Response to interpellation 2024/25:728 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 argues that the government has implemented extensive measures and invested more in psychiatry than any other government 1 2 3. KD has provided funds for more care beds, given agency mandates for better discharge methods and is preparing proposals on increased state responsibility for forensic psychiatry 3. KD believes that the state should play a larger role in the discharge processes 4 2. KD is also working on competence supply 3. S argues that the regions are underfunded and that the government has not provided sufficient resources to healthcare or forensic psychiatry 5 6. S believes that the state must take responsibility through increased resource allocation and structural changes 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)
Mr. Speaker! Eva Lindh has asked me what measures I intend to take to handle the strained situation within forensic psychiatry.
Initially, I want to emphasize that I, like Eva Lindh, take the challenges within forensic psychiatry seriously. However, I do not share Eva Lindh's view that the situation within forensic psychiatry is a result of the government not having allocated sufficient resources to health and medical care. I also do not share the view that the government has not compensated the regions in a difficult economic situation.
On the contrary, the government has implemented a large number of measures to support the regions as the primary providers of health and medical care, both regarding the development of health and medical care in general and regarding forensic psychiatric care in particular.
For 2025, the government allocates, for example, over 7.5 billion kronor to shorten healthcare queues and increase healthcare capacity. These are funds that, depending on the principals' priorities, can be used for, for example, efficiencies and to thereby increase healthcare capacity within forensic psychiatry.
Furthermore, the government allocates 700 million SEK through the agreement between the state and Sveriges Kommuner och Regioner in the area of mental health and suicide prevention 2025, specifically to strengthen, among other things, involuntary care and forensic psychiatry, both regarding care capacity and appropriate discharge processes.
In addition, the government allocates a further 450 million kronor to the regions during 2025 to increase the number of care beds for adults and the number of places for self-selected admission. These are funds that the forensic psychiatry will receive.
These investments, which are the first ever to have been carried out in this area, are important for strengthening forensic psychiatric care and supporting the regions in that development work.
The government is also working long-term to strengthen the conditions for healthcare, including forensic psychiatry, throughout the country. In June 2023, the government gave a parliamentarilly composed committee a mandate to review a full or partial state ownership for healthcare.
The committee, which adopted the name the Care Responsibility Committee, submitted the report Responsibility for Health and Medical Care (SOU 2025:62) to the government in June 2025. In the report, it is proposed that the state should take greater responsibility in a number of areas and for issues in health and medical care in order to create better conditions to meet the care needs, including forensic psychiatric care. The report has been sent for consultation until October 31, 2025.
I do not intend to precede the continued preparation of the matter, but I can summarize that forensic psychiatric care ranks high on both my and the government's agenda.
Eva Lindh (S)
Mr. Speaker! Thank you, the Minister for Social Affairs, for the answer to my question!
Those who suffer from a serious mental disorder and commit a crime shall be sentenced to forensic psychiatric care. But it is a very strained situation within forensic psychiatry. The need for forensic psychiatric care for those with serious mental illnesses who are convicted of serious crimes has increased. More people, therefore, need a place within forensic psychiatry. The increased need has been particularly clear in recent years.
The overcrowding and the long queues that are now affecting forensic psychiatry have devastating consequences in several ways. Patients sentenced to care for serious crimes can be left without necessary treatment, while at the same time patients who are ready for discharge are forced to remain in inpatient care due to a lack of resources in outpatient care. This leads not only to inefficient care but also to unnecessarily long deprivation of liberty in some cases. It has also led to the European Court of Human Rights criticizing Sweden for violations of human rights.
It is the regions that have responsibility for the interventions or the care within forensic psychiatry. But their possibilities to influence the inflow, that is, whether more patients come to forensic psychiatry, but also the outflow, that is, whether one is discharged from forensic psychiatry, are strongly limited. The regions can influence many other things, but they cannot influence that.
Several regions have allocated resources because they see that the situation is acute. Just a few weeks ago, a measurement was made of what the situation looks like within forensic psychiatry: The occupancy – the over-occupancy – within forensic psychiatry is 110 percent. That is, there are more people situated within forensic psychiatry than there are places available.
Several regions have, as said, been allocated resources. But they are in a very tough position. The Minister for Social Affairs and I do not share the picture of how things look within healthcare and for the regions as a whole. It became clear in the Minister for Social Affairs' response.
In my own home county, Östergötland, 900 fewer people are now working than a year ago. The economic situation for the regions also affects forensic psychiatry. And the regions' economic situation and their responsibility for forensic psychiatry and the entire healthcare system is dependent on the funding they receive from the sitting government and the majority in the Riksdag.
I and many others believe that the regions and healthcare are underfunded. I think it is enough to look at the figures from, for example, my own home region. But I visit healthcare facilities quite often and am increasingly stopped by people and healthcare staff, not just at home but everywhere in Sweden, who want to tell about the situation in healthcare today, with understaffing. It naturally also affects forensic psychiatry.
