Response to interpellation 2024/25:193 on the possibility of parental leave for older children with mental illness
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns the possibility of VAB (parental leave for childcare) for older children with mental illness. M argues that the government is implementing historical investments in child and adolescent psychiatry 1 2. M emphasizes that temporary parental leave is important 1 3 and that medical certificates are necessary safeguards against benefit fraud 3. M wants to take a holistic approach to parental leave 3 4 and sees the investigation proposals regarding interventions decided by social welfare boards as further steps 3 4. S argues that the requirement for medical certificates creates unnecessary waiting times, risks worsening the children's condition, and wastes doctors' time 5 6. S wants the proposals from the VAB investigation to be implemented 5 7 and is disappointed that the requirement for medical certificates is not scrapped 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.
Statsrådet Anna Tenje (M)
Madam Speaker! I have been asked if I intend to act so that mentally ill children older than twelve, who need their parents' help to be able to visit, for example, a psychologist, shall be able to do so without a medical certificate.
All children have the right to life, development, and the best possible health. We know that mental ill-health is increasing among children and young people. Mental ill-health affects individuals, families, and relatives through stress, anxiety, and grief. Therefore, mental health and suicide prevention is a priority area for the government. The government's work to ensure that those who need care can also receive it within a reasonable time requires both long-term and short-term focus as well as close cooperation between different actors.
During 2024, Madam Speaker, the government has implemented powerful initiatives in the area of mental health and suicide prevention. One example is an increased investment in accessibility to child and adolescent psychiatry, which includes 530 million kronor for 2024. It is a historic and record-high amount. For the coming years, the government has announced further powerful investments, which include, among other things, 470 million kronor for 2025 and 850 million kronor for 2026 and 2027 respectively to shorten the queues to child and adolescent psychiatry.
Such powerful initiatives are completely necessary to increase mental well-being and reduce the risks of suicide among the country's young people.
The temporary parental allowance is of great importance for parents and their ability to combine family life and work life. The benefit can today be granted in a number of situations, and the child's age is a factor that affects when and under what circumstances and conditions compensation can be granted.
A parent is entitled to temporary parental allowance for the care of a child who has turned 12 but is not 16 years old if it is proven that the child is in need of special supervision or care as a result of illness or disability. The special care and supervision need shall then be proven with a medical statement. If a child is seriously ill, the parent does not, however, need to submit additional certificates if Försäkringskassan already has sufficient documentation to assess the right to compensation.
The VAB investigation (S 2020:14), which has conducted a review of the rules for temporary parental leave, has among other things submitted proposals implying that dentists shall also be able to certify a child's need for a parent's presence and care, for example if the child has undergone a somewhat more extensive dental operation or similar. The investigation's final report (SOU 2022:31) Rätt och lätt - ett förbättrat regelverk för VAB has been submitted for consultation and is now being prepared in the Government Offices.
In the work with any potential changes to the regulatory framework, my starting point is that there must be a sensitivity to the fact that families look different and have different needs. It is a high priority for me to facilitate for families to make the puzzle of life fit together.
Åsa Eriksson (S)
Madam Speaker! I thank the Minister for the answer. The debate originates from a meeting at the Karolinska Institute to which I and the Minister's party colleague Caroline Högström were invited by the Insurance Medical Society. It was a very interesting and good meeting and a very good dialogue. We then received a joint message on this from several professions present.
Psychiatrists, psychologists and rehab coordinators testified about the major problems that arise for parents of older children with, for example, severe mental illness or disabilities such as NPF diagnoses. They must have a medical certificate to be able to take parental leave (vabba) when they are to accompany the children to visits with, for example, a psychologist.
The Minister says in her response that there must be a sensitivity to the fact that families have different needs. That sounds nice and good, but will the Minister do anything about it? The VAB investigation has gathered dust on her desk throughout the entire parliamentary term. As far as I know, none of the VAB investigation's proposals for changes are in the SD government's budget bill.
The problems with the requirement of a medical certificate to take time off work to care for older children are primarily two.
Older children with mental ill-health or disabilities are forced to wait to meet a psychologist or counselor if they feel so poorly that they cannot manage to get there on their own and need to have their parent with them - because they are forced to wait for an appointment with a doctor who can write a medical certificate. These children are therefore suffering unnecessarily, without receiving help.
Furthermore, their situation risks worsening. It concerns, for example, as the Minister mentioned, suicidal children. In the worst case, they may manage to act on their thoughts before they manage to get to a psychologist – it would be terrifying.
The requirement for medical certificates also consumes a lot of precious doctor's time unnecessarily. Both the Minister and I know that there is currently a shortage of doctors and psychiatrists within Swedish healthcare. That an available slot in the doctor's schedule should then be occupied just for issuing a medical certificate for a child who is unwell so that the parent can take parental leave is, I believe, very inefficient and a waste of society's resources in the form of precious and important doctor's time.
