Response to interpellation 2023/24:461 on access to acute psychiatric clinics during evenings and nights
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns access to acute psychiatric clinics during evenings and nights. KD considers healthcare to be a high priority and that the state is providing funds to shorten waiting times. KD argues that 6 billion is a large addition and that the regions are responsible for the organization of care 1 2. KD considers that healthcare cannot handle everything alone without the society being mobilized for protective factors and that it is important to develop support for relatives 2 3. S argues that it is unacceptable that psychiatric acute care is missing in parts of Skåne 4 5. S argues that staff shortages and poor conditions cause the closures 4. S considers that the government's 6 billion does not solve the staff shortage or the care queues 6. S argues that ambulance resources are being drained and that the situation creates pressure on other authorities as well as negatively affects the police 4 6.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Madam Speaker! Ewa Pihl Krabbe has asked me if I consider it reasonable that psychiatric acute care is included in the offerings of a central hospital or acute hospital around the clock. If I do not, she wonders if I intend to take any general initiatives.
Ewa Pihl Krabbe has also asked me how I view the fact that other agencies, such as the police and ambulance services, have to spend a lot of time transporting patients who could have received adequate care at a hospital for their mental distress instead of performing their normal duties. She wonders if I am prepared, within my area of responsibility, to take some initiatives based on my assessment.
Finally, Ewa Pihl Krabbe has asked me how I view the complications patients are affected by and the risks to patient safety that the current situation entails, given the tasks assigned by the involved actors, and what measures I could imagine taking to counteract this.
The questions are posed against the background that the psychiatric emergency department in Kristianstad has been closed during evenings and nights since June 2022.
The increasing mental ill-health in the population is worrying. In addition to the personal suffering it entails, it also places increased demands on our societal functions, including the Swedish Police Authority. I want to emphasize the importance that for every individual patient, there must be access to the best possible care, regardless of where in the country one lives. This also applies to persons in a mental crisis.
The regions are responsible for the organization of healthcare, including psychiatric acute care. In my role as Minister for Social Affairs, it is my responsibility to provide the regions, which are the primary providers of health and medical care, with the conditions to offer high-quality care and services. Therefore, healthcare is highly prioritized in the Tidö Agreement and in the government's budget bill for 2024.
Within the framework of the agreement between the state and Sveriges Kommuner och Regioner in the area of mental health and suicide prevention, approximately 1.6 billion SEK is allocated. Funds are also allocated to shorten waiting times and develop strategic accessibility work in health and medical care, including through an agreement between the state and Sveriges Kommuner och Regioner where 530 million SEK is set aside for increased accessibility to child and adolescent psychiatry. Such measures can contribute to better care and reduce the need for acute psychiatric care.
The Government is also taking measures to support the principals in the work with competence supply and has given the National Board of Health and Welfare and the National Health Care Competence Council a mandate to develop proposals for a national plan to improve the competence supply in health and medical care.
The Minister for Justice has recently answered a question from Ewa Pihl Krabbe regarding police interventions in connection with closed psychiatric wards (answer to written question 2023/24:481). I agree with that answer. I also want to emphasize that ambulance care is for both persons with mental ill-health and for persons with somatic ill-health, and that an important area of development is to increase the ambulance staff's competence to meet persons with mental ill-health.
In conclusion, I would like to mention that several initiatives are underway regarding psychiatric acute care. During 2024, 50 million kronor will be distributed to the regions through the ordinance (2021:18) on state grants for the development of pre-hospital acute care for patients with mental ill-health. This is an important measure to develop support for persons with mental ill-health and suicidality.
The Government has also given the National Board of Health and Welfare a mandate to map the activities carried out at the psychiatric emergency departments. This includes issues regarding precisely organization, interventions, patients' experiences, and patient safety.
Ewa Pihl Krabbe (S)
Madam Speaker! I would like to begin by thanking the Minister for Social Affairs for the very detailed answer.
For over 600 consecutive evenings and nights, the psychiatric emergency department in northeastern Skåne has been closed. It is 600 evenings and nights when people with severe anxiety, suicidal thoughts, and other severe mental conditions have been without the possibility of the care and the attention at their hospital that somatically ill people have had during the same period. They are instead referred to the hospitals in Lund, Malmö, or Helsingborg.
For a person in that situation, it is often an insurmountable thought to get to these hospitals using public transport. At night, it is furthermore completely impossible, because no trains run then. Many also do not have the financial means to transport themselves or relatives who can help.
The reason for the closed psychiatric ward is that it has not been possible to staff it, and the reason for that is that it has not been possible to attract staff and meet their demands upon employment. Are there any specific demands that the staff have? No, I don't think so. As usual, it is about higher wages, monthly passes on Skånetrafiken for those who might travel all the way from Lund and Malmö, reduced working hours, work shoes, and professional development during working hours.
