A more integrated care for persons with harmful use or addiction and other psychiatric conditions
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns a reform for a coherent care for persons with harmful use, addiction, or psychiatric conditions. SD considers the reform to be an important step towards knowledge-based care and a modernization of the legislation 1. S welcomes the proposition but demands a clear economic structure and that resources accompany the responsibility 2. M motions for approval and emphasizes that the care shall be based on the individual with allocated resources 3 4 5. V considers the resources to be insufficient and wants an evaluation of the narcotics legislation 6 7 8. KD welcomes the reform as a historic shift to reduce stigmatization and create safety 9. C argues that the proposal lacks financing and clarity 10. MP considers the reform to be insufficient as it lacks clear treatment responsibility, long-term financing, and sufficient child perspective 11.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Jessica Stegrud (SD)
Madam Speaker! There is a growing group of people who often live with very complex needs for both care, treatment, and social support. These are people who have a harmful use or addiction in combination with one or more other medical conditions, often psychiatric. It concerns people with so-called comorbidity.
Research shows that addiction rarely constitutes an isolated issue. In fact, more than half of the adults treated for addiction also have a psychiatric diagnosis. Among young people with extensive care needs, mental ill-health, neuropsychiatric disabilities, and traumatic experiences are very common. This means that many need several interventions simultaneously.
Despite this, society's support has long been divided between different activities, authorities, and areas of responsibility. Psychiatry is responsible for one part, social services for another, and addiction care for a third. The consequences have been that people all too often fall between the cracks. It is against that background that this reform should be understood.
The government's proposal means that the regions shall organize care for persons with harmful use or addiction so that it is provided in a coordinated manner with other psychiatric care. At the same time, the regions' responsibility for the care and treatment that constitutes health and medical care is clarified. This is an important step towards a more coherent and knowledge-based care.
Madam Speaker! A central part of the bill is the new law on coordinated care and support activities. It is aimed at persons who, over a long period, have a need for coordinated interventions from both health and medical care and social services due to mental disabilities.
Municipalities and regions shall jointly conduct the operations. The purpose is to promote the individual's health, safety, and living conditions. For people with extensive needs, care and support shall no longer consist of a series of separate contacts, where responsibility risks falling between different actors. Instead, the interventions shall be coordinated around the individual and, as far as possible, planned and implemented together with the individual. Ultimately, it is about creating a care system that starts from people's needs and not from authorities' organizational charts.
Madam Speaker! Those who are the most ill simply should not have to navigate the welfare system themselves. The path to the right care and the right support should be simple and clear, not complicated and vague. Therefore, we strengthen the coordination between municipalities and regions. We clarify the responsibility for care and treatment and create new structures for people with the most extensive needs.
Madam Speaker! The bill thus contains several concrete changes that shall contribute to ensuring that people do not fall through the cracks. The requirements for individual planning are tightened for persons who are admitted to homes for care or housing.
The Social Welfare Board shall notify the region when someone is received so that the need for an individual plan is highlighted early in the process. A duty is also introduced for the region to compensate the municipality if the region does not fulfill its obligations regarding that specific individual plan. These are important changes. For people with complex needs, responsibility must not only exist on paper; it must also work in practice.
Madam Speaker! Behind almost every person with a severe addiction or a serious mental illness, there are other people who are also affected. It can be a parent who constantly carries worry, a partner who tries to keep everyday life together, a sibling who time and again tries to help, or a child who is forced to take on a responsibility that no child should have to bear.
To be close to someone with extensive problems often involves a great responsibility, a large emotional burden, and sometimes also a sense of shame and inadequacy. A well-functioning care system must simply look at the entire situation, not just at the one who is ill.
That is why it is important that we strengthen the support around the individual but also pay attention to the needs of the relatives. It is also something that the new Social Services Act ensures in a good way.
Madam Speaker! The legislation is also being modernized by replacing the term "abuse" with the concepts "use", "harmful use", and "dependence". It may seem like a minor change, but words can matter. The legislation must also reflect the knowledge we have today regarding addictive diseases and mental ill-health.
Madam Speaker! This reform does not solve all the challenges within psychiatry, addiction care, and social services. But it takes an important step away from fragmented interventions and unclear responsibilities. It takes a step towards a care system where people with harmful use or addiction and other psychiatric conditions meet a society that holds together.
Sick people should not have to adapt to the system. The system should adapt to the needs of sick people, and no one – no one! – should have to fall through the cracks.