My question remains. What does the Minister intend to do about the situation?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Thank you, Eva Lindh, for raising this question! It is incredibly urgent to discuss the conditions for forensic psychiatry and the conditions for psychiatry in general. I have a concern that sometimes psychiatry is cut disproportionately much when changes are made.
The regions have had it tough with the high inflation, which has created a cost pressure for them. Now it is brightening significantly. It is very good. I accounted for the extensive supplements that the government has made so that we can get through this period of inflation.
I think Eva Lindh points out several things that I have also identified. Not least is the fact that the discharge processes absolutely do not function well enough. There are not sufficiently good cooperation agreements between municipalities and regions when it comes to discharge. People therefore remain, even though they are actually ready to be in other forms of care and support. That does not work. That is why we have concluded the agreement with SKR and made a specific initiative. In the discussions and the agreement with them, we have for the first time clarified this in this way. It is because we have identified the problem and want to do something about it.
It is the same thing with the assignment to Socialstyrelsen to develop methods and other things to support the discharge process so that it functions better. It is not always enough with more resources. One must also solve the structural problems that exist. I think that is incredibly important.
I am pleased that Eva Lindh and the Socialdemokrater are showing interest in the state playing a larger role in this area. I also believe that it should. Now we have a healthcare responsibility committee that has concluded that this is an area where the state should play a larger role going forward. Again: I will not anticipate the preparation of this. But it is clear that it is not difficult to see the arguments and motives for a future arrangement where the state would take a greater responsibility. Eva Lindh herself has touched upon it. Let us see what the preparation lands on and what comes in from referral responses and other things. I think this is very important to work on.
I have a couple of counter-questions for Eva Lindh. When Social Democratic governments have had preparatory documents to make a change and move forensic psychiatry from the regions to the state, they have chosen not to do so. Why has it not been done when such preparatory documents have existed historically?
The Social Democrats have also sat in power at times, but they have not made any investments in forensic psychiatry. I have tried to look but have not succeeded in finding any. Eva Lindh perhaps can inform me about which investments were made up until 2022 in forensic psychiatry?
Eva Lindh (S)
Mr. Speaker! I thank Minister for Social Affairs Forssmed for this contribution.
It is tough within the regions. The Minister himself also says that. It would be good if there is a brightening. A budget process is underway, and it is clear that we have high expectations. More money was needed for both regions and municipalities to strengthen psychiatry, forensic psychiatry, and all parts of healthcare, but also the opportunities for municipalities to do both the preventive work needed so that one does not end up in forensic psychiatry at all, and the work needed to be able to receive those who are discharged from forensic psychiatry.
More resources are needed. I agree that resources are not the only thing – it is also about what structures one has. But resources are not unimportant; they mean very much. If one does not have enough staff, it is crucial whether one gets more staff or not. Both resources and good structure are, of course, completely crucial. There are not enough resources, and this government has not provided sufficient resources to either healthcare in general, psychiatry and outpatient care, or forensic psychiatry. That is my firm opinion.
When I say that it is high time for the state to take responsibility, I really mean it. It is, as said, very clear that the forensic psychiatry cannot influence how many are sentenced to forensic psychiatric care. One also cannot influence that the municipalities have very great difficulty in receiving those who are ready for discharge.
But a greater state responsibility does not have to mean that the state takes over the entire responsibility for forensic psychiatry. I just want to point that out. The state can also take a greater responsibility through what we have agreed upon in the Swedish Riksdag, the so-called funding principle. When municipalities and regions are assigned greater responsibilities or when there are increased costs that the state can influence – and this is such an issue – sufficient resources are provided so that municipalities and regions can handle it. It is an important funding principle. It is also a state responsibility. Whether forensic psychiatry should be completely taken over by the state or not, we shall see. But the small thing that the government can do today is to provide sufficient resources.
Now we are at the time for the budget work. I understand that most of it is already done. But if resources are not added to healthcare, there is still an opportunity for the Minister for Social Affairs to influence there so that there are more resources for healthcare, which would also affect the conditions for forensic psychiatry, so that it can become better.
I think it is high time that the state takes its responsibility both through increased resource allocation and by conducting a review of what the Minister for Social Affairs is also involved in, that is, solving structural problems and reviewing what potential legislation may be needed. This problem is, in fact, completely acute. It is completely crazy that people who are ready for discharge remain when they could manage in outpatient care and get out. It is crazy that it looks the way it does – the recidivism rate risks becoming higher when it is so crowded that one cannot provide the care that is needed. It is also completely crazy that some of the people who are sentenced to forensic psychiatric care actually go free in society. Who bears the responsibility if something happens and someone commits a new crime?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! No government has invested more in mental health and psychiatry than this government does. One could say that it is too little, and it is always possible to do more. But no government has ever made more and larger investments in psychiatry than we are doing, including forensic psychiatric care. I have accounted for it, but it is thus 4.1 billion that we are spending on this during the current year. In the spring, we also added further funds for precisely more places. I see a concern that there are not enough places, both in forensic psychiatry and in other inpatient psychiatry, compulsory care and so on. There we see a great need to do more, and I am very eager for that.
