Response to interpellation 2025/26:327 on crime prevention responsibility within psychiatric care
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
The debate concerns crime prevention responsibility within psychiatric care. KD believes that psychiatry needs to become better at assessing and implementing interventions for individuals who risk committing violent crimes 1. KD argues that psychiatry has been deprioritized and that the government is now allocating 1.5 billion per year for increased care capacity 2. KD wants to review confidentiality rules to improve cooperation 2, investigate how the compulsory legislation can be improved for better discharge 2, and provide staff with concrete support for risk assessments 3. KD wants to develop outpatient care and open psychiatric compulsory care 3, create common working methods between police, psychiatry, and social services 3, and carry out a co-morbidity reform 4. SD believes that deficiencies such as long care queues and lack of follow-up can lead to serious violent crimes 5. SD wants a legal text that defines a crime prevention mandate for psychiatry in cases of concrete stated risk for serious harm 6 and wants clear rules for information sharing between social services and police in cases of concrete threats 6. SD believes that the measures are important but perhaps not sufficient to prevent deadly violence 7. SD argues that it is crucial that the seriously ill receive care in proportion to their needs 7 and that murders that are acts of insanity should not be considered part of the issues surrounding men's violence against women 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)
Mr. Speaker! Clara Aranda has asked me several questions about how I and the government are working to ensure that psychiatric care receives a clearer responsibility for crime prevention work.
I would first and foremost like to thank Clara Aranda for her commitment to the issue of psychiatric care. I also want to highlight that the vast majority of people with complicated psychiatric and social problems never commit any acts of violence. However, several acts of violence in recent times where women have been killed or injured show that psychiatry, together with many other actors, needs to become better at assessing and implementing interventions for individuals who actually risk committing violent crimes and at preventing future propensity to commit violent crimes both in and outside of close relationships.
The Government is implementing extensive reforms and major investments to strengthen and develop efforts for mental health and suicide prevention.
Psychiatry has a special responsibility to make assessments of individual patients' danger to others in order to prevent acts of violence. Carrying out such risk assessments is acknowledged to be difficult, but we know that it occurs that risks are not detected and that interventions are therefore not adapted to the needs. Cooperation between different actors, including health and medical care, social services, and judicial authorities, also needs to be developed.
The government therefore decided last week on two assignments. One assignment, to the National Board of Health and Welfare, means that the authority shall carry out measures to strengthen and develop the support to the health and medical care in the work of preventing, assessing, and managing patients' risk of harming others (S2026/00227). The second assignment, to the Health and Social Services Inspectorate, consists of reviewing the work with assessments of patients' risk regarding future propensity to commit violent crimes in society (S2026/00228). That assignment concerns operations in psychiatric compulsory care and within forensic psychiatry.
The Government further intends to investigate how the psychiatric compulsory legislation can be improved to achieve a regulatory framework that meets the needs of patients, relatives, and society. Today, the gap between compulsory care and voluntary care is often too large and the transition too abrupt. Compulsory care is not stepped up and, above all, not stepped down. It results in short, recurring periods of compulsory care that do not lead to real improvement. The directives are being prepared within the Government Offices, and the Government intends to return to the issue.
Clara Aranda (SD)
Mr. Speaker! I would like to begin by thanking Minister for Social Affairs Jakob Forssmed for the answer to my interpellation. The background to this interpellation is fundamentally the fact that for a long time there has been a lack of clarity and deficiencies regarding psychiatry's mandate and the possibility of identifying persons with serious mental illness who pose a risk or danger to other people.
Last year, for example, there were many cases, both brutal and high-profile, where people fell victim to fatal violence and where it turned out that the perpetrators had a documented history of serious mental illness. I mean that it is time we bring the connection between fatal violence and mental illness to the surface. This is something that must be taken seriously.
As the Minister for Social Affairs points out, it is obviously the case that the vast majority of people with mental illness do not commit violent crimes. At the same time, it is also important to emphasize the fact that we must stop being afraid to tackle these types of difficult issues due to an overriding fear of stigmatizing people with mental illness. We must be able to see things as they are and act accordingly.