Madam Speaker! I would therefore move for the approval of the committee's proposal for a decision and the rejection of all reservations.
Anna Vikström (S)
Madam Speaker! I move for approval of reservation 6.
For all too long, care has been lacking when it comes to people with harmful use and addiction and other psychiatric conditions. In this context, it is called comorbidity.
Despite the fact that healthcare resources shall, according to the Health and Social Services Act, be prioritized for patients with great care needs, it is often persons with more complex care needs who are most affected by deficiencies in the healthcare system. Persons with harmful use and addiction and other psychiatric conditions are among those affected by being bounced between the municipality's social services and regional healthcare, and between different specialties in healthcare. The responsibility of the care is unclear, the access to care is unequal, the knowledge and competence are insufficient, and only one in five with needs is reached by the correct care.
The Social Democrats appointed the Comorbidity Inquiry, which has now submitted its proposals. We now have a government bill for more coherent care for persons with harmful use and addiction and other psychiatric conditions. The bill also contains an entirely new law on care and support activities for those with mental disabilities. It is a limited group, not so small, and a law shall now support them and ensure that they receive coherent support. Otherwise, the proposals concerning a broader target group with comorbidity shall be implemented through knowledge support and governing documents from the National Board of Health and Welfare, as well as redistribution and additional resources. 400 million is provided over five years. How the redistribution shall look is not yet clear.
The investigation on comorbidities examined which goals people with comorbidities and their relatives themselves considered were most important for society's collective efforts to achieve. Here are some examples of these target goals:
early help for mental ill-health and harmful use
support and care that hang together as a whole
not being excluded from support and care
to get help with both addiction and mental illness
to be listened to, to be understood and to be treated with the same respect as others.
We truly welcome the bill, but we assess that more needs to be done from the government side for the implementation of the bill's proposal to be successful.
Mr. Speaker! There is much that speaks in favor of the reform now being discussed. Improving coordination and creating more equal conditions within care and support is important and necessary. But for the proposals to become a reality, more than well-formulated goals and intentions are required. Clear conditions for implementation are required.
A crucial question is the financing. If responsibility is shifted between municipalities and regions, the resources must follow. Otherwise, we risk creating new imbalances instead of reducing those that already exist. Therefore, the government needs to take a holistic approach and ensure a clear economic structure. It is about both a fair redistribution of funds and the state taking responsibility for the extra costs that arise when changes are implemented. Without this, it will be difficult to guarantee equal healthcare throughout the country.
For the reform to work in practice, clear support in the implementation is also needed, which we believe will be quite long-term. Major changes require coordination, knowledge exchange, and practical guidance. Knowledge support from Socialstyrelsen will arrive in August. It is unclear when regulations from Socialstyrelsen will arrive, and not until March 2027 will a national plan for the authorities be available.
We think it is a bit late and that there is therefore a need for a national support function that can support municipalities and regions throughout the entire process. Such a function could gather experiences, spread good examples and contribute with concrete support. It would increase the chances that the reform is implemented in a way that works in the whole country, while local conditions are taken into account.
Equally important is to follow up on how the reform actually works. There are a number of fears and questions that need to be taken seriously.
One is about the staffing within psychiatry. There is a well-documented competence shortage within psychiatry regarding specialist nurses and doctors, and more psychologists are also needed. Reports say that there is a risk that today's shortage situation will be reinforced in the long run because the supply is assessed to be unchanged while the demand increases.
Here, the government could have implemented some of all the proposals included in the national plan for the healthcare sector's competence supply and in a number of investigations concerning continuing education and other types of measures for the competence supply. But unfortunately, that has not happened.
Mr. Speaker! We need to get answers on whether the reform leads to better coordination for people with addiction problems and other psychiatric conditions and to the fulfillment of the goals that the people with co-morbidity and their relatives themselves considered were most important for society's collective efforts to achieve. Will it become easier to get help? Will they be listened to? Will they receive understanding and be treated with the same respect as others? Do care and support interventions connect better than before? Is there functioning treatment?
This reform is important. That is why we Social Democrats have submitted proposals that ensure municipalities and regions receive better conditions to implement the change in practice. Clear financial frameworks, well-considered support in the implementation, and careful follow-up are required. We believe that this will be decisive for whether there will be real improvements for those whom this bill is intended for.
Cecilia Gustafsson (M)
Mr. Speaker! Today we are debating the Social Affairs Committee's report SoU34 A more coherent care for persons with harmful use or addiction and other psychiatric conditions. It is a report based on the government's proposition on the first stage of the so-called comorbidity reform.