I am also concerned that the gaps that arise when people do not receive help should be closed in a better way. That is why we have entered into this agreement with municipalities and regions – it should not be the case that one is forced to remain in forensic psychiatry when one is actually ready to leave it, or that people who are in other parts of psychiatry, in closed psychiatry, are sometimes discharged to nothing. I do not think that is sufficient. We must do significantly more than we have done until now. I am very pleased that we are now doing so and taking all these initiatives to change the life situation for people and, moreover, create a safer and more secure society.
I have already accounted for a good deal of these measures and for the extensive government mandates that we have now given to the authorities, not least Socialstyrelsen, to develop methods for forensic psychiatric care, discharge processes, and other matters. We have also just made a decision on an extensive supervisory mandate for Ivo, which, over a four-year period until 2029, shall carry out special efforts regarding precisely psychiatry, forensic psychiatry, compulsory care, and psychiatry in general to ensure that the response, methods, and so on are the best imaginable. This is not just traditional supervision but is also done so that knowledge can be fed back and we can work on how we can work better and become better in the operations we have. It is important to develop these things as well, I think.
I am pleased with this discussion and that we seem to have a greater consensus than before that the state needs to take a greater responsibility in healthcare issues and that this is an issue where the state can play a larger role. Let us now look forward to the proposals from the Healthcare Responsibility Committee being further prepared so that we can see what they yield.
Mr. Speaker! I note that I did not quite receive an answer to my questions as to why the Social Democrats, when they were in government, did not make changes to the organizational structure of forensic psychiatry with the preparatory documents that existed at the time, and also did not make any specific investments.
Eva Lindh (S)
Mr. Speaker! I understand that the Minister for Social Affairs would like to engage in historical talk about what happened before 2022 and what did not. That is not what I intended to do. We now have an acute situation in forensic psychiatry, and I think we need to focus on that situation here and now.
It is not true when the Minister for Social Affairs says that one has never given so many resources to healthcare. Allow me to be technical for a moment. The Minister for Social Affairs counts up very many so-called targeted government grants that are directed here or there. This is very problematic for both municipalities and regions.
I know that we fundamentally agree that we should have fewer targeted government grants and more general ones so that municipalities and regions can adapt them to what they need. On the whole, we Social Democrats are investing twice as many resources. We have largely done that all the time for health and medical care. It matters for healthcare in general, and also for forensic psychiatry, which we are talking about here, because it is the regions that have the responsibility for it.
What is happening is problematic, even though it is now being said that it is seen that there is a great need and that we need to do things within forensic psychiatry and psychiatry. Because it is full within forensic psychiatry, patients who should have been within forensic psychiatry are taking up places within outpatient care. It is also full there. These are very large demands, because the mental ill-health is great.
General preventive psychiatry must be strengthened. There we absolutely need more resources and better structure. But it is also important to highlight that it is a matter of the working environment for those who work within forensic psychiatry and a safety issue. We know that overcrowding puts a great pressure on the staff. It is also problematic here and now.
My question remains: What does the Minister for Social Affairs intend to do to handle the acute difficulties and challenges that forensic psychiatry faces today?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I have stated that no government has ever invested this much in psychiatry. It is worth emphasizing in this context. We have the agreement with Sveriges Kommuner och Regioner to provide 700 million kronor, among other things, to strengthen the discharge processes and specifically focus on the situations within forensic psychiatry, involuntary care, and inpatient psychiatry.
We added more funds in the spring precisely because we saw that we needed to secure more care beds in the area. Furthermore, we give extensive agency mandates so that focus is placed on developing better methods for discharge and developing forensic psychiatric care and compulsory care in different ways. In addition, we give extensive supervisory mandates.
We are taking a long series of measures to ensure that it works better. It is both about allocating resources and ensuring that it functions structurally better than it does today. Fundamentally, it is about people receiving the best possible care and treatment during the time they are locked up within forensic psychiatry and that we have a system that is as safe as possible for the general public.
There we can do more. It is a strained situation. That is why we are taking all these measures. In addition, we now have to consider the Vårdansvarskommitténs proposal on increased state responsibility for forensic psychiatry. A lot is happening in the field. It is very important, because it is an important area.
It is also, as Eva Lindh has pointed out, partly a bit of a communicating vessel with psychiatry in general. Therefore, it is also very important to make an effort from my side and the government's side, and we do that, but also from the regions' side, for psychiatry in general. There is a fair amount else to be desired.
The staff often do a heroic job. We see that, and we appreciate it. We work with skills supply and other things, and the regions also need to prioritize these issues.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.