Locked-door residential care in the custody of adolescents with severe behavioral problems has been a controversial subject in Germany for many decades. Sometimes the debate is held on an ideological level, sometimes it concerns the legal and ethical legitimacy of such actions, but it always is about providing the best care possible for severely disturbed adolescents with attachment disorder, severe conduct disorder, and psychosocial disintegration. Because of differing viewpoints on this issue, some German federal states have set up locked-door youth welfare institutions, whereas as others do not. Here, we present two stereotypical case constellations from the state of Saxony, where the absence of such locked-door residential institutions has served to shift the problem to clinics for child and adolescent psychiatry. Based on these case constellations, we discuss the present knowledge concerning the necessity and efficacy of these institutions. The discussion is followed by a critical reflection on constraint and autonomy in youth welfare.