Madam Speaker! The VAB investigation proposes that parents of children between 12 and 18 years of age should have the right to temporary parental leave if the child has a special supervision or care need. Skipping the requirement for a medical certificate would help the families involved and save precious resources in healthcare.
I realize that this is not a question that lies at the very top of the Minister's agenda. It does not concern a huge number of children. But for the families it affects, this can be a matter of life and death. I therefore appeal to Anna Tenje to take up the proposals from the VAB investigation and review the requirement for medical certificates. Can the Minister promise the parents of children with disabilities or mental illness to present a government bill with the investigation's proposals?
Statsrådet Anna Tenje (M)
Madam Speaker! We are talking about very important issues here today. The interpellator himself touched upon the increased mental ill-health, which, if the youth in question is suicidal in the worst case, can lead to dreadful events.
It is also this that is the biggest and first problem we must start to combat. It concerns the growing mental ill-health - the social problem that is perhaps the highest priority right now. The Government also elevates the issue of mental health to a priority area, with powerful investments in both mental health and suicide prevention.
We have unfortunately seen an increased demand for both psychiatric care and other forms of professional help. Most evident is the increase within BUP. Since 2017, the proportion of children who have been in contact with BUP has increased by 35 percent. In the ages of 10-17 years, more than every tenth child has a psychiatric diagnosis, and 17 percent of all teenage girls have had some form of contact with BUP. Never before have so many children and young people been cared for by child and adolescent psychiatry as now.
This has obviously led to what the interpellator is pointing out: increased waiting times within both child and adolescent psychiatry and adult psychiatry. It is a development that the government now intends to reverse through the largest targeted investment in this area ever, so that it will function better both for children and young people and for their families.
We have also carried out major investments in primary care, the supply of skills, and the digital infrastructure within health and medical care, which may well be very useful to have when one might want to make simplifications and efficiencies regarding statements.
We have also carried out initiatives to increase the number of available healthcare beds and taken the initiative to establish a state national healthcare brokerage, which can make visible the available healthcare capacity between the regions and in this way shorten the queues.
In addition, we have allocated 1.6 billion SEK through an agreement with Sveriges Kommuner och Regioner during 2024, to among other things support the primary providers in the work of developing care for mental ill-health and shortening the queues for care. We are also carrying out, for the second year in a row, an intensified initiative on accessibility within child and adolescent psychiatry, which covers 530 million SEK for 2024 - a record-high amount.
The Government is also presenting a new ten-year national strategy in the area of mental health and suicide prevention, based on a basis from 26 agencies. The strategy is currently being prepared in the Government Offices and will be presented shortly.
This important work is about addressing the very root of the problem when it comes to care and interventions and the issue that the interpellor raises in their interpellation. But even the temporary parental leave is of great importance for parents and their ability to combine family life and work life. I will gladly return to this, Madam Speaker, in my next contribution.
Åsa Eriksson (S)
Madam Speaker! It was fortunate that the Minister had that concluding remark, because I did not hear a single word about abolishing the medical certificate requirement for parental leave when it concerns older children. I heard no promise to the affected families. I hope that it will be included in the Minister's next contribution.
Let me quote a mother of a boy. She testifies about how the requirement for medical certificates can hit, and writes as follows in an email to me:
"Our eldest son, who has high-functioning autism, was offered a consultation with a psychologist to understand his disability. Great. The psychologist was located in Borås. Public transport from our place of residence to Borås is largely impossible. I therefore take sick leave in order to be able to drive him. I ask the psychologist for a certificate. The psychologist refuses to write a certificate because she believed that the son certainly would take public transport. Despite my explaining to her why he could not take public transport and why I had to drive him, she refused. I lost a day's wages and felt so damn dismissed as a parent and as a human being. A day's wages may be small change for some, but for me, who worked within LSS, the loss was clearly felt in the wallet."
To the matter, Madam Speaker, that the psychologist, if it were not a psychiatrist, does not have the right to write medical certificates, so it would not have helped even if they had written a certificate.
We must, of course, have systems to combat fraud and abuse. But the severely tested parents of children with mental illness or disabilities do not need more obstacles to be able to help their children to a better life. If a child or a young person has anxiety or depression issues and needs support from the parent on any given day, as can happen, one must first go to a doctor to get a certificate before the parent can take leave. And the Minister knows how long it can take before one can get a doctor's appointment.
"Many treatments of children and adolescents are conducted with psychological treatment, for which the parents themselves need to arrange leave if they must accompany the child. Within healthcare, we have discovered that many parents have difficulty resolving this and their employers complain that they are not performing their work. Other employers protest because they feel forced to give these parents paid leave that others do not have a right to."