Creativity is not wrong when one has this type of problem in healthcare. But the politicians have unfortunately stubbornly said no to everything, despite everyone knowing that it is difficult to recruit in northeastern Skåne. It has been that way for a long time and within different sectors in healthcare, not just here. But problems are meant to be solved. In this case, one has such a large problem that not only are the patients suffering greatly; many other authorities and staff groups are subjected to both pressure and stress. Even the general public is suffering.
Last week, the announcement came that the nurses at the psychiatric emergency ward would now receive 4,000 kronor more per month. From the political side, it was assessed that with this measure, they would eventually be able to keep open until 8:00 PM. The only thing is that it turns out that it is not any additional wage increase, because the supplement that previously existed had been removed. Instead, they have raised the base salary.
Madam Speaker! A major problem after this long period is that the need for staff with exactly the competence that is needed now has increased greatly in Kristianstad and north-eastern Skåne. It cannot come as a surprise. We have a prison in Vä that constantly advertises. And in September, the large newly built detention center in Kristianstad opens, which requires a lot of staff with the same competence. I suspect that the wages there are significantly higher. It is a situation that one must contend with.
I also want to emphasize that it is not actually problems with the economy, as stated here, that cause the closure without that in the northeast do not want to make special solutions for the staff. So that has been reasoned for quite a long time.
The commitment to people with mental illness is not temporary. The commitment to the psychiatric acute care in northeastern Skåne is also not temporary. Every week, sometimes several times a week, there are articles in our local newspaper about the closed evening and night clinic and the consequences for society. It affects us all. It is important.
There have also been many letters to the editor in the local newspaper and articles from users but also relatives, describing difficult situations that occur when they can no longer manage the situation. We must not forget the relatives, who can be hit incredibly hard.
I would like to thank you once again for the answer. I am genuinely concerned about what is happening in our part of Skåne. But problems are there to be solved. I would like to take the opportunity to ask the Minister if there is any knowledge of similar situations in the country and how they were solved in those cases, or are we in north-eastern Skåne unique?
Anna Wallentheim (S)
Madam Speaker! Just as the Minister says, the growing mental ill-health is an incredibly worrying problem. A report from the Public Health Agency shows that 17 percent - even more than that - of the population between 16 and 84 years of age experience diminished mental well-being. At the same time, we also see how suicides, self-murders, are increasing. It is estimated that around 1,200 people every year die as a result of this.
The number of referrals from both adult and child psychiatry has increased during recent years, and in Skåne, psychiatry faces particular challenges. I live in the neighboring municipality that the interpellator Pihl Krabbe mentioned, namely Hässleholm. It is clear that Hässleholm is also hit hard by what we see happening in Kristianstad. All of northern and eastern Skåne is affected when there is no psychiatric emergency department to turn to.
The psychiatry in Skåne is in a critical situation. Within five years, it is expected that almost 300 of the 2,300 employees within psychiatry will retire. That is not even talking about the people who leave for other reasons, for example, being lured to other organizations such as the Prison and Probation Service where they are offered higher salaries and better schedules. We primarily see negative effects in my part of Skåne. It affects my entire region.
For many people, as the interpellator Pihl Krabbe mentioned, it is a great challenge to even seek out healthcare when experiencing problems – especially acute mental health problems. It is an enormous step to make one's way to an emergency room when suffering from severe anxiety or even having suicidal thoughts. Those who dare to seek care must be able to trust that they will be well cared for, but all too often one is met with a closed door nowadays. In my part of Skåne, one is urged to instead go to Lund or Malmö to get the care one needs – even in the middle of the night, when, as already mentioned, there is not even a possibility to get there by public transport.
Another important aspect to highlight, perhaps especially today, March 8, is that in Försäkringskassan's report From back pain to exhaustion, it can be read that between June 2019 and June 2023, the number of people with sick leave due to stress-related diagnoses or mental ill-health increased from 28,000 to 42,000 people. That is an increase of 49 percent. And who is most affected? Well, women. They account for the overwhelming majority of sick leaves due to stress and mental ill-health. Is the message to these women that they are to become ill on weekdays, because unfortunately, it is not possible to get help in the local area during evenings and weekends?
The situation is, as said, serious, and it requires action. It is not reasonable that the entirety of northern and eastern Skåne is left without psychiatric emergency care during evenings and weekends. I am aware that this specific issue may not be a national problem, but all around the country we actually see that health centers, psychiatric clinics, midwifery clinics, and so on are closing. We see that there is an enormous staff shortage within the healthcare system. This makes it a national problem that also requires national accountability.
It is important that people can trust the welfare and the healthcare. Now we find ourselves in the middle of a national healthcare crisis. What is the government doing to solve it?
