Response to interpellation 2024/25:324 on forensic psychiatry
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD considers that forensic psychiatry is in a strained position 1 2 and that the quality of the discharge process must be improved to free up places 2. KD argues that the government is making historically large investments in psychiatry and suicide prevention 1 2 and wants the regions to prioritize these resources 3 2. KD advocates for state ownership of the care as a whole 3 and emphasizes the importance of developing discharge processes to increase accessibility 1 3. KD considers it urgent to improve the interventions for persons under the management of Kriminalvården 2 and that forensic psychiatry needs to be discussed more 4. S notes that there seems to be an agreement on the issues.
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! Sanne Lennström has asked me what future measures I intend to take to handle the situation within forensic psychiatry.
I would like to emphasize initially that healthcare, including forensic psychiatric care, is primarily the responsibility of directly elected politicians at the municipal and regional levels with taxing rights. At the same time, it is a fact that forensic psychiatric care is in a strained position. It is an issue that I and the government take very seriously.
To support the regions in the work of developing forensic psychiatric care, the government is implementing several measures. This involves both measures here and now and measures that are judged to have an effect in the longer term.
In the budget bill for 2025, the Government proposes continued reinforcements of health and medical care in the regions, including by extending the sector grant given specifically to facilitate the regions' economic situation. In the budget bill for 2025, the Government also announces a record-sized investment for mental health and suicide prevention, which amounts to 3.6 billion kronor for 2025.
The Government intends to, in accordance with established processes in the Government Offices, report back on how any funds to municipalities and regions within the framework of that initiative will be distributed during 2025.
To support the primary authorities in the development work, the government has also tasked Socialstyrelsen with strengthening and developing the psychiatric compulsory care and the forensic psychiatric care (S2024/01004). The assignment includes both support to the primary authorities regarding, among other things, improved discharge processes, which are an important part of increasing accessibility to forensic psychiatric care, and carrying out mappings and analyses to develop knowledge of forensic psychiatric care from various aspects, for example regarding occupancy rates. Such knowledge bases, which are based on facts about the current situation and development needs, are an important foundation for the continued work in the area.
In addition, the government has commissioned a parliamentary committee, the Healthcare Responsibility Committee, to prepare a decision basis that makes it possible to introduce a full or partial state ownership of healthcare in a gradual and long-term manner (dir. 2023:73). The assignment, which also includes forensic psychiatric care, shall be reported by June 2, 2025, at the latest. The committee's work will also be important for the continued development within the area.
I would finally like to take the opportunity to mention the national strategy for mental health and suicide prevention (skr. 2024/25:77) and the mandate to 27 agencies to coordinate, support, and monitor the implementation of the national strategy (S2025/00016) which the government presented on 10 January 2025. Through the strategy and the agency mandate, conditions will be created to develop the interventions for mental health and suicide prevention, including forensic psychiatric care.
The development within forensic psychiatric care is an issue that both currently and continuously ranks high on my and the government's agenda.
Sanne Lennström (S)
Madam Speaker! Thank you, Minister, for the answer!
Healthcare within forensic psychiatry is a specialized part of psychiatry that focuses on persons with mental disorders who have committed crimes or who pose a danger to themselves or others. Forensic psychiatric care is a combination of psychiatric treatment and security measures, and it is regulated by laws and guidelines aimed at balancing the individual's care needs with society's requirements for safety. The goal is that the patients shall afterwards have a functioning life in society.
In line with healthcare in general, forensic psychiatry in Sweden is, however, in a very strained position. The need for care places for seriously mentally ill persons who have been convicted of serious crimes has increased significantly in recent years. The number of persons within closed forensic psychiatric care increased by 9 percent in the autumn. The periods of care have also become longer.
This increased need is a direct consequence of stricter sentencing and other measures within the justice system, but while Kriminalvården's need for new prisons and detention centers has received significant resources, forensic psychiatry has not received the same attention.
Just as the Minister mentioned, it is the regions that are responsible for forensic psychiatric care, but many regions already have a very strained financial situation. The government's insufficient investments in care have led to several regions being forced to lay off staff and make cuts.
Region Uppsala is no exception. One is faced with a rapidly increasing number of people who have been sentenced to forensic psychiatric care, and in addition to this increase in people, the costs have also increased sharply over the last four years. As an example, the daily price for care regarding a patient one day was 6,259 kronor in the year 2020. Last year, the cost per patient and day had increased to 9,741 kronor in Uppsala.