I am convinced that we agree on the deficiencies in psychiatric care. These deficiencies, for example long care queues and non-existent follow-up, contribute to creating worsened mental ill-health and to frustration and desperation among patients. This, in turn, can mean serious consequences such as suicide and serious violent crimes.
Mr. Speaker! The Crime Prevention Council has, in its own study, investigated the connection between lethal violence and mental illness. The results confirm what previous research has shown, namely that many perpetrators had been in contact with psychiatry before the crime. The study shows that it is seven times more common for perpetrators to have had contact with psychiatry in the year before the crime compared to the population at large during a calendar year. Four out of ten perpetrators who were involved in lethal violence between 2006 and 2017 had had at least one contact with psychiatry in the year before the crime, and as many as the sixth perpetrator had additionally been treated in a hospital for serious mental illness.
We can see how confidentiality rules hinder cooperation between actors who should collaborate, that the follow-up after various healthcare interventions is in many cases non-existent, and that there do not seem to be functioning tools to handle serious warning signs and threats of harm at an early stage. In fact, psychiatry with today's regulatory framework and resources clearly does not even in cases where the risks are completely obvious have sufficient opportunities to work on crime prevention.
At the same time, relatives testify to a sense of powerlessness, and there are parents who struggle for their children to receive care without anything happening. Therefore, it is relevant to discuss how today's legislation and resource allocation need to be changed so that psychiatry can counteract deadly violence and other serious crimes that can be linked to serious mental illness.
Mr. Speaker! The Minister for Social Affairs has commented on the fact that psychiatry has too little capacity and on the ongoing work to try to establish more intermediate care forms to ensure that people who are in need of care also receive care. It is good that work is underway to handle this and that the government, as recently as last week, as I understand it, gave the National Board of Health and Welfare and Ivo a mandate in connection with the issues that I raise in the interpellation.
Despite the fact that most things, in my opinion, point to the fact that psychiatric care in our country must be reformed fundamentally, this is in any case a good start.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Thank you, Clara Aranda, for the interpellation and for the opportunity to discuss these very important issues! I think the interpellator in their statement points out very many of the problems that psychiatry struggles with. I want to say that we are now making changes on virtually every point, and it is also absolutely necessary.
Psychiatry has been deprioritized by the regions for far too long, I think. Cuts have been made. Care beds have been closed down. Capacity within psychiatry has been reduced, and it is my absolute conviction that this has led to people now being treated for short periods, being discharged too early, and not receiving the care and help they need. The staff cannot do a sufficiently good job, and the operations are not being developed in the way that would be needed.
This is very serious, and that is why the government – even though this is the regions' responsibility – is now adding funds in the budget that we have worked out together with Sverigedemokraterna. We are adding 1.5 billion per year for a number of years to actually achieve an increased healthcare capacity. It is fundamental for psychiatry to fulfill its mission.
We are also investing particularly in what is called self-selected admission. When people with diseases and conditions that occur in flare-ups feel that they are heading towards a deterioration in their well-being, they should know that there is a place for them. It is a very good way of working that creates security. Sometimes it actually also leads to the fact that one does not need to use that place, because one feels a security in knowing that one will receive the care one needs on the day one needs it. That is something we are now investing extra resources in.
Then I think it is important to highlight precisely this that in many of the examples we have seen – even though one should be careful about drawing conclusions from individual cases – we see things that must be addressed. We see that relatives warn and alarm and sometimes succeed in getting the person admitted to psychiatry, i.e., into compulsory care. Then the person is discharged, and then relatives do not even receive information about this. The person is discharged to nothing.
It is the same thing when it comes to the Police Authority's possibilities to cooperate with psychiatry. The confidentiality rules that exist sometimes lead to staff, so to speak, stepping outside their professional role – so to speak, taking off their work clothes – in order to call the police as private individuals and inform them about things. So, that is not how it should be, and therefore we will review the confidentiality rules between psychiatry and other actors. It is about creating a situation where everyone who cares about these individuals can prevent them from ending up in situations where they commit the type of terrible acts of violence that we have seen recently. It is extremely urgent.
It concerns, in particular, the role of the relatives. They often feel that they take care of a large part of the care but are not really involved. One must remember that this is a very special patient group; they are admitted to compulsory care or full-time psychiatric care because they do not really have the capacity to manage themselves. Therefore, those who care for them must be given greater opportunities to do so in a good way, so that is what we must change.
