Response to interpellation 2025/26:240 on deficiencies in psychiatric compulsory care of children and young people
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns deficiencies in psychiatric compulsory care for children and young people. KD considers that the government is implementing powerful measures to improve care and strengthen legal certainty through national guidelines 1. KD argues that the children's rights perspective is important, that resources are allocated for increased accessibility 1 and that coercive measures should only be used when absolutely necessary 2. KD emphasizes that the regions must take responsibility to avoid compulsory care 3 and that capacity must be expanded to avoid people being left without support 2 4. SD argues that the development is not moving in the right direction 5 and that coercive measures often lack legal basis 5. SD considers that belt-slapping and segregation must be prohibited as they conflict with the Convention on the Rights of the Child 6. SD argues that belt-slapping can be phased out through investments in staff and training 7.
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! Clara Aranda has asked me what additional measures I intend to take to improve the psychiatric compulsory care of children and young people. She has also asked me how I and the government view the prohibition of the coercive measures of belt restraint and isolation being used on children and young people.
Furthermore, she has asked me if I will work to ensure that the child rights perspective is fully implemented in psychiatric care. She has also asked me how I intend to further follow up on the deficiencies that the Health and Social Care Inspectorate has presented regarding the psychiatric compulsory care of children and young people. Finally, she has asked me which measures I consider necessary to address what appears in the National Board of Health and Welfare's latest report on mortality after psychiatric compulsory care.
I would first like to thank Clara Aranda for her commitment to the issue of psychiatric compulsory care for children and young people. As Clara Aranda notes in the interpellation, children and young people in psychiatric compulsory care are a particularly vulnerable group. The care for these children and young people is also associated with great development needs, which has emerged in several investigations and reports.
The Government is carrying out powerful measures to support the regions in their work to improve psychiatric compulsory care for children and young people as well as for adults. As an example, it can be mentioned that the Government, as Clara Aranda mentions in the interpellation, has tasked the National Board of Health and Welfare with strengthening and developing psychiatric compulsory care and forensic psychiatric care (S2024/01004). The assignment includes, among other things, supporting the regions in the work to prevent compulsory care and compulsory measures, strengthening legal certainty, and developing the care and its content, including through national guidelines for children and young people in psychiatric full-time care and compulsory care.
The Government has further given a renewed mandate to the Health and Social Services Inspectorate to strengthen and develop the supervision within mental health and suicide prevention (S2025/01452). The mandate includes paying special attention to 24-hour care and compulsory care. Furthermore, the authority shall develop the work of returning knowledge from the supervision to support the regions and strengthen the cooperation with, among others, the National Board of Health and Welfare to ensure a purposeful and effective state governance based on knowledge. The children's rights perspective is an important starting point in this work.
The Government allocates for 2026, in addition, approximately 1.3 billion SEK through an agreement between the state and Sveriges Kommuner och Regioner, SKR, for mental health and suicide prevention, which among other things contains targeted funds to the regions to improve compulsory care and to prevent and counteract the need for compulsory measures.
The question of good care for children and young people with complex psychiatric issues cannot be solved solely with targeted interventions towards compulsory care; it must be met from several different sides. To strengthen the children's rights perspective, counteract compulsory care and coercive measures, and reduce the excess mortality among persons who are subject to compulsory care, a simultaneous focus on preventive and promotional work, a strengthened suicide prevention effort, an accessible primary care level, high-quality specialized psychiatric care, and a well-functioning highly specialized care for the most severely ill is needed.
To strengthen and develop this work, the government will carry out several powerful initiatives during the mandate period. Examples include that the government allocates 1 billion SEK in 2026 to increase accessibility to child and adolescent psychiatry and 100 million SEK in 2026 to develop care for eating disorders. At the same time, a targeted initiative is carried out on primary care's work with mental ill-health, and targeted funds are allocated through the agreement with SKR regarding mental health and suicide prevention to develop the preventive work for children and young people.
In the issue of coercive measures, restraint with belts, and segregation when it concerns children and young people, both I and the government are keen that measures are implemented to prevent and minimize the need for coercive measures, and that the coercive measures that need to be taken, for example as a result of danger to the patient's life or health, are carried out as gently and respectfully as possible.