The regions cannot themselves influence the increasing need for more forensic psychiatric care beds, and it is therefore a national issue that requires a certain national and state responsibility.
I thank the Minister for the answer and for that forensic psychiatry is something the Minister intends to have on his agenda now and in the future. It is needed. The Minister also mentions several different initiatives that have a direct or indirect effect regarding the forensic psychiatry that we are debating here today.
I would still like to dwell on the Care Responsibility Committee, which is to report on its work towards the summer. It is therefore about what and how much of the care should be a state responsibility. My question to the Minister is therefore whether he considers forensic psychiatry to be such a part where the state should take more responsibility than it does today.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I am not here primarily as a party representative but as a minister, but it is no secret that my party, Kristdemokraterna, considers that healthcare as a whole should be taken over by the state.
What has been agreed upon in the government is that we shall prepare a basis for a full or partial takeover of the care into a state ownership. The work is ongoing, and it is naturally extremely important to follow it. I look forward to constructive dialogues between the parties in that work.
Regarding forensic psychiatry, it is a very strained situation. There is a high occupancy rate. Previously, there have been greater opportunities to utilize capacity between regions when someone had vacant beds that could be used by another region. That possibility has decreased. At the same time, they are extremely skilled at ensuring that the situation is still managed.
It is clear that the situation is strained, just as the situation in psychiatric care in general. It concerns me. Now the government is making a record-breaking investment in psychiatry, mental health, and suicide prevention. It concerns 3.6 billion. Never before has a government allocated so many funds to this area. Therefore, I naturally want to see that the regions respond to this and do not deprioritize psychiatry. I think there are tendencies toward that sometimes. This is a patient group that is not always heard so much in the discussions, and it is important that they are prioritized in a good way.
Forensic psychiatry, of course, has specific challenges. It involves high security and, not least, the discharge processes. When people are discharged from forensic psychiatry, how are they received by the municipalities? Sometimes there are not so many such discharges to a certain municipality each year that there are sufficiently well-established routines for how to handle it in a good way. I believe we can develop that, because sometimes people who are actually ready to be discharged from forensic psychiatry cannot be discharged because there is no receiving capacity outside.
A person cannot go from being fully cared for within forensic psychiatry to receiving no interventions at all. It is not good in most cases. If they remain in forensic psychiatry, it means that new people who would need to be there – for their own sake and often also for the sake of the surrounding community – will not be admitted. In that way, the shortage of places increases. It is therefore an incredibly important area to work on. I look forward to taking part in the work that Socialstyrelsen is carrying out to develop exactly this.
I think that one can discuss the pros and cons of whether forensic psychiatry should be more of a state responsibility in relation to psychiatry. I do not know if the interpellant's view is that forensic psychiatry should be separated from the rest of psychiatry and become a state responsibility, while psychiatric compulsory care should continue to be a regional responsibility. They obviously have quite a few points of contact. It is often about people who have previously been subjects of psychiatric interventions. Psychiatric compulsory care is also forensic psychiatric care. There are, therefore, obvious disadvantages with that as well. The advantages could be that forensic psychiatric care is also a penalty and that the state otherwise has responsibility for the justice system.
There are, therefore, advantages and disadvantages to this. I naturally assume that the committee will highlight them in a good and clear way. But I can state that when the Social Democrats have had preparatory documents, they have chosen, among other things against the background of the views of referral bodies, not to proceed with proposals that make forensic psychiatry a state matter, in contrast to other psychiatry.
Sanne Lennström (S)
Madam Speaker! Thank you, Minister, for the answer! The reason I took the initiative for this interpellation debate is that I have been contacted by several regional politicians from different regions because the situation within forensic psychiatry is as strained as we have just described.
I have mentioned that the costs and the number of people in need of care have skyrocketed. Of course, it is the regions that bear the responsibility for forensic psychiatry today, but as I said, it has also been financially significant for these regions. And it is not only forensic psychiatry that is straining the finances for Sweden's regions. Healthcare has truly not received what I would call many resources.
The regions have had a strained economy for a longer period of time, which we Social Democrats have pointed out several times in this chamber. Naturally, that situation spills over onto forensic psychiatry. Forensic psychiatry is not an isolated island for which one could arrange good conditions. It is about the economy as a whole.