Then we shall also review the laws on psychiatric compulsory care. We see, for example, far too small opportunities to discharge people in a more structured and better way. Often, one is either admitted at one hundred percent or receives zero percent care, and that does not work. We must have a discharge process or an intermediate care – something that steps in when one leaves full-time care. It is, after all, the goal that one should be able to do that, of course, but that requires significantly more than what we see today.
Clara Aranda (SD)
Mr. Speaker! I agree with the Minister on very much. I intended to continue developing my thoughts regarding what mission and responsibility the psychiatric care actually needs to have.
The Minister and I share the view that psychiatry's work with making risk assessments does not function purposefully. Because it does not, we need a legal text that defines a crime-prevention mandate, and it must apply in cases of concrete expressed risk of serious harm to others. That legislation can, in turn, give the care system an expanded opportunity to continue following up high-risk patients after discharge. This can, for example, occur with the help of scheduled contacts and outpatient plans.
Another completely decisive factor is clear rules for information sharing, which we have talked about. This concerns information sharing between social services and the police in cases of concrete threats, where there must be requirements for documentation. It is also important that the legal text specifies what the care is not allowed to or should do, in order to protect the patient from arbitrariness and unnecessary coercion. In addition, it is also completely fundamental that the primary mission of psychiatric care shall be care and risk minimization.
This is important to ensure that psychiatry remains a healthcare profession and to maintain trust in psychiatry. There are opportunities to create legislation that allows psychiatry to act in cases of clear risks, without compromising the patient's safety and rights, in order to be able to prevent, for example, serious violent crimes. Simply put, a new mandate and an expanded responsibility are needed without changing the core mandate.
Mr. Speaker! What I raise in my interpellation is not a foreign task for psychiatry. Preventive work is in line with the healthcare's existing mandate. Psychiatry's core mandate is to treat mental illnesses and mental ill-health and to minimize the risk of serious harm.
If a patient expresses an intention to commit a crime or exhibits behavior that could lead to harm, measures need to be taken. There must be well-functioning routines. Including crime prevention measures as part of the work within Swedish psychiatry can therefore be seen as an extension of the healthcare's basic mandate, with a particular focus on safety and security. This also places demands regarding the patient's long-term safety and rehabilitation, and beyond that, it can reduce suffering for both the patient themselves and for those around them.
Mr. Speaker! A formal crime prevention mandate would entail clear powers for psychiatry while both the responsibility and the requirements are expanded. I am pleased that we agree that cooperation between different actors – such as health and medical care, social services, and judicial authorities – needs to be developed. There is much we can do to ensure that psychiatry can fulfill its responsibility in an ethically, medically, and legally sustainable way. I look forward to seeing what the ongoing efforts will lead to.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! I thank you again for the opportunity for this discussion. It is very important that psychiatry becomes better at preventing acts of violence in society, and I believe that many different things are required for it to become so.
The first is what we are doing now, that is to review the possibility of making better risk assessments and examine how they are carried out today. How often are these types of questions asked? My impression after having spoken with many within the sector and the profession is that they are not asked to a sufficiently large extent.
The second point is about providing the staff with concrete support. Through a mandate to Socialstyrelsen, we are now establishing a national function to support the staff in making these risk assessments. We have also, via Statens beredning för medicinsk och social utvärdering, developed a basis so that they can become better. I believe it is very important, because even though this happens relatively rarely, it is very serious when it does. It is therefore necessary to provide the staff with better support in making these assessments in the best way possible.
At the same time, we cannot rely on the risk assessments. That is, 500,000 people come into contact with specialized psychiatry every year, and from evaluations and the research that exists, we know that there are also major deficiencies in the assessments that are made – even if they are done in the best possible way. They must, however, still be done, because it is significantly better to do them than not to do them. But that is why we also need the other things, for example, the follow-up. People should not be discharged into a no-man's-land where no one has responsibility for them just because they no longer meet the criteria for psychiatric compulsory care.
