Response to interpellation 2023/24:281 on mental health among young people

Socialministern Jakob Forssmed (KD)

Madam Speaker! Linus Sköld has asked me how I intend to act so that society can best prevent mental ill-health among young people. Linus Sköld has also asked me if I intend to take any initiative to investigate whether teaching about mental health should be introduced as a measure in the strategy for mental health.

I want to begin by underlining the importance of measures to promote mental health and prevent mental ill-health and suicide among children and young people. Such efforts are of great importance to achieve more equal health and good upbringing conditions for children and young people. This, in turn, can create better conditions for children and young people to meet the knowledge goals in school and be able to establish themselves in the labor market and in social life.

It is important that actors throughout society, based on their respective roles and responsibilities, contribute to strengthened promotion and prevention work. The Government is implementing several measures to support the actors involved in that work and to create conditions for good health in the child and youth group.

For 2024, the government allocates, among other things, just over 1.6 billion SEK through an agreement between the state and Sveriges Kommuner och Regioner to strengthen and develop the work with mental health and suicide prevention in municipalities and regions. Children and young people are a prioritized target group within the framework of the initiative, which includes funds to strengthen the promotional and preventive work as well as the work with suicide prevention.

The Government has also taken the initiative to introduce a leisure card that shall give children and young people an active and meaningful leisure time in community with others through increased access to sports, culture, outdoor life and other association life, as well as to initiatives for sports activities in vulnerable areas. The Government has also taken the initiative for measures to prevent and counteract involuntary loneliness, among other things through the development of a national strategy.

In addition, the government has given the National Board of Health and Welfare, together with a number of relevant agencies, a mandate to develop a national health program for children and young people up to 20 years of age. The program shall contribute to promoting the health and development of children and young people, preventing ill health, and creating conditions for improved health monitoring. The mandate shall be final reported by October 31, 2026, at the latest.

Another important measure to strengthen the preventive and promotional work is the national strategy in the area of mental health and suicide prevention, which is to be developed after the reporting of agency mandates on September 1, 2023, and which is currently being prepared in the Government Offices.

I cannot precede that preparation, but the starting point for the underlying material that has been prepared by the relevant authorities is to indicate an overall direction for the work on mental health and suicide prevention during the coming ten years. It appears from the authorities' proposals for the underlying material that the strategy may need to be supplemented on an ongoing basis with action plans and interventions from relevant actors at different levels in order to achieve the objectives in the strategy.

I cannot, as I have mentioned, anticipate the preparation but can assure Linus Sköld that strengthened promotion and prevention work is high on my and the government's agenda. By supporting the relevant actors in that work, we can together create conditions for good and equal health and good upbringing conditions among children and young people.

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Linus Sköld (S)

Madam Speaker! Thank you, Jakob Forssmed, for the opportunity to debate such an important issue! As Jakob Forssmed emphasizes in his response, measures to promote mental health and prevent mental illness and suicide among children and young people are of great importance.

Every fourth child in Sweden has recurring mental health problems. Every other 15-year-old experiences mental health problems. Suicide is the most common cause of death among young people aged 15-24. The prescription of antidepressants to children and young people is increasing.

Mental health issues have lifelong and socio-economic consequences. Psychiatric conditions account for half of all sick leaves, and every second person involved in organized crime has had contact with psychiatry.

Everything indicates that an important preventive and promoting measure would be that children and young people continuously get to learn about their own emotional lives, about social and emotional issues, and how to manage oneself, one's emotions, and the emotions of others.

The Public Health Agency has on repeated occasions pointed this out as a measure that would prevent mental health issues among young people. The World Health Organization points it out as the prioritized measure to prevent mental ill-health. The European Union points it out as one of several things to do to strengthen children's school success and mental well-being, not to mention a number of civil society organizations.

A campaign is underway collecting signatures, and about thirty civil society organizations have joined it. Well-known organizations such as Bris, Rädda Barnen, Röda Korset, professional associations, school health services, the teachers' union, the school leaders' union, and so on, are joining the demand to introduce mental health into the curriculum as a prioritized measure.

When I ask the Minister if he is prepared to consider any measure and if this could be an issue that needs to be included in the strategy, the Minister does not want to answer but refers to the preparation in the Government Offices - as if the preparation in the Government Offices is a process that the Minister does not really have anything to do with. It is a common trick for Ministers to do so. I therefore request instead the Minister's opinion, that is, a political position. Is this a measure that would be worth considering to strengthen the preventive and promotional work, that is, to introduce mental health on the schedule in all Swedish primary and secondary schools?

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Sofia Amloh (S)

Madam Speaker! Good health is among the first things most people wish for themselves and their loved ones. Those who are ill wish for good health. There are few things in life that are as important as feeling well and being healthy. We measure and assess a country's prosperity, among other things, based on how the population fares.