I share the view that increased penalties may be needed to stop the violence affecting Sweden, but that is not what this debate is about. The consequences of the increased penalties do, however, deserve some attention. The queue for forensic psychiatry hardly looks like it is decreasing. It is perhaps rather the opposite. There are examples in the regions of people who belong in forensic psychiatry instead taking up space elsewhere, perhaps in detention or within psychiatry. This leads to a displacement effect, which is very harmful.
I want to be clear that if you are convicted of a serious violent crime, for example, for forensic psychiatric care, that is where you should be. You should be within forensic psychiatry. That is the care you need and the care you are sentenced to. That is not how it looks everywhere today. It is very serious. It is serious because the possibility of achieving the goal itself – to try to ensure that people are reintegrated into society – is made very difficult.
Madam Speaker! We talk far too little about forensic psychiatry in this chamber and in politics in general. That does not mean the problems are not very large. The debate today is being held because the regions are struggling, but also so that those who need forensic psychiatric care receive good and functioning care in order to be able to return to society. Unfortunately, the problems within forensic psychiatry do not stop at poor finances for the regions and a lack of space. The Minister preceded me in mentioning the problems with the discharge process. That is because the municipalities do not have an outpatient care that functions. The overcrowding also creates very stressed staff, which leads to further problems.
This debate is about giving the regions a reasonable chance for better finances and a functioning forensic psychiatry. The state must step in and invest in better functioning healthcare. In this chamber, we have a responsibility for what the situation looks like within forensic psychiatry, even though the responsibility today lies largely with the regions.
It is time to give healthcare the right resources. The government's budgets so far have not been anywhere near that. Therefore, I ask the most fundamental question of all: Is the Minister and the government willing to give welfare and healthcare the resources required in future budgets so that the regions, including forensic psychiatry, can be in a better position?
Socialministern Jakob Forssmed (KD)
Madam Speaker! This government safeguards the welfare. We have added very large amounts to Swedish welfare during the recent years to protect important welfare activities. As I mentioned, the government is making historically large investments in psychiatry. No government has been anywhere near the 3.6 billion that we are now investing in mental health, psychiatry, and suicide prevention. It is just over 1.5 billion to Sveriges Kommuner och Regioner in an agreement that we are in the final phase of discussing. My view is that increased focus should lie on precisely forensic psychiatry and inpatient psychiatric care, where there are great needs to provide resources but also to develop the operations.
We are also investing 1 billion to increase accessibility within child and adolescent psychiatry. It concerns special development teams to strengthen and improve accessibility within both child and adolescent psychiatry and psychiatry in general. These are, therefore, incredibly urgent areas of development that the government and I are working very actively on.
I completely agree with the interpellor regarding the picture of the situation in forensic psychiatry. It is strained. We must work on improving the quality, not least in the discharge process, and free up places for those who need to be there. Those who have had the opportunity to be treated should re-enter society with the right support and the right help. That is something we must develop. It is very urgent, I think.
It is also important, as the government's security preparedness points out, to improve the psychiatric interventions for persons under the jurisdiction of the Prison and Probation Service. We have, after all, a high threshold for those who are there and who have a serious mental disorder. It is therefore important that more interventions reach those who are not within the scope of forensic psychiatry. It is also important for how the development looks moving forward.
I intend to continue working on this issue and will closely follow the Socialstyrelsen's mandate. I am not unfamiliar with further measures to strengthen forensic psychiatry. We naturally need to constantly look at the need for resources, but I also see, as I said, the importance of the regions prioritizing psychiatry. These are urgent areas. It is fragile, vulnerable people who are in these operations. Very much good work is being carried out here, and good care and treatment are provided. But it is also urgent that when the government now adds resources, the regions respond to this. I have no other opinion on the strained situation and the development needs that exist.
Sanne Lennström (S)
Madam Speaker! I thank the Minister for the two debates in the chamber today.
It is gratifying that we seem to be relatively in agreement on the issues themselves in both of the interpellations that we have debated. It is not always the case that we agree on the problem picture.
What the solution will be, we may perhaps return to when we approach the summer, when the Care Responsibility Committee is to submit its report. There is an opening.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I also want to thank you for the debate. I share the interpellant's view that forensic psychiatry needs to be discussed more. It can be developed in different ways, and it is important that we discuss this. I look forward to following the National Board of Health and Welfare's work in connection with the assignment it has received from the government.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.