The background is well-known: Too many people with addiction problems and concurrent mental ill-health today face a system where the division of responsibility is unclear, where care and support do not always hang together, and where people risk falling between the cracks.
The proposition aims to change this by strengthening the coordination between psychiatry, addiction care, and social services, clarifying the distribution of responsibilities, and creating better conditions for person-centered and integrated care. It is fundamentally about ensuring that society's interventions are based on human needs, not on organizational boundaries.
Against this background, I move for the committee's proposal to be approved.
Mr. Speaker! Behind the legislative changes we are discussing today are people. These are people who often find themselves in a very vulnerable situation. These are people who simultaneously live with addiction problems and mental ill-health, and they have often for a long time tried to get help from different parts of society. All too often, they have been met by a system where care, support, and treatment have not been sufficiently well-connected.
I believe we in the chamber agree that today's situation is not good enough. When people with co-morbidity are forced to navigate between different activities and different primary owners, the risk increases that they do not receive the help they need in time. It is precisely that problem that the reform aims at.
One of the most important changes, Mr. Speaker, is that the regions' responsibility for care for harmful use or addiction will be clarified and organized more closely than the rest of psychiatric care. At the same time, the requirements for cooperation between municipalities and regions are strengthened. This is an important starting point because people do not seek help based on how society has organized itself or its activities, but based on their own needs. Therefore, the care and support must also, to a greater extent, be based on the individual and not on organizational boundaries.
Mr. Speaker! I have experience in this area from my municipal mandate where issues of addiction, mental illness, and social vulnerability are part of everyday life. There it becomes clear that people rarely fit into our organizational structures. The person who needs help does not care where the region's responsibility ends and where the municipality's responsibility begins. One simply wants to get the right help at the right time and experience that society's various interventions are working towards the same goal. Precisely for that reason, functioning cooperation is so crucial, and precisely for that reason, this reform's ambition for a coherent care system is so important.
During the committee's deliberations, several parties have raised questions regarding funding, the national support to the primary providers, and the need for follow-up. These are important issues, and this is a comprehensive change. Major reforms require both precision and perseverance. The government has therefore chosen to implement the reform in stages. It is a deliberate choice because the change must work in practice for both patients, municipalities, and regions. But at the same time, it is important to note that the government is not only proposing legislative changes. Simultaneously, significant resources are being allocated for implementation. A total of 400 million kronor per year is allocated during the period 2027–2031 specifically to support municipalities and regions in the transition. In addition, special funds are also allocated for the agencies' work with implementation and support. Municipalities and regions will receive support for the transition, and several national agencies have received special mandates to support the reform work.
The mental health delegation is already working to follow, support, and facilitate the implementation. This means that questions regarding financing, implementation support, and follow-up are not left to their own fate but are already part of the reform work.
A reform of this size requires not only new rules, but it also requires long-term work for the changes to work in practice.
Mr. Speaker! Requests have also been put forward for additional national plans, new strategies, and new steering documents. Several parties, for example, raise the issue of a new ANDTS strategy. The Government's assessment is that there is already clear steering through the updated goal for ANDTS policy, the national strategy for mental health and suicide prevention, the authorities' joint work, and the reforms that are now being implemented. The important thing is ultimately not how many documents we produce, but the important thing is that people get help in time.
Mr. Speaker! I believe it is important to see the reform for what it is, namely the beginning of a long-term reform effort, not an endpoint. It will require continued development, continued follow-up, and continued cooperation. But that cannot be an argument for waiting. On the contrary! People who have co-morbidity have waited long enough for society's interventions to work better together. Precisely because of that, this is an important reform, not because it solves all problems, but because it takes a decisive step away from silos and shifting of responsibility and towards a more coherent care where people's needs are at the center.
The person seeking help should not have to wonder which organization is responsible for what. Society's task must be to meet the human being where the needs are.
Karin Rågsjö (V)
Mr. Speaker! The hour is late, and I will not be long-winded.
I have looked at the entire reform, and I have thought a lot about the psychiatry reform. It was clear and good, and there were several points that were to be implemented. Unfortunately, an economic crash got in the way, and the psychiatry reform was blurred a lot.
Therefore, I must still ask Member Cecilia Gustafsson about the possibilities of looking at the economic conditions. Just as the Member describes, 400 million is spent per year, and that is a lot of money.