Madam Speaker! When I was born in the 80s, it was said that there was one thing that could not be bought for money, namely good health. But today I doubt whether it really is impossible to buy good health for money. It might not be, but it is not far off. Economic gaps are by far the biggest causes of the large health gaps today. It is absolutely crucial whether your parents are high- or low-income earners or where in the country you live for what living conditions you are born into. The geographical difference does not need to be large at all. Sometimes it is just a bicycle path or a few subway stations that make a difference in several years of life. Economic and social conditions play a role today in how long you live. The health effects are reflected directly in the ultimate consequence, i.e., the number of years of life.

The organization Makalösa Föräldrar presented a report last week on what the economic situation looks like for single parents - almost exclusively single mothers. Only one-third can afford to give their children organized leisure activities. In the investigation, specifically addressed to the Minister, it appears that it may not be the leisure card that will make the biggest difference for them.

That the government is now, with one hand, increasing the economic gaps with its economic policy, and thereby region after region laying warning after warning, and with the other hand introducing a leisure card, represents only a small bandage on a large wound. It is not good enough for the mental health of our children and young people.

In what way is the mental health of children and young people prioritized when the regions go through the economic slaughter? In what way will 1.6 billion play a role when municipalities and regions have over 30 billion in the forecast for next year?

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Fredrik Lundh Sammeli (S)

Madam Speaker! I thank the Minister for the answer.

It is certainly commendable that the Minister in his answer highlights the agreement between the government and SKR. But from the answer, one might get the impression that this is something new, that it is this government that is initiating this agreement. The truth is that it is merely a continuation of the agreement in this area that we have had in recent years, which is important and good.

Good mental health is fundamental for people to be able to realize their potential, manage life's difficulties, and contribute to society. Mental ill-health, on the other hand, has a multitude of negative consequences. It causes great suffering in people's lives and affects society as a whole, socially and economically.

Society's and the health and medical care's efforts for persons with mental ill-health need to be improved. In that regard, I am pleased that as vice chairman of the Committee on Health and Social Affairs and as Minister, I share the view that this is a reality that must be addressed politically. The statistics are clear. Over a number of decades, psychiatric diagnoses have become increasingly common while drug treatment with psychopharmaceuticals has increased.

We previously had a debate with the Minister for Education. I pointed out that it is remarkable that since 2006, the proportion of children and young people who have received a diagnosis of depression or anxiety syndrome has tripled. The prescription of medication is three times more common when looking at antidepressants in Sweden than in comparable countries in the Nordics. This is one of the absolutely most important issues here and now for today's children and young people.

An important part of that work involves taking the broad approach, a systematic effort, to improve interventions and structures to increase mental health. I am pleased that during the previous mandate period we began the broad work of developing the new strategy. The Government also highlighted the work that many agencies have been involved in, namely the basis that Socialstyrelsen and Folkhälsomyndigheten were commissioned to develop with 24 other agencies.

Now the basis has been prepared, and it is of course important that the government continues to work with it. When does the Minister intend for the strategy to be completed? How does the Minister envision the work ahead when it comes to creating the national mobilization so that it does not just become a strategy but becomes an important platform for moving positions forward? What role does the Minister want to take personally in this important work?

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Socialministern Jakob Forssmed (KD)

Madam Speaker! There were many questions, and I will try to answer as many as I can in the time I have at my disposal.

I would like to start by thanking Linus Sköld for the interpellation. The question is incredibly urgent. The development is worrying. The interpellator Sköld describes some of the statistical figures that are extremely alarming and which require us to do more and do right.

It is good that the work for a broad and long-term strategy for mental health is underway. My view is that for far too long we have viewed this as an issue for the health and medical care sector to handle and have conducted the discussion in that way in society. I do not think that is enough. We must work significantly broader than we have done historically. The basis we have received is a good start. I intend to work intensively with this and listen to additional parties in the work to get a strategy in place with broad support, and I will return with the exact forms of how it shall proceed, as a response to Fredrik Lundh Sammeli.

I also think there is much to do. To answer the question of how we should move the matter forward in different ways in school, I can refer to the interpellation debate with my colleague Lotta Edholm. I know that you discussed, among other things, the importance of the curricula for mental health, for the possibility of understanding what is expected of a student to handle those types of demands from school. I know that in that context you have discussed school health and an investigation which, among other things, shall review how school health can better contribute to health in different ways in school. I am eager that we should do this and that school health should receive a clearer mandate regarding health than it does today. These are some important components for moving forward when it comes to the students' mental health.

I share the view that we as a society need to become better at sorting through this issue of mental ill-health, which I think we sometimes describe as a large black cloud that we have some difficulty grasping and explaining. We as a society need to become better at that, not least for children and young people.