We want to look at how we can work more with what the interpellator also points out, that is, outpatient care – and also open psychiatric compulsory care. It is about people being able to, in a better way than today, for example, be required to follow medication or have certain healthcare contacts.
The investigation will also look at something that I think appears important to look at, and that is that with today's LPT we do not have the possibility of open psychiatric compulsory care before the person is admitted to full-time care. We therefore cannot use less intrusive measures, for example, ordering someone to attend certain medical appointments or take their medication, without them first having been admitted for full-time care. It does not appear to be the most expedient way to handle those types of measures.
We therefore need to be able to do more things in a better way and also create the common working methods between the police, psychiatry, and social services that today's secrecy legislation hinders. This, in turn, will be crime-preventing. It will lead to fewer being left at the mercy of the waves and fewer ending up in those situations where it becomes total chaos, which then affects people who happen to be in the wrong place at the wrong time.
It is therefore extremely important to do this, and I am very pleased with the commitment shown by the interpellant. I am also pleased that we are now taking these measures – and not least that we are allocating large resources so that it will be possible to provide psychiatric care in Sweden in a better way than we have seen until now.
I would like to say, however, that we are not sending out these funds to the regions indiscriminately. Each region needs to sit down with Socialstyrelsen and describe exactly in what way they intend to increase their capacity. It is about care beds, mobile teams, and other things to be able to carry out advanced psychiatric home care and to follow up much better than we do today.
Clara Aranda (SD)
Mr. Speaker! I agree in large part with everything that the Minister for Social Affairs highlighted here. These are very important and good measures. I do not know, however, if I can quite agree that they are sufficient. One must be able to have two thoughts in one's head at the same time. What I mean by that is that we need to do what is required to prevent innocent citizens from falling victim to deadly violence and serious crimes that we know could have been prevented with the right interventions. It is our responsibility to do so.
It is also absolutely crucial that those who are seriously ill receive care and treatment and that the interventions are in proportion to the actual need. It is not a question of which resources are available.
This is fundamentally about what kind of society we want. We have fresh survey data showing an increasing sense of insecurity in society. A significant proportion of Sweden's population, 57 percent, experience increased insecurity as a result of the crimes that have occurred recently. This insecurity is particularly evident among young women, not least with the crimes that took place during Christmas. It is completely understandable.
At the same time, I think it is important also in this context to emphasize what the Crime Prevention Council has stated, namely that it is not possible to view the murders that have now occurred as part of the larger issue surrounding men's violence against women, because in eight out of ten cases involving acts of madness, it actually concerns a man who has been killed by another man. Therefore, it becomes a bit misleading, I would say, when one tries to make this an issue of men's violence against women. It is, after all, important that we face reality and how the problems actually look.
Madam Speaker! I would like to thank you for this important debate and for the answers I have received. It feels reassuring nonetheless. The work being done is incredibly important, and I thank you for that.
Socialministern Jakob Forssmed (KD)
Madam Speaker! There are places in and around psychiatry in Sweden that are a kind of no man's land where people are left at the mercy of the elements and do not receive the help and support they need. They end up in a darkness, or chaos, which risks affecting people who are nearby. It can be in close relationships or outside of close relationships. It can be women or men who are affected by this. We need to do more so that these situations do not arise in this way.
In addition to all the initiatives we have taken and will take, I would like to mention an issue in this context that is very urgent. There are people who have a comorbidity between psychiatric conditions and addiction as well as substance use that can contribute to very large risks. We are now carrying out a comorbidity reform so that these people are not bounced between municipal and regional care and support interventions. Instead, there shall be a unified responsibility to provide those people with the right care and the right support. It is very urgent.
It is a major reform that we are implementing, but it is also incredibly urgent. We have seen far too many examples of people who have turned to psychiatry, who have told the person in question: You have an addiction; you need to turn there. When the person has arrived there, they have been told: You have psychiatric problems; you need to turn to the region to get help.
Now we are centralizing the responsibility for the care of these persons within the regions. I think that feels very urgent, both to help these persons in the best way and to reduce the risks of it affecting others in terms of violence, for example violence in close relationships, when they do not receive help.
I would like to thank you for the debate and for the opportunity to account for what the government is doing. I would also like to thank the interpellant for their wise input in this context.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.