Response to interpellation 2025/26:407 on comorbidity
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 is implementing historically large investments in psychiatry and addiction care to improve care for people with co-morbidity 1 2. KD emphasizes that the Government Offices' referral clarifies the regions' ownership and responsibility 1 3. KD intends to provide 400 million kronor annually during 2027–2031 as well as 1.5 billion kronor to increase capacity in adult psychiatry 1 2. KD considers it urgent to reform the system so that patients do not fall between the cracks 3 and that gaps must be closed so that people are not bounced around in an undignified manner 4. KD wants to investigate legislation for better cooperation between authorities 4. S argues that the system is fragmented and unclear 5. S considers the financing for the system change to be unreasonable 5. S argues that there is a lack of clarity regarding how money should be redistributed 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 the timeline looks like for the implementation of the comorbidity reform and whether I and the government intend to implement the core proposals from the Comorbidity Inquiry regarding a unified primary responsibility and a clearer responsibility for health and medical care. Eva Lindh has also asked me how I intend to ensure that new legislation for more uniform and coherent care for persons with harmful use and addiction and psychiatric conditions is implemented according to the intentions in the inquiry, as well as what measures I will take to ensure that people with comorbidity do not continue to fall through the cracks while waiting for the reform.
I would like to begin by thanking Eva Lindh for that the member highlights people with co-morbidity. For far too long, care has been lacking regarding these individuals and their relatives. It is also why I and the government have chosen to prioritize this issue highly in our work and are now implementing historically large investments in both psychiatry and addiction care.
On 26 February, the government decided on the referral to the Council on Legislation, "A more coherent care for persons with harmful use and addiction and other psychiatric conditions". The proposals in the referral to the Council on Legislation are based on the reports of the Comorbidity Inquiry (SOU 2021:93 and SOU 2023:5). Through the proposals in the referral to the Council on Legislation, the regions' ownership and responsibility for the care of persons with comorbidity in the form of harmful use or addiction and mental ill-health are clarified and strengthened. The responsibility between municipalities and regions is also clarified. The legislative changes are proposed to enter into force on 1 July 2027.
The Government intends to stimulate the proposed legislative changes with funding. In the budget bill for 2026 (prop. 2025/26:1), it was announced that 400 million kronor per year during the years 2027–2031 shall be allocated to municipalities and regions for this purpose. Furthermore, 50 million kronor are allocated for the current year for agency assignments or other interventions to support the primary providers in the implementation of the reform. Of these funds, the Government has already decided to give 35 million kronor to the National Board of Health and Welfare for an assignment concerning supporting the implementation of the reform (S2026/00382).
The proposals in the Government Offices' referral can be expected to mean that the regions take responsibility for the interventions that constitute health and medical care and for which the municipalities have previously in practice taken a large responsibility. The Government therefore makes the assessment that a general redistribution of resources from municipalities to regions needs to be made within the framework of the general state grants upon the entry into force of the provisions. The Government intends to return to the issue of calculations for this redistribution of funds but wants to emphasize that, overall, through the investment of 400 million per year, resources are added beyond the upcoming redistribution.
In addition to what has now been mentioned, the Government has also made a historic investment in adult psychiatry to meet the growing need for psychiatric care. In the budget bill for 2026, 1.5 billion kronor are allocated with a focus on increasing the care capacity in adult psychiatry.
The State has since 2024, through agreements with Sveriges Kommuner och Regioner, SKR, allocated funds to develop interventions for persons with complex needs, with a particular focus on comorbidity. For 2026, the government allocates 600 million kronor to the municipalities and regions for this purpose.
The Government has also, in June 2025, commissioned several national agencies to develop a national plan for improved addiction care (S2025/01284).
All the aforementioned measures are important to enable the reform and to ensure that those who need support and help, both for their harmful use and addiction and for their mental ill-health, actually receive it.
Eva Lindh (S)
Mr. Speaker! People with what we call comorbidity, that is, mental ill-health in combination with addiction, are among the most vulnerable in society. Today, they do not encounter a coherent care system. They encounter a system that is fragmented and unclear and which does not provide the care that is needed.
I myself have worked as a social worker for quite many years and seen what happens when the responsibility is unclear. People are bounced between psychiatry and addiction care. No one takes overall responsibility, and in the end, these people fall between the so-called chairs. We have systems that do not function well when people have several different difficulties to grapple with.
The investigation commissioned by the S-led government showed exactly this: The responsibility is fragmented. Compulsory care is more about custody than about treatment. There is a lack of a functioning link between care before, during, and after interventions. And that has consequences. People are discharged without support, and many unfortunately relapse. I have met quite a few recently, actually – some whom I have met in my profession and some whom I grew up with – who have both mental health challenges and addiction. They tell me how it looks and that they are worried.
We can sometimes believe that not all people are following the politics. But they are following. They know that an investigation has been conducted, and they also ask about this.
Care for this group requires something completely different than what we see today. It requires a coherent care chain, person-centered care, and a clear responsibility where the health and medical care steps forward.
This was not controversial. Nor has it been controversial. On the contrary, many of us have seen this. The investigation received unusually broad support from professionals, from researchers, from user organizations and from principals.
But the reason for my question, besides the obvious interest in this and that I really want to see something positive happen for this group, is that for every day that passes, it is another person who does not receive coherent support.
Since the investigation was completed some time ago and nothing has happened yet, it is important for me to ask the question: What is happening? The Minister for Social Affairs has mentioned the questions I have asked: What is the timetable, and what will happen?
During the time that has passed, reality has continued as before. People have continued to be bounced around. Relatives have continued to bear an unreasonable responsibility, and operations have continued to work in a system that works against them.
My questions concern partly what is happening and what the