Socialministern Jakob Forssmed (KD)
Madam Speaker! It is difficult to delve into the details regarding an operation led and run by the region, for example, the exact conditions the staff have. But for the sake of the minutes, I can still say that I have spoken with the responsible regional councillor, Per Einarsson in Region Skåne, who is immensely committed to the mentally vulnerable and their situation. I have met few people with the same drive and commitment for people who are affected in different ways by mental illness, psychiatric conditions, and mental ill-health. I know that his ambition is to reopen the psychiatric emergency reception in Kristianstad at night and in the evening as quickly as possible.
The supply of skills is a major challenge, and it is a national concern. The regions have had problems with this and have failed in various ways. We have tasked the national skills council to truly tackle the issue and come up with recommendations on what more the state can do to assist in this. The challenges described by both the interpellor and Anna Wallentheim are indeed very serious.
The supply of competence is a major challenge for Sweden, and it has not been eased historically by a fragmented healthcare system. Issues regarding the ownership of healthcare are now being investigated by the government so that these types of problems can be addressed in a better way than before.
I am deeply concerned about the developments regarding mental health. Anna Wallentheim pointed out how women, in particular, are affected. It is also important in such a discussion to see that there are different types of mental illness. Not everyone requires turning to a psychiatric emergency clinic, but the care a person needs must exist and be accessible. Additionally, we need to work on better prevention so that fewer people end up in these types of problems. But when that has been done, the care must naturally be there.
We know that the regions have major economic challenges. Some of the deficits and problems have built up over time. Some occurred temporarily due to the inflation that has hit the regions' finances in particular, given the pension agreements. As a response to this, the government has announced an additional supplement of 6 billion directed towards health and medical care to partially remedy the situation and also make it possible to retain staff.
Ewa Pihl Krabbe (S)
Madam Speaker! Thank you, Minister, for the answer!
I intend to focus on what the consequences for the rest of society look like when the mentally ill person cannot reach their healthcare provider when it is acute. When the psychiatric emergency room is closed, some patients go to the regular emergency room. Such patients take up a lot of time and resources, and they do have every right to do so. But those patients who come to the emergency room because of physical ailments may then have to wait much longer for the help they need. The regular emergency room also struggles with the problems that high workload and a shortage of nurses entail.
The ambulance physician states that the ambulances have to drive long distances during the nights with patients to night-open psychiatric emergencies. It often involves three-hour journeys, and they take ambulance resources from the district. He also states that 15 percent – which is quite a lot – of the ambulance patients have mental ill health. They are actually more than the trauma patients.
I also want to say that there is a psychiatric ambulance that runs between 17:00 and 01:00. It performs a very important service, but it does not cover the entire night and not everyone who needs it. In some cases, the ambulance staff need to request assistance from the police, but then they must first contact a doctor to get permission to contact the police, and then it takes 1 ½ hours before they can depart. Then one police officer accompanies the ambulance while another police officer follows the ambulance. Many hours are tied up. Another unpleasant consequence can be that one has to use handcuffs. That does not benefit the patient's well-being.
The police leadership in Blekinge and northeastern Skåne has, as I wrote in the interpellation, warned about the effect of the closed psychiatric ward and stated that a police patrol can spend three to seven hours of a work shift on a single healthcare case. Other police matters must then be redirected or take a backseat. Police statistics also show that the suicide cases they come into contact with have increased dramatically during this time. A sharp increase in the number of cases linked to mental illness where police patrols are sent to the scene means that they often end up in situations involving acute detentions according to the Act on Psychiatric Compulsory Care. This leads to the summary conclusion that other police matters or crime prevention activities must be redirected or take a backseat.
As I said earlier, we must not forget the relatives, who can end up in very difficult situations with threats and violence when they can no longer master the situation. I am thinking not least of the children and what they have to experience.
As has been said, there are many who are affected when society fails the weakest for as long as this has persisted. We all need to join forces in society to solve problems of this nature. Obviously, the resources are not sufficient, as the Minister states.
There is a great focus in society on mental health and not least among the young. We must all find better solutions.
Anna Wallentheim (S)
Madam Speaker! Thank you for the answer, Minister!
The 6 billion that the government has presented is not something that solves the situation for all those who work in healthcare or all the people who are waiting for care right now.
We know that the regions already have a deficit of 24 billion. I believe it is calculated that 21 billion of them are specifically within the healthcare part. In my home region Skåne alone, we are talking about a deficit of over 4 billion.
The Minister's and the government's answer is therefore that 6 billion shall solve this crisis. How is it going to solve the staff shortage? How is it going to solve the care queues? How is it going to solve that people in my part of Skåne get the access to care that they have a right to on evenings and weekends?
In the week, furthermore, a number of regions have already come out and announced that the savings requirements in healthcare will remain despite the supplements that have been presented. The layoffs will remain, because it is unfortunately not enough. One cannot solve a problem of 24 billion with 6 billion.