We have looked at this major reform at a time when psychiatry is down - even addiction care - regardless of the majority. I wonder if the resources are sufficient or if we can expect that the financing principle will be looked at during large reorganizations of activities affecting municipalities and regions. The state should cover what it costs. We do not quite believe that is the case in this.
Cecilia Gustafsson (M)
Mr. Speaker! I thank Member Karin Rågsjö for the question.
Municipalities and regions are absolutely under a hard economic pressure. There is no doubt about that. But the government is not only implementing legislative changes. Just as I said, and as the member himself mentioned, we are allocating 400 million kronor per year over a five-year period. In addition to that, resources are allocated to the authorities for the implementation itself.
The reform is primarily about creating clearer cooperation and responsibility. In that regard, we believe it is responsible to make those types of changes of that magnitude in stages over a period.
The development must, of course, be monitored closely, and significant resources have already been allocated for the implementation.
Karin Rågsjö (V)
Mr. Speaker! I thank the member for the answer.
We have looked a bit at this, and we think that significantly more resources are needed to get the major reform properly running so that it does not crash from the start. We do not believe that the 400 million are sufficient. When it is a question of a major reorganization affecting both municipalities and regions, it would have been good with 1 billion per year. It is an area that is underfunded from the start.
My next question, Mr. Speaker, concerns the follow-up. How does the government believe this should be followed up? How will it be seen that accessibility actually improves, that the care and support chains become more cohesive? Who will take responsibility for an evaluation, so that it can be seen early if something is not working?
Cecilia Gustafsson (M)
Mr. Speaker! I believe that follow-up is a very important part of a major reform effort, regardless of what type of reform effort is to be carried out. It is not that the government says no to follow-up. On the contrary, it is already a central part of the reform.
The mental health delegation has a clear mandate, and several other agencies have received specific assignments linked to the reform. The difference is probably not about whether follow-up should take place, but about which structures are needed to carry out the follow-up. The Government has chosen to strengthen the existing structures instead of creating new ones.
Karin Rågsjö (V)
Mr. Speaker! This is a very large and important issue that affects a group of citizens whom we have ignored for far too long.
Vänsterpartiet has taken the lead for a drug policy based on research and evidence. We have gone furthest when it comes to demands for needle exchanges, harm reduction measures, equal health for those with addictions and better care and treatment, as well as in the matter of investigating the criminalization of personal use – which is not legalization, I want to say once again.
The number of drug-related deaths increased over several years during the 2010s, but in 2018 the curve turned downward, and we were all happy about that. Despite this, 725 people died in 2024 as a result of drug and narcotic poisonings, and that is no measure of a good policy.
The affected are mothers, fathers, sisters, brothers, friends, and the deceased themselves. It is about a lost life. The stigmatization and vulnerability have increased over the years, and people with addiction have been treated more as criminals than as people who need care. The basis for all of this is that there is a great need to evaluate how the narcotics legislation, including criminalization, works in practice, as there is a lack of knowledge regarding what effects the legislation has had. SKR, the Public Health Agency, the National Board of Health and Welfare, and a multitude of researchers want the current legislation to be investigated.
I worked 1986–1987 with HIV-infected addicted intravenous drug users at the LVM home Serafen in Stockholm, which is located opposite the Stadshuset. Everyone who was there simply knew that they were going to die; HIV meant AIDS and therefore death. They were also men and women who had their own apartments with contracts, and they had contacts with addiction units, social services, and psychiatry. Resources were allocated to the addicted women and men. They were not completely forgotten under the ice as they are today.
This was before the 90s crisis and the enormous cuts to the public sector, before the criminalization of private use, before the sell-off of public services and before misery became legion. Many politicians turned a blind eye to this for decades.
Mental illness is an issue that we have been very united on and driven together, and one can be grateful for that. We also see now that the government is moving forward.
We have looked a bit at what needs to be done: One must enter with early interventions and intervene early before the harmful practice has accelerated and created problems when it comes to housing, supply, and so on.
Mr. Speaker! Research results show that nine out of ten people with an addiction would prefer to seek help within the health and medical care system. Only 5 percent want to seek help within social services. In other countries, care and treatment are organized in a completely different way than in Sweden, and there, they also have lower mortality rates.
This issue is addressed in the Co-morbidity Inquiry, whose final report From Parts to Whole was presented in January 2023. The inquiry is the basis for what we are talking about today. It is an incredibly good inquiry, which I also believe should be rolled forward. The same applies to the Narcotics Inquiry, and we are waiting for a decision on what will happen with that as well.