In summary, psychiatric compulsory care for children and young people and for adults is high on my and the government's agenda. Now, the regions need to show that psychiatric compulsory care, which is a care that affects one of society's most vulnerable groups, is an issue that is placed high on the agenda even at the regional level.
Clara Aranda (SD)
Madam Speaker! I would like to begin by thanking the Minister for the answer to my interpellation.
It is very pleasing that the government and the minister are working so actively and purposefully with issues concerning mental health and suicide prevention. I feel reassured that these issues are being taken seriously.
With that said, I want to take a look back. It has now been more than five years since the legislation on coercive measures within psychiatric compulsory care for children and young people was tightened. The purpose was to strengthen the protection for children, limit the use of coercion, and ensure that the child rights perspective would have a clearer impact in care.
Despite this, we can state today that the development is not moving in the intended direction. Children and young people who are cared for under compulsion are one of society's most vulnerable groups. They have very small opportunities to influence their situation or assert their rights, and for that very reason, particularly high requirements are placed on legal certainty, knowledge, and respect for the child's best interests. Nevertheless, both supervision and reports show that these requirements are often not met.
The Health and Social Care Inspectorate has, within the framework of its government mandate, pointed out serious and recurring deficiencies in psychiatric compulsory care. Compulsory measures are carried out without clear legal basis, without correct documentation, and sometimes without sufficient knowledge of what actually constitutes a compulsory measure. Patients are not always informed about the right to follow-up interviews after measures have been carried out, even though these interviews are important for processing what is often a deeply traumatic experience.
Madam Speaker! During 2023, Ivo conducted a national inspection of compulsory psychiatric care for children and adolescents. Of 26 inspected operations, 21 had deficiencies. In eleven cases, the deficiencies were so serious that the healthcare providers were required to submit action plans. These are figures that clearly show that the problems are structural and not individual exceptions.
The report also shows that the risk of repeated involuntary care and suicide is elevated in this group, that young women are heavily overrepresented, and that – not surprisingly – there are large regional differences in how involuntary care is used.
The government has taken important measures, including through assignments to Socialstyrelsen. Against the background of the serious deficiencies that continue to be identified, my party nevertheless argues that more needs to be done.
One reason I have submitted this interpellation is the fact that IVO's supervision and the Socialstyrelsen's latest report point to a system where coercive measures are still used in a way that risks harming children and young people and where the child rights perspective does not achieve full impact.
When the rule changes were introduced in 2020, the purpose was to strengthen the protection and legal certainty for children and young people in psychiatric compulsory care. This was to be achieved through clearer separate regulations, limitations on how long compulsory measures may continue, increased requirements for documentation as well as follow-up and strengthened supervision. The Sweden Democrats welcomed these ambitions but were at the same time clear that the legislative changes were not sufficient. I therefore look forward to hearing how the Minister intends to proceed to strengthen the protection for children and young people in psychiatric compulsory care and ensure the children's rights perspective.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I share the interpellant's view that it does not function well enough and has not become good enough. The measures that can be implemented shall be implemented when it is justified, and not otherwise, and it is justified when there are extreme conditions and measures need to be taken to protect life and health, though well aware that the measures themselves have the negative consequences that the interpellant clearly points out.
I want to point out some things that we have done and are doing. Just a few months ago, we gave Ivo the most extensive supervisory assignment ever directed specifically at psychiatric care and the various operations working with mental health and suicide prevention, with a particular focus, among other things, on inpatient psychiatric care and coercive care. The reasons are those we have seen in previous reviews, namely that coercive measures are carried out without legal basis and sufficient documentation and follow-up in the manner the interpellor points out.
I would like to point out important things in the assignment we have given Ivo. It is partly about resources to be able to do this in a good way, and partly about returning knowledge to the operations on how they should do it. It is important not only to criticize and point out errors but also to work on how one can improve to avoid this happening in the future.
Now there is a better opportunity to do this, because we have also tasked the State Board for Medical and Social Evaluation to produce the best knowledge base for how one can work with alternative methods to avoid coercive measures as far as possible. This report has now been presented, and it is important for Ivo but also for Socialstyrelsen in the guidelines that are now being worked on for the psychiatric full-time care.
