as a positive resource in outreach work with PWUD with similar backgrounds:

We found quite early on that it was important that they could feel that we were on their side; not against the authorities, but more as a bridge to the authorities perhaps. Sometimes these people have had pretty negative contact with authorities, it might be the police, the social services, the prison system, authorities in general really. And when they met us, they felt that they could open up and talk and they felt that we listened to them and actually tried to help them. (Participant 5, male)

Through their social contacts with PWUD that had developed over time, staff sometimes offered support in meetings between the client and the social services, as a support person or as a more formalised ombudsman. Many of the interviewees offered such support, for example by accompanying the person to meetings:

I’m one of those empowerment people so I try to get them to get their lives in order themselves. So I might say: “Call the social services”, “No I don’t dare”, “Okay, but call them and ask for an appointment and I can come with you if you want”. And then I follow them along to the social services, or the Social Insurance Agency or the Public Employment Service. (Participant 1, male)

This role offers an opportunity for the staff to exercise power in relation to the social services or other public agencies. One interviewee explained that accompanying users to meetings was perceived by them as having an impact on how requests for services and help may be resolved:

I have been with confidants in meetings with the social services several times. And my view is that I think that the demands they make in order to assist a person in such a situation are quite alright. / … / But then also, a lot of times the confidant says – ‘It was really good that you where there, the problems are usually never resolved this smoothly’. Of course, I understand that we have an impact when we are there. (Participant 3, male)

There was also some criticism regarding the role of the publicly funded social services and the FBOs. One interviewee commented on how the social services expected FBOs to act:

We are not supposed to pretend to be the social services or to be some sort of replacement for society’s failed social care. That’s not our task. But that’s what the municipality wants us to be. The municipality is happy to call on … the civil society as we are called, to get help with what they fail to do. But that’s not our main task. We can help with establishing contacts and cooperation, but our task is to bring about reconciliation, forgiveness and restoration, healing the spirit, the soul and the body. (Participant 1, male)

Several interviewees presented similar criticism of the social services, but some also viewed their role as complementary. One deacon viewed the role of the Church as complementary toward the publicly funded social services:

Sometimes it’s not being … to have another kind of perspective and being able to offer other kinds of support and be an addition [to the social services’ support]. But I view our role as a church to be a complement. That we have to act when things fail. To give economic support is the role of society and its function. We need to complement when society fails, and point out deficiencies. (Participant 14, female)

The notion of ‘not being the authorities’ and being able to act in the ‘midfield’ position between the client and the social services was a recurrent theme in the interviews. The fact that PWUD found that staff members’ presence could result in more desirable outcomes draws attention to stigma, discrimination and power relations between public social workers and marginalised clients. It can also be interpreted in the frame of the role that FBOs play in their relationship with public social work in the social welfare setting under study. To accompany PWUD to meetings to offer encouragement may be defined as an aspect of prophetic diaconal work, since the position taken by the staff could highlight a structural issue of potentially discriminating treatment by government officials and street-level bureaucrats who approve or deny welfare support, although this work was mainly carried out on an individual level in specific meetings.

Discussion

Both internationally and in Sweden, Christian churches and congregations provide extensive social work in tandem with the publicly funded social welfare system (Elander et al., 2012). In Europe, there is a tendency toward a professionalisation of faith-based social work in that such organisations provide welfare services in competition with other providers in an open welfare market. As such, FBOs may become increasingly ‘business-like’ (Maier et al., 2016) and may tone down overt religious elements or expressions in the services to be able to entice clients regardless of personal religious affiliation or faith. On the other hand, Churches conduct much work that complements existing social welfare provisions (Lindström, 2009), although FBOs as providers of publicly funded welfare services are rare in Sweden. Persons who experience a complex problematic situation regarding drug addiction, mental illness and homelessness represent one defined group that seeks support and services at FBOs. A personal calling among FBO staff is channeled through an organisation, which may result in a congregational will to offer help and support to this group. To maintain a religious identity in secular settings is an important task for some FBOs, and the religious identity may be an important calling that can attract and motivate staff and volunteers (Bielefeld & Cleveland, 2013; Lindström, 2009). We find that the FBO staff in this present study mainly represent a holistic view on diaconal work, in which the faith-based social work is seen as a goal in itself and not the basis for evangelisation (Bäckström, 2009).

The FBOs represented in this study conduct their work with an approach centred on openness by providing services to anyone in need, regardless of whether that person is a believer or not. As such, they are not guided in any obvious way by the religious views of PWUD; rather they take a position that does not delimit the diaconal mission based on theology. However, the FBOs may direct their work toward certain marginalised groups and may also be hesitant to offer services based on factors such as age, which was the case in one organisation that did not want younger PWUD to be influenced by older PWUD. This kind of boundary work was also present in discussions about strategies for diaconal work in terms of whether to conduct the work primarily at the church premises or in the streets. Street-level outreach work can be challenging since staff who go searching for potential recipients of support are entering the personal space of individuals or groups who congregate in public spaces, which means that these encounters may be less predictable compared to those at the church premises (Cloke et al., 2010). However, services at the church premises may also have an impact on the congregation if drug dealing occurs in the church or just outside, and if intoxicated service users act in ways seen as threatening for congregation members who visit the church but not to access emergency needs services.