Among those living with addiction, it is common to have several health problems simultaneously, and these individuals risk falling through the cracks. We have seen this countless times in various reports and with our own eyes. Therefore, psychiatry needs competence within the area of addiction. There must be opportunities for persons with addiction problems to receive treatment for psychiatric conditions, for these are as intertwined as straw and hay.
I am worried that we already have a psychiatry that is very strained. A recurring problem is the lack of accessibility to treatment for addiction, which is of course difficult for both the patient and from a societal perspective. It must not become like with the psychiatry reform, that is, that one develops a reform that is very good, but in the end, resources are lacking to realize what one wants.
The reform involves very significant costs linked to organization, skills development, expanded cooperation, and reinforced psychiatric care. But despite that, this is missing, we think in all parties in the opposition, and it may also risk pushing out other care. The social services activity has also already been pressured, and therefore we think it would have been good if the financing principle had applied fully in the entire matter. The state shall take responsibility for the reform's costs.
I therefore move for approval of reservation 5, Mr. Speaker.
In line with several referral bodies, for example National Cooperation for Mental Health, we believe that the reform should be followed up and evaluated with a particular focus on whether persons with harmful use, addiction, and other psychiatric conditions actually receive more coordinated interventions and whether this makes a difference and yields results. One should also look at whether the reform leads to displacement effects, for example.
This implies major organizational changes for regions and municipalities, and for this to be legally secure and patient-safe, it is incredibly good that there is a transition plan that one can be guided by – a kind of map that should be developed together with regions, municipalities, professional representatives, and user organizations.
I therefore move for approval of reservation 7 as well, Mr. Speaker.
This is a very important reform, and we are fairly in agreement on most of it.
I think of all the addicts who have talked about this for a long time, and I think of their relatives. They are worthy of a decent life. I address this to the addicts: Sweden's politicians are obligated to give you that after years of ignorance regarding your needs.
Dan Hovskär (KD)
Mr. Speaker! I would like to begin by expressing my support for the committee's proposal.
There are few areas where the welfare system's shortcomings are as clear as for people living with comorbidity – people who simultaneously struggle with addiction and mental illness. For far too long, these people have fallen between the cracks.
A few years before I started as a member of Parliament, I worked within psychiatry at Falköping Hospital, both within addiction care and within acute psychiatry. There, I met people when life was at its most difficult for them. I saw the consequences of substance abuse, the suffering of mental illness, and the hopelessness that many people lived with.
I also saw something else. I saw how people often encountered a system that did not hang together. It was a system where different primary stakeholders were responsible for different parts of the care and where the responsibility was sometimes very unclear. It was a system where individuals themselves had to bear the consequences when the coordination failed.
This has led to people with great needs not receiving the right help at the right time. It has also led to unnecessary suffering and, in many cases, to people losing faith that society is there when life is at its hardest. This is not worthy of a welfare society.
Mr. Speaker! For the Christian Democrats, human dignity is the foundation for all politics. Every human being has an inviolable value, regardless of life situation, illness, or background.
The person living with addiction or mental illness is not a diagnosis but a human being with dreams, relationships, and hopes for the future. Therefore, care must be based on the human needs, not on organizational boundaries. This is precisely what the comorbidity reform is about. Therefore, I am glad that we are now taking this important step.
Mr. Speaker! The Government's proposal signifies a historic shift. For the first time, it is clarified that care for persons with harmful use or addiction shall be organized together with the rest of psychiatric care. It is a crucial change.
We know that many people with addiction simultaneously live with mental ill-health. Treating these conditions in different systems has not been reasonable. When care is integrated, the possibility increases to see the whole person, to provide the right help at the right time, and to help people back to health, independence, and hope for the future.
Mr. Speaker! Another central part of the reform is the new law on coordinated care and support activities. Municipalities and regions shall jointly conduct activities for persons who for a long period need coordinated interventions from both social services and health and medical care. This is an important step to move away from the silos.
For the individual, it does not matter which authority is responsible for which intervention. What matters is that the help works, that someone takes responsibility for the whole, and that the human being is spared from being their own coordinator. It is precisely this that the reform aims to achieve.
Mr. Speaker! The Christian Democrats have long spoken about the importance of local care. But local care is about more than geography. It is about relationships, about continuity, and about being seen and met with respect.
Many people with co-morbidity have been forced to tell their story over and over again. They have met new healthcare contacts, new assessments, and new waiting times. This creates frustration, resignation, and mistrust. This reform is an important step to break that pattern.