I also want, as a final part, to highlight the fact that the interpellor Ewa Pihl Krabbe just concluded with. I sit on the Committee on Justice. For me, it is incredibly important to look at the part that concerns other authorities and where we see that the police are so severely affected in my part of Skåne. It is important to understand that the lack of access to psychiatric acute care not only affects patients but also affects other social actors, such as in this case, the police.
The police leadership in Nordöstra Skåne and Blekinge has already highlighted the serious consequences of the psychiatric clinic in Kristianstad being closed at night. It significantly affects the police's work. One now has to devote an incredibly large part of their working time to perhaps treating only a single medical case. This, in turn, affects the possibilities to respond to other alarms and needs from the public.
I wonder, of course: Is this how we increase safety in society?
Socialministern Jakob Forssmed (KD)
Madam Speaker! I thank you for the questions.
When it first concerns the 6 billion, I would still like to point out that it is a large addition that is now occurring. If one were to compare it with when more general state grants are given to municipalities and regions, it corresponds to an addition of 20 billion, because 30 percent of that type of general addition goes to the regions. In context, 6 billion is not a small amount of funds. It is a large amount of funds.
Are they sufficient to cover a projected deficit? No. It will also require efforts from the regions to, among other things, increase the focus on core activities. If I have understood the matter correctly, the 6 billion that the government is now injecting corresponds to the funds that the Social Democrats have in their budget. Therefore, there is no difference, as far as I have understood it.
I share part of what Ewa Pihl Krabbe says about the importance of having a strong focus on mental health in society. However, I do not think the focus is sufficient. I believe that we need to mobilize significantly more parts of society if we are to be able to reverse the development.
I think we have said for far too long that it is a matter for the healthcare system to handle on its own. The healthcare system should do its part. It should have good opportunities to do so. But it will not be enough, and we need to work with the protective factors that exist – people should have good mental health, a meaningful existence, and community with other people.
Basic factors that favor mental health, not least in the lives of young people, need to be in place. It is about sufficient sleep, movement, and relationships, and about having someone to turn to so that there is someone who can provide compassionate support. This can complement, not replace, what the healthcare system provides so that the healthcare system gets the opportunity to treat the patients who are in need of healthcare interventions.
I cannot go into further detail regarding Region Skåne and the matters that the interpellor has set out here. But I can state that I know that there is the ambition to reopen during evenings and nights when a patient-safe staffing situation at the psychiatric emergency clinic can be achieved.
I also want to say that the government supports development work regarding psychiatric ambulances. It is extremely important to get more of them. This applies in terms of reducing the burden on the police, but above all for the people who are directly met. It is about the staff having a competence and knowledge regarding their situation, in contrast to the police, who do not have the training and capacity that the staff who travel in a psychiatric ambulance have.
I cannot say how Region Skåne should proceed. It is, of course, the one who ultimately decides on that. But we have a support for developing this type of activity. The activities I have visited that concern psychiatric ambulances, I find very promising and very pleasing and something that is worth continuing to work with.
Ewa Pihl Krabbe (S)
Madam Speaker! I fully agree with what the Minister for Social Affairs says regarding preventive work. Much more focus must be placed on it, especially when it concerns children and young people, in order to prevent them from developing mental health problems later on.
The Minister describes many measures that are underway for those who are in a mental health crisis. The regions have the primary responsibility. But at the national level, one must provide the conditions to offer care of good quality.
There are measures in several areas described in the response from the Minister for Social Affairs which are, of course, welcome. These include, among other things, a plan for competence supply issues and state grants for the development of pre-hospital emergency care for patients with mental ill-health and suicidality. Regarding patient safety, which I have also asked questions about, I have received the answer that Socialstyrelsen has been tasked to look into this.
All these measures are good. But it is here and now that measures are needed to guarantee that even patients with mental illness in Nordöstra Skåne receive the care they need. 600 evenings and nights without psychiatric acute care is enough! Thank you for the debate, Minister for Social Affairs!
Socialministern Jakob Forssmed (KD)
Madam Speaker! Thank you, the interpellor Ewa Pihl Krabbe, for the interpellation and the opportunity to discuss these important issues!
I would like to particularly thank the interpellor for highlighting relatives in this situation. They often receive insufficient support in connection with having a loved one affected by mental illness, psychiatric conditions, or other mental ill-health. It is important that we develop our support for these individuals.
I also want to highlight in this context that the government is working very actively with a broad strategy on mental health and suicide prevention. There, our goal is to mobilize more actors to counteract mental ill-health and to prevent suicide.
We also have the ambition to create an order where we learn better from the situations where people end up in such a situation that they perceive that there is no other way out than to take their own lives. It is not to point fingers but to learn, so that we can become better at preventing that type of situation.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.