Based on the conducted interviews, we perceive the FBOs to be postsecular spaces (Williams, 2015) in terms of the services provided to PWUD, but that overt evangelisation was uncommon. In his study of a drug programme in the UK run by The Salvation Army, Williams (2015) noted how the staff were involved in ‘careful management of [their] organisational image, for example, by curtailing overt displays of unwanted proselytisation, both on an individual and organizational level’ (Williams, 2015, p. 196). This theological ethos of offering services separated from participation in religious activities can be seen in relation to the need for FBOs to win and fulfil public contracts of welfare provision, but in the studied FBOs is seemingly more related to their strong position on openness toward all, in a holistic view of diaconal work (Bäckström, 2009).

Deacons employed by the Church of Sweden appear to be comparable to professional social workers employed by the social services, although they work in an obvious religious setting. For example, they handle applications to receive funds from the Church by individual recipients, where they assess individual eligibility and are required to employ their personal and professional discretion in deciding who will receive such funds. The overall impression is that the work conducted, to a large extent, concerns offering the opportunity for community and meetings that aim at making PWUD change their lives away from drug use. The deacons also guided users in the organisational bureaucracy of social welfare institutions. This relationship between faith-based social work and the social services is clear in the empirical material through the cooperation and staff contacts between these two, but also when staff accompany users to meetings with the social services. Overall, the interviewees seldom spoke about prophetic diaconal work aiming to change social and political structures that maintain inequality. However, when FBO staff accompany PWUD to meetings they play a role that many believe affects how PWUD are treated and their opportunities to receive relief efforts from the public sector. This may be understood as prophetic diaconal work that moves beyond individual emergency need services, but is a strategy that may produce only limited changes to discriminating social structures.

Strengths and limitations

Very little research has been conducted on faith-based social work with PWUD in the often highly secularised setting in Scandinavian countries, and our study fills an important gap in the research literature. Our study has focused on the professional side of faith-based social work, and the views of PWUD are not included in this study. Such an inclusion would possibly result in different experiences and knowledge.

Conclusions

Staff at faith-based organisations in Sweden provide extensive services to marginalised people who use drugs and who may experience homelessness and mental health problems. FBO staff are inspired by a personal calling to offer help and support to this group, and channel resources through their organisations. The role of FBOs as welfare services providers and being complementary to publicly funded social services means that they engage in boundary work toward other services. Notable examples of boundary work are discussions about what kind of help to offer and whether the work should focus on services at church premises or on outreach work. When FBO staff act as ombudspersons for PWUD in contacts with other welfare providers they can engage in prophetic or political diaconal work, although we found that FBO seldom engage in this activity at a structural level. We cannot say how common it is that the social services direct their clients to the FBOs when they are denied economic or other support. However, that this seems to happen is an indication that FBOs are stabilisers that cover up cracks in publicly funded welfare state provisions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Riksbankens Jubileumsfond [grant number P18-0892:1].

Notes on contributors

Johan Nordgren

Johan Nordgren is PhD in social work and senior lecturer at the Department of Social Work at Malmö University, Sweden. His research mainly concerns social work interventions for people who use drugs, and he has conducted research about drugs and ethnicity, online drug dealing, police officers’ views on harm reduction services, and parents to adult children with drug use problems. His work has been published in several international journals such as International Journal of Drug Policy, Nordic Social Work Research, Contemporary Drug Problems, Journal of Family Issues and Harm Reduction Journal. He teaches on the social work programme at Malmö University and is course coordinator for the online course Social work: Alcohol and drug problems – understanding and working with drug abuse and addiction.

Torkel Richert

Torkel Richert is PhD in social work an holds a position as associate professor at the Department of Social Work at Malmö University, Sweden. Richert’s research concerns drug markets and drug policy, social work and harm reduction services for people who use drugs, everyday life and risks for marginalised people who use drugs, women’s roles, opportunities and vulnerability in drug economies, drug addiction and affected family members, older people with drug use problems, and substitution treatment and diversion of medications. Richert's work has been published in several international journals such as International Journal of Drug Policy, Nordic Social Work Research, Journal of the Society for Social Work and Research, Addiction Research & Theory, Contemporary Drug Problems, Journal of Family Issues and Harm Reduction Journal. Richert works as a teacher and course manager on the bachelor’s and master’s programmes in social work and on the master’s programme in sexology at Malmö University.