Mr. Speaker! An important part of the bill is also that the concept of abuse is replaced with the concepts of use, harmful use, and dependence. It may seem like a small change, but words matter; language shapes attitudes.
When people feel judged or stigmatized, it risks becoming harder to seek help. The task of politics is not to moralize. The task of politics is to create conditions for treatment, recovery, and a better life.
Mr. Speaker! This reform is not just about the individual. It is also about families, about parents who worry about their children, about children who grow up with a mother or father suffering from mental illness or addiction, and about relatives who for years try to navigate a system that does not work or that is difficult to find. When the care becomes more cohesive, greater security is also created for the relatives. This is in line with the Christian Democratic view of society, where close communities are crucial for people's security and well-being.
Mr. Speaker! This is not the end of the work – it is the beginning. Much remains for the municipalities, the regions and the state. But the direction is clear: We are moving from fragmentation to coordination, from silos to a holistic view. We are moving from organizational boundaries to human needs.
No human being should have to fall between the cracks because society is unable to coordinate its efforts. No human being should be left alone in the struggle against addiction and mental illness. With this reform, we take important steps towards a more cohesive, person-centered, and dignified care.
Christofer Bergenblock (C)
Mr. Speaker! The hour is late, as is the time for this extremely important reform. Initially, I would like to move for approval of reservation 10 under point 11, regarding the follow-up and evaluation of the reform.
From the Center Party's side, we argue that drug policy must to a greater extent be based on science, proven experience, and evidence. Therefore, we have also pushed for a transition to a policy that is more about harm reduction and damage minimization. Access to needle exchange programs, medication-assisted treatment for opioid addiction, and naloxone to reverse overdoses are among the changes that have been important in recent years. But we also want to investigate the issue of consumption rooms and the possibility of smarter punishments, such as care and assistance instead of fines or summary orders.
Many good proposals for reforms have already been submitted by both the Co-occurrence of Mental Illness and Addiction Inquiry (Samsjuklighetsutredningen) and the Narcotics Inquiry (Narkotikautredningen), but the pace of change from the government's side has been incredibly slow. The Narcotics Inquiry was submitted in October 2023 and has so far not led to any proposals at all from the government's side. The Co-occurrence of Mental Illness and Addiction Inquiry was submitted in January 2023 and has, after pressure from the Center Party (C) and the rest of the opposition, resulted in the appointment of a co-occurrence delegation and now finally in the first reform proposal regarding integrated care for persons with harmful use or addiction.
As early as 2011, the Center Party, Mr. Speaker, took a position for a changed primary responsibility with a transfer of responsibility for addiction care from social services to healthcare, not least based on the knowledge that the majority of persons with harmful use or addiction have an underlying mental or somatic illness. The Center Party therefore welcomes the bill to create a more coherent care for persons with harmful use or addiction in combination with other psychiatric conditions. It concerns one of the most vulnerable groups in our society, and the gap between municipal social services and regional health and medical care all too often leads to individuals falling between the cracks. A reform that strengthens cooperation and puts the individual at the center is therefore both necessary and long-awaited.
The social services shall always take responsibility for the social support for those who are in harmful use or dependency, while the regions shall take full medical responsibility. It may sound simple, but it will place great demands on changes. For a reform of this dignity to succeed in reality, in practice, out in the country's municipalities and regions, long-term commitment, sufficient resources, and clear support are required. Here we unfortunately see that the government's proposal falls short, which risks affecting the implementation and the outcome of the reform.
It is, after all, the regions and municipalities that are to implement the reform in practice. It is about building up new ways of working, developing the competence of staff, and ensuring functioning care chains. This will require significant resources. It is clearly stated in the bill that a number of referral bodies, including Sveriges Kommuner och Regioner, SKR, have emphasized that the reform involves a clear increase in ambition and thus increased costs – not only during implementation but continuously.
The basis for the funding concerns a redistribution of funds between municipalities and regions, but to claim that the funding principle is not applicable because it would not involve new tasks is, Mr. Speaker, to turn a blind eye to reality. The government proposes time-limited stimulus funds instead. That is not enough and creates great uncertainty for municipalities and regions, which in the end risks affecting the patient.
Financed reforms always risk overturning more than they help, as they can force difficult priorities that can affect other core activities. To ensure equal care throughout the country, the state must take its responsibility and fully compensate regions and municipalities for the extra costs that the reform entails.