So, there is new knowledge here that needs to be spread, and the regions naturally need to take their responsibility and incorporate this into their operations.
An interesting study was released which, although it did not specifically concern children and young people, showed how many in Sweden have their first contact with specialized psychiatry under coercion and how much this differed between different regions. It is obviously a poor grade that so many in certain regions debut in psychiatry under coercion and that one has not been able to catch people who are suffering in other ways and at an earlier stage. The regions that did not fare as well in this review need to see how they can change their way of working and their methods to avoid coercive care.
Sometimes compulsory care is necessary to save the lives and health of the individuals concerned, but also because these individuals have a potential to harm other people. But we also know that compulsory care in itself and the measures the interpellor points to can lead to deteriorated well-being, and therefore one needs to be very careful in this work.
I am therefore pleased with the initiatives we have put in place, and I am convinced that they will make a difference.
Clara Aranda (SD)
Madam Speaker! The work currently underway is good, and important efforts are being made. But let me remind you that the UN Committee on the Rights of the Child has recommended that Sweden completely ban the use of belts and segregation of children. The Children's Ombudsman has previously agreed with this assessment and argues that these measures violate the Convention on the Rights of the Child, and this view is supported by the Sverigedemokraterna.
Despite the UN's recommendation, these controversial coercive measures are still used within Swedish child and adolescent psychiatry. Belt-slapping is one of the most intrusive coercive measures that exist. For children and young people, this measure can be deeply traumatic and cause long-lasting consequences.
As I mentioned earlier, the Sweden Democrats have the view that this should be phased out and have for a long time pushed for this to happen. The focus is particularly on patients under 18 years of age. At the same time as this happens, we want new methods of work to be implemented and resources to be added. This is not an isolated position but part of a broader work to improve psychiatric care, which we believe will reduce the need for coercion, strengthen legal certainty, and ensure that severely ill patients are treated in an ethical and patient-safe manner, which is not the case today when coercive measures are used in this way.
In summary, this interpellation debate shows why there is still a need to push for further measures within the psychiatric compulsory care of children and young people. This is also in line with the criticism and the recommendations provided by both supervisory authorities and several referral bodies.
Let me give a concrete example from my hometown Norrköping that shows why the issue is so relevant. This summer, both staff and patients in the psychiatry department there testified about serious violations and abuses. On one ward, patients were subjected to subordination through coercion. Testimony from patients showed that coercive measures were used as punishment when they did not obey the staff. It clearly appears that much depends on which staff members are working. Patients have received completely different treatments depending on who is on site, which shows that the care is not always characterized by consistency, legal certainty, or the best interests of the child.
It is completely unacceptable that coercive measures are in some cases used as punishment or in a way that can be described as an abuse of power. It means that measures such as belt-slapping cannot be considered safe even if the legislation allows them. That this is allowed to continue is both deeply problematic and worrying. Children and young people should never have to risk trauma as a consequence of arbitrary decisions or ignorance.
The legislative changes in 2020 were a step in the right direction because they entailed clearer rules, shorter time limits, increased requirements for documentation, and strengthened supervision. But the reality on the ground shows that this is not enough. If the staff's individual actions determine how coercion is used and if coercive measures are abused, it does not matter how strict the legal text is; the patient is still vulnerable.
Madam Speaker! I would like to know how the Minister views the serious deficiencies that I have described and which occur within psychiatric care in Norrköping but also in other parts of the country.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I thank Clara Aranda for this important discussion.
I believe that several things are absolutely necessary. The first is to expand the capacity in psychiatry so that there are sufficient resources, enough places, and enough space to provide good psychiatric care. That is why the government, in cooperation with Sverigedemokraterna, is allocating very large resources to both child and adolescent psychiatry and adult psychiatry. I view with concern that the capacity within these operations is not sufficiently good, which I believe can affect the quality of care through, for example, too short treatment periods. But it also entails other risks.