We need to become better at distinguishing between the common colds of mental ill-health, if one may use that expression, and the life-threatening illnesses of mental ill-health. What can one, so to speak, manage on one's own with the right tools and the right support, a compassionate support, and what does one need the collective resources of the healthcare system to manage?

This will require a lot from us in different ways. In that case, it is naturally interesting what happens in school and how the school can contribute to mental health.

The questions from Sofia Amloh are also important. It is clear that the issue of resources matters. How many colleagues one has matters.

But we have also expanded child and adolescent psychiatry very significantly. This government did, during previous years, and is doing during the current year, a record-breaking investment in precisely child and adolescent psychiatry. We try to do what we can to increase accessibility, but it is obvious to me that we must also mobilize the entire society. It must become the entire society's task to take on mental health. It is not something for the healthcare system to handle alone.

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Linus Sköld (S)

Madam Speaker! Thank you, Jakob Forssmed, for the answer!

In my eagerness to avoid answering the question I asked about education on mental health, which was quite specific, the minister risks making this a school debate. I will not do that, but I will quickly say that I am completely in favor of us reviewing how the school can become more health-promoting as an organization in terms of what requirements are set, how the knowledge content is organized, what the resources look like, what the group sizes look like, what adaptations are available, and so on.

It is not least about stress and pressure, but when this government commissions a grade investigation, the question of how grades affect mental health is not included as a factor. It is regrettable.

It is rather the case that when one gives amendment directives to ongoing investigations, one removes the directives to evaluate the occurrence of the rejected grade level, which I consider to be a factor that has an impact on mental health. But it is such things that this government does not bother with. They would rather have repressive measures in an investigation on safety and study environment. I think that is regrettable, because it will not strengthen the school's health-promoting and preventive organizational capacity.

In the same way, the organization of school health under the regions - or if it becomes the state if healthcare is nationalized, whatever I know - will also not strengthen the school's ability to be health-promoting and preventive, on the contrary. I do not want this debate to be about that. If Jakob Forssmed and I can keep our eyes on the ball together, I believe we will get out of this better.

The question, therefore, is how Jakob Forssmed views the inclusion of content regarding mental health on the agenda. It is not about the organizational issues.

In the needs analysis conducted within the framework of the assignment to develop the proposal for a national strategy, the following wording was included: "The school's role in increasing children's and young people's knowledge of mental health and tools to manage mental ill-health should be strengthened, for example by including teaching on mental health and the ability to manage life's difficulties as part of the curriculum."

But in the draft strategy that was subsequently delivered, in the final product, this wording has been dropped. It is no longer there.

Therefore, the representatives for civil society organizations who are listening to this debate and the 19,000 people who have signed the petition are very interested in hearing the Minister's view. Is mental health on the agenda, the substance regarding mental health, a measure that the Minister is willing to consider? The question is simple. Do not dodge it - eyes on the ball!

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Sofia Amloh (S)

Madam Speaker! Yes, of course, the whole of society must help. Civil society, all parts of society, need to have a focus on the health of children and young people and on mental health.

We Social Democrats did a number of things in government. Several of them, I believe, this government would not have objected to but also saw as good.

We made investments, among other things, in the service that one should call when feeling unwell, that is, the emergency service. We included over 20 agencies in the national strategy. They are included here, because there are so many parts of society that are needed.

Civil society does an incredible amount every day for mental health and against mental ill-health among many people.

But the fact remains, and there are as many investigations and as much research as there are that show that what makes the absolute biggest difference in closing the health inequalities we have is to close the economic inequalities. It is visible everywhere; it is incredibly clear that the large economic inequalities play a role. We see that it matters what living conditions one is born into. Whether one has an uphill or downhill climb plays a major role. We cannot ignore that.

The answers we have received so far from the Minister do not show any proposals on how to address the economic gaps. We say in politics that we should keep an arm's length distance, but this government seems to keep an arm's length distance from the societal problems. It is troubling for me.

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Fredrik Lundh Sammeli (S)

Madam Speaker! Regarding the mental health of children and young people, the most important measures are early detection, early intervention, and good cooperation between different actors and levels of care.

We both know here that there are deficiencies. Detection is too low and waiting times are too long, and it fails when it comes to structured cooperation and follow-up.

This is something that really needs to be taken further. Cooperation between the school, student health services, social services, and health and medical care must be developed, and the queues to child and adolescent psychiatry must be reduced.

I also believe it is important to take back control and stop the sell-offs of BUP, to expand first-line psychiatry, to strengthen school health services across the country, to open more youth clinics, and to ensure a national support line for mental ill-health with public funding and licensed staff.