Mr. Speaker! Bridging the gap between two principals with different legislations and cultures is a complex task. Municipalities and regions must receive the help and support they need during the implementation of the reform. The Government announces funds for "agency mandates or other interventions to support the principals," which is far too vague. The Center Party therefore considers that the National Board of Health and Welfare should receive a clear and long-term mandate to establish a support and coordination function to assist the municipalities and regions.
This function shall be able to provide guidance, spread good examples and offer concrete support to the principals throughout the entire implementation process. It would reduce the administrative hassle and ensure that the reform is implemented in a more equitable and efficient manner across the entire country, taking into account local and regional conditions. This is needed not least in light of the fact that SKR has pointed out that the roles of responsibility between municipalities and regions are changing and can be perceived as unclear. To avoid the reform leading to inequality across the country, clear coordination is needed.
A reform is only successful if it leads to actual improvements for the people it affects. It is not enough to enact a law – we must also know that it works.
The investigation that forms the basis for the bill proposed that the activity should be monitored continuously and that the participants should participate in the follow-up. The Government, however, dismisses this and argues that existing provisions, legal framework, and requirements for quality development are sufficient. But with such a large and complex reform, we must have a follow-up that is systematic.
We therefore consider, from the Center Party's side, in line with the investigation's original proposal, that there must from the start be a clear plan for how the effects of the reform shall be measured. Do more individuals receive the right support at the right time? Does the reform lead to better health, safety, and living conditions? Does the cooperation between the main authorities function better?
By following up and evaluating, we can ensure that people with harmful use or addiction actually receive the help and support they need or, if necessary, adjust the reform.
In summary, Mr. Speaker, it is an important change we are debating today: a more cohesive care for persons with harmful use or addiction and other psychiatric conditions. The government's proposal is not sufficient, however, and more is required for the good intentions to become a reality.
Secured funding, a clear support and coordination function, and not least continuous follow-up are required. With these three prerequisites in place, we could, in a significantly more secure way, create a dependency care and a psychiatry that is cohesive, close, and accessible in all parts of Sweden.
Nils Seye Larsen (MP)
Mr. Speaker! For far too long we have lived with an epidemic, I would almost call it, where people far too early lose the spark of life and die from an overdose in a form of comorbidity where mental ill-health and harmful use interact. This reform is about this. I therefore thought to begin with a small retelling of what actually happens almost daily, all around Sweden.
As an example, Malvina can be mentioned, who died when she was 23 years old. In an article, her parents describe the situation. In this way, with the benefit of hindsight, they can say that they saw that she was trying to self-medicate.
When one starts to feel unwell, one finds something to dull it. Then it is a steep uphill climb, says Tobias, her father. Has he told how mental illness and addiction affects everyone in the entire family. For those who have never struggled with such things, it is difficult to understand how complex it is.
He tells about how meetings, conversations, and contacts were arranged with different authorities but without success. That the healthcare system is not optimal, the parents quickly realized. There are long healthcare queues, and it is authority personnel who time and again pass the ball to someone else.
After a series of articles in Aftonbladet where the parents Annika and Lars told about the struggle for their son Daniel, 18, who had been trapped in drug abuse since he was 14, the emails began to pour in. They say it was as if a floodgate had opened, and out poured worry and helplessness – from all over the country, from all social classes and backgrounds. They were stories about similar situations. It is about parents mourning a child who is still alive. It is about families who see the children they love changed by drugs. It is about the enormous and sometimes hopeless struggle to get the right help at the right time.
One example among these is the parents of Emil, who died when he was 28 years old. The mother says: I know that I cannot get Emil back, but I do not want anyone else to have to go through the hell we have gone through. She tells about how Emil's mental well-being became increasingly worse. He was admitted to and discharged from the psychiatric ward. The panic anxiety attacks came more and more frequently, and Emil began to self-medicate.
On September 21, 2021, Emil and his parents were called to a so-called SIP meeting, where representatives from psychology, the substance abuse unit, LSS, and housing support were present. Tina describes the meeting as the worst she has ever participated in, which was also confirmed by the Lex Sarah investigation that was subsequently conducted. The professionals polemicized and tried to shift the responsibility onto one another. The meeting ended without any proposals for solutions. Then the cycle continued with acute LVM, care, and bouncing between authorities.
It is also this that Mona Dahlgren, who has lost two sons to overdose, tells about. It is not an isolated tragedy – it is an example of how a system functions when addiction with mental illness is met with control and suspicion rather than with early and accessible care.