Parents need to be able to take parental leave (vabba), even after the child has turned 16 and without requirements for a medical certificate, in order to accompany their child to a practitioner for psychological treatment.
So, once again: Does the Minister intend to take the initiative so that medical certificates are not required for sick leave when it concerns older children?
Statsrådet Anna Tenje (M)
Madam Speaker! The right to temporary parental leave applies in a large number of situations when the child is ill or has a disability. Parents can, for example, receive temporary parental leave for the failure or illness of the child's regular caregiver, medical visits, dental visits, visits to the child health center, as well as participation in certain courses to learn how to care for the child. Compensation can also be granted in connection with the child's birth and adoption.
The main rules are, as we have discussed here several times now, that one can use the temporary parental allowance until the child has turned twelve. But in several situations, it is also possible to receive compensation even for older children. If the child, for example, is seriously ill and there is a danger to life, one can be granted compensation until the child is 18 years old.
It was reported in among others Ekot last week about increased claims of temporary parental leave for children of high school age. It often concerns extremely serious illnesses such as eating disorders and depression. It was also mentioned in the segments. That in those cases, confirming the need for care and supervision with a medical statement should not be impossible but is likely feasible, especially against the background that the government is now making historical investments in, among other things, child and adolescent psychiatry to assist and help just the affected young people, children and their relatives. One must also remember that when a child is seriously ill, the parent does not need to submit additional certificates if Försäkringskassan already has sufficient documentation to assess the right to compensation.
Our social insurance systems are largely built on trust and that individuals are honest and sincere in their applications. That is also how we have designed them to a very large extent. At the same time, we know that regarding the temporary parental allowance, 800 million kronor are paid out incorrectly every year. It can involve outright benefit fraud. These are no small sums.
Madam Speaker! This can, for example, be contrasted with the historical investment of 530 million kronor to bup, where the number of incorrect payments and grant crimes within vab alone is 800 million. Those who are entitled to compensation shall receive compensation. It is extremely central and important, but it is also important to ensure that it goes to the right and correct place and that we have safeguards in the system so that it is not exploited.
Madam Speaker! It is, after all, the case that 15-20 billion kronor annually are estimated to go to benefit crime and incorrect payments. These are funds that could have done very great good elsewhere, for example in child and adolescent psychiatry or, for that matter, as support for families affected by either mental ill-health or other diseases.
Recently, Minister Camilla Waltersson Grönvall received a memorandum from an investigation which, among other things, proposes that parents who participate in interventions in open forms decided by a social welfare committee for the purpose of supporting their child shall receive temporary parental leave. It is another step in the question of how the temporary parental leave can be used in an expanded way. It is also a question that I and the interpellor have discussed previously. We also have other questions.
Madam Speaker! My ambition is to take a holistic approach to this issue and return regarding changes in the temporary parental allowance.
Åsa Eriksson (S)
Madam Speaker! I note that the Minister also will not this time provide any promise to the affected families that she will take the initiative to scrap the requirement for a medical certificate for sick leave when it concerns older children. This disappoints me, and it surely also disappoints many others.
Madam Speaker! It surprises me that the Minister does not seem to trust the profession. Here we have psychiatrists, psychologists, and rehab coordinators who testify that the requirement for medical certificates for sick leave when it concerns older children causes great problems for the sick children, their parents, and the parents' employers. It steals valuable doctor's time that could have been used to treat and investigate children instead of issuing medical certificates.
I am disappointed that the Minister cannot provide a better report, but I guess that this is not a sufficiently high-priority issue for the Minister. If she can provide a promise in her final statement, I would very much like to convey it to the Insurance Medical Society and the parents who have contacted me.
Statsrådet Anna Tenje (M)
Madam Speaker! Thanks to the interpellor for the interpellation and this constructive debate!
As I said initially, the VAB investigation has submitted proposals to further expand the right to temporary parental leave so that parents can receive compensation for more situations compared to under the current regulations. The final report also contains proposals that enable, for example, dentists to be able to certify a child's special care and supervision needs.
As I mentioned at the end of my previous speech, Camilla Waltersson Grönvall has also received a memorandum from an investigation suggesting that parents who participate in interventions in open forms decided by a social welfare committee for the purpose of supporting their child should also be able to receive temporary parental leave benefits. This is precisely so that they can take their responsibility as a parent and be involved in the child's journey back. Those proposals are further steps regarding the question of how the temporary parental leave benefit could be used. We have previously here in the chamber also discussed parents who need to take leave from their jobs to instruct school staff if, for example, they have a child with diabetes.
Madam Speaker! My ambition is quite simply to take a holistic approach to the temporary parental leave benefit and see how it can be changed and used in many different ways so that it reaches even more parents and, above all, more children.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.