These are many important issues. I have full understanding that it takes time after the authorities' work to prepare the basis for the national strategy. I hope that it does not take too long and that the government maintains a high pace in that part.

But here and now, it is interesting to hear what the Minister intends to take for concrete measures to handle these issues instead of just waiting for a national strategy that will come in the future. What can the Minister do here and now? And will there be any national helpline?

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Socialministern Jakob Forssmed (KD)

Madam Speaker! There is much we must do here, and we must maintain a high pace. The health development is extremely concerning, and we see no signs that the inequality is decreasing.

What can we do? Well, we are expanding the home visit program, among other things. It is important that everyone gets a good start in life and establishes good habits, and that trust is built between, among others, people in vulnerable areas, in economic hardship, and in other types of vulnerability and authorities. The directives for developing a health program for young people include, among other things, following young people until they are 20 years old and that all different capacities within healthcare shall have the same access to knowledge support in order to be able to meet children and young people in a good way. This is important for working more structurally and for not letting the children go when they have left BVC but continuing to follow up on them.

We are also building parental support programs. Parents are incredibly important and need to be given tools in a life that can be quite difficult, not only when the children are small but also when they are teenagers. How do we meet the current reality with the new demands placed on children and young people regarding, for example, the difficulty of sorting all the impressions that flood over them from the screens they have access to 24/7? More and more indicates that this plays a significant role in mental ill-health. I am concerned about this development, and we need, as said, to do a lot. Children in ninth grade sleep far too little. How can we change the conditions here? This is incredibly important for us to be able to achieve more equal health.

Economy plays a role. Sofia Amloh mocks the leisure card a bit and says that it is a small bandage on a large wound. One might think so, and previously the Social Democrats were against this bandage. But now you have changed your minds, and that is good. The point of the leisure card is to provide targeted support for an active and meaningful leisure time, so that children do not end up in a situation where the parent needs to choose between the child's leisure activity, the grocery bag, and the electricity bill. Children's leisure time should be protected from this. One might think that it is insufficient, but it is at least something and something new so that more children can have a chance at a meaningful leisure time. I think it is right to try to do something here, also to counteract the inequality in health that worries me very much.

Mental health on the schedule and learning more about one's own emotions and being able to sort through them is an interesting thought. The strategy for mental health in the proposal from the authorities, however, has a slightly different level of abstraction. The proposals are more at a strategic level, and then one needs to fill in with more concrete measures. How the curriculum and schedules should look is not my area of preparation, but it is obviously interesting to support children and young people's opportunities in different ways to better sort through this and understand why they feel the way they do and what can be done about it.

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Linus Sköld (S)

Madam Speaker! No, it is not Jakob Forssmed's responsibility what the curriculum should look like. But a couple of hours ago, the responsible minister stood here in the chamber and spoke about the investigation into exactly the curriculum review that is to be appointed tomorrow, and she could not say anything about this measure either. It is remarkable that Jakob Forssmed has no real conception of this when the minister's own agency advocates for an introduction of mental health on the schedule as a prioritized measure and the World Health Organization considers this measure to be the most cost-effective preventive measure.

Jakob Forssmed says that the strategy he is working with is at a different level of abstraction. But he can point out that the competence and knowledge regarding mental health need to increase among teachers and staff in student health. Why can he not point out the same thing for the students? Why are the students being sorted out? For me, it is completely incomprehensible. It does not have a higher level of concreteness to say that students should know things about their own health and ill-health than it does to say that teachers should do so.

My question remains unanswered because Jakob Forssmed is trying to avoid answering it by saying that it cannot be packaged into this context. I think it is regrettable. Much suggests that it would be worth at least investigating how this could contribute to children and young people being better able to understand themselves in relation to their surroundings and that we could thereby prevent mental ill-health.

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Socialministern Jakob Forssmed (KD)

Madam Speaker! I thank Linus Sköld for the interpellation debate.

I am interested in all cost-effective measures that can make a difference in different ways. But can I, here and now, give a statement regarding what Linus Sköld is requesting? No, I cannot. I do, however, think it is worth considering many measures, and I exclude no measures given the developments.

I emphasize the importance of student health services and the teaching staff having knowledge of this, but the knowledge should, of course, not stop there but be transferred to the students in various ways. These professional categories do not exist for their own sake, but for the students.

We face great challenges in these issues, and society needs to become much better at handling them. Here, a school with multiple actors can play an important role.

But let me conclude by saying that we can all play an important role. I often think of what a woman in her 20s, who had suffered a lot of mental ill-health, worry, and anxiety during her teenage years, answered to the question of what she had needed to hear as a 16-year-old: I needed someone to take me by the hand and say that it will work out and get better.

I believe that we are more for each other and building that into different contexts is very important and decisive.

The interpellations debate was hereby concluded.

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