She is struck by a clear pattern that emerges. It is not about individual mistakes but about a system where responsibility is fragmented and help is often conditional – a system where parents are expected to raise the alarm but where the alarms are not always received in time.
Every victim of a fatal overdose is a light extinguished far too early. Nearby, other lights stand and burn – with sorrow, with longing, with questions that remain unanswered, and with a frustration and helplessness over the struggle they have had to wage many times. They have fought for help that did not arrive, arrived far too late, or was far too small.
Why do I mention all of this? I do so because these are the people we are talking about. I am thinking of what was the intent in the report of the Mental Illness Inquiry, From Parts to Wholeness, and in the Narcotics Inquiry, and on the things that even the Narcotics Inquiry did not get to investigate, for example, the question of decriminalization. We needed to take a real holistic approach regarding the dysfunctional support. Therefore, I want to raise a warning finger. Sometimes it is painted here as the great reform – the paradigm shift, perhaps one might call it – that is supposed to make this more coherent. But we are worried that it is not enough.
Miljöpartiet has long pushed for regions to be able to take full responsibility – the primary responsibility – for care and treatment in cases of harmful use and addiction in accordance with what the investigation proposed, while the municipalities have the clear responsibility for social support measures when it comes to, for example, housing, employment, relative support, and support in everyday life.
We will stand behind this bill. It is long-awaited, but it is also insufficient. For example, we do not think the separation is clear enough, and it is not fully in accordance with the Samsjuklighetsutredning's proposals. There, the regions would be responsible for treatment and the municipalities for social support, but in the bill, one chooses not to sharpen and change the Health and Medical Services Act in a way that clearly states that it is the regions that have the responsibility for treatment. Then we are left with a bit of a problem. If the problem is unclear distribution of responsibility, the solution must be much clearer responsibility, and that is not quite the case in this reform.
The implementation must also be feasible – I am thinking of all the problems that we are obviously aware of. People who already have contact with healthcare or social services must not end up in a continued gap when the responsibility is shifted or clarified. Important competence must not be lost in the transition, and it must be clear when and how the municipalities' treatment responsibility ends and the regions take over the responsibility.
We share the view that a national support and coordination function is needed for the implementation of the reform that can provide guidance, disseminate good examples, and offer concrete support to the heads of institutions throughout the entire implementation process. It would ensure that the reform is carried out in a more equitable and efficient manner across the entire country – with better-functioning interventions.
The reform also requires long-term funding, which several have pointed out. For the reform to lead to a real change, resources are required to build up a well-functioning regional addiction care across the country, strengthen psychiatry, and develop social services' support measures and well-functioning low-threshold activities.
It is this that worries us a little. If staff and resources are not available and if the long-term resources required are not provided, the change in responsibility risks not leading to the desired results but rather to longer waiting times and fewer treatment options – in an area that is already long-term underfunded and inadequate.
The children's perspective is also insufficient, which several referral bodies have highlighted. We therefore want the government to return with an in-depth child impact analysis and a specific plan for BUP and first-line care. The analysis should cover children as relatives, children and young people with their own harmful use or addiction, children in HVB, Sis and LVU situations, and children's access to integrated medical and social interventions.
We are pleased that the bill contains improvements regarding needle exchange, but it is not enough. All regions should offer needle exchange and harm-reduction low-threshold activities. But when the law also continues to say that activities may be conducted instead of shall be conducted, there is a risk that access will become dependent on where in the country a person lives.
Low-threshold activities are often an important gateway to care and support. It is there that people can come into contact with healthcare, infection control measures, counseling, naloxone, treatment, and social support. That is why it is so important that there is access to this regardless of which region one lives in.
We have many proposals in our motion. This reform is important, but with this bill, only parts of the reform that is actually needed are being implemented.
It remains to be clarified the regions' accountability. It remains to be secured an orderly implementation. It remains to be financed the reform in the long term. It remains to be strengthened the children's rights perspective, the equality perspective, the influence of customs, and the low-threshold activities. And it remains to be developed a unified and knowledge-based ANDTS strategy.
Sweden needs a policy that holds the preventive work together. It is about harm reduction, early interventions, accessible care, social support, and reduced mortality. That is how we can move from parts to a whole, not only in the legal text but also in people's actual encounters with care and society's support.
I would like to move for approval of reservation 8, among all our reservations, as we want to see the collective timetable and how it is intended to move from parts to the whole.
With this, I thank you and wish you a pleasant evening.
The deliberation was hereby concluded.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.