With this said, care needs to be conducted in a good way. One reason why I and the government have made decisions regarding Ivo's extensive supervisory mandate is precisely testimony and previous review of reports which show that there are deficiencies that need to be noticed and addressed.
One needs to work in a more systematic way to address these problems, and I am thinking particularly of Socialstyrelsen's ongoing work with national guidelines for full-time child and adolescent psychiatric care and the support to the regions regarding follow-up. It is important to do this also at the operational level. Now, work is also being done to develop a national educational concept and competence goals regarding psychiatric full-time care and involuntary care, and measures are being implemented to reduce the need for just coercive measures through support to the regions. I am convinced that this will contribute to improved care.
It is very important to develop healthcare and utilize the knowledge that exists to avoid these types of situations. At the same time, we can observe that the investigation that formed the basis for the changed legislation in 2020 did not entirely want to exclude coercive measures because it was seen that they can have a role to play for life-saving purposes and that the reference groups linked to the investigation did not want to do so. This also needs to be taken into account.
We are in complete agreement on the part concerning the fact that, from a supervisory perspective, we must work much more systematically and actively to ensure that coercive measures are only used when they are absolutely necessary, not on any other grounds or in any other forms or contexts. As the interpellator pointed out, the measures themselves entail risks for the patient.
Clara Aranda (SD)
Madam Speaker! Thank you, Minister, for important announcements in this matter!
Before the rule changes that I have now raised in the debate became reality, the bill Improvements for children within psychiatric compulsory care was on the Riksdag's table. At that time, it was actually two parties that, in their respective follow-up motions, had demands to phase out belt-slapping as a compulsory measure for patients under 18 years of age. Those were Sverigedemokraterna and Kristdemokraterna.
We believe that phasing out belt restraint is entirely possible. Iceland has shown this, for example. There, belt restraint is not used within psychiatry; instead, they have invested in staff presence, training in de-escalating approaches, and early individualized interventions. We can therefore state that safety has been maintained without children being strapped down against their will.
If Iceland can provide psychiatric compulsory care without the use of physical restraint, Sweden must also be able to take the important step of phasing out physical restraint, especially when it concerns patients under 18 years of age. My firm opinion is that it would also force psychiatry to use safer, more dignified, and evidence-based measures. Let us work together to make this a reality.
In conclusion, I want to highlight the important work that I believe the minister has carried out in this area so far during the mandate period, which is not much left of. Much has been done, and I think that is positive. It is very pleasing to see how issues of mental ill-health and suicide prevention are taken seriously, with concrete measures and an understanding that it is a long-term task. Thank you very much for that, and thank you for the debate!
Socialministern Jakob Forssmed (KD)
Madam Speaker! Thank you again, Clara Aranda, for an important and pressing discussion!
It is about vulnerable people who are in a very vulnerable situation. They are suffering greatly, and they are subjects of interventions that they have not consented to. It is a special situation that we need to handle with care.
Coercive measures are something that will be necessary, and the question then is in what forms they shall take. My view is that we must move away from what we have seen historically, namely that coercive measures can be resorted to in a way that is not quite compatible with the legislation. That is why we are now, among other things, increasing the supervision. We are developing guidelines and other methods that can function just as well. These shall be used to a greater extent – in that part, we are in complete agreement.
I am, however, not in a position to say here and now that we promise to submit a law to abolish coercive measures. I do not have that basis given the previous investigation into this issue, but I promise to work to ensure that they are reduced and only used when it is absolutely necessary.
As the interpellator pointed out, we have done a lot, but we will do more. Every day until the election, and preferably after that as well, we will continue to improve things for the people who are having an extremely tough time in our country. They do not receive the best interventions, I want to say, because psychiatry does not have sufficient capacity, because people do not work well enough, and because the staff do not have the best conditions. Sometimes people are not caught and are left at the mercy of the waves between different actors in society. That is not good enough, I think.
There is far too much no-man's-land in Sweden when it comes to psychiatric care. People are left without support and help, and this can lead to them ending up in an even worse situation where involuntary care eventually becomes necessary because one has not caught them and provided the right interventions at an earlier stage. This is something we must move away from. More actors must cooperate, work together and have a common way of working to help the individual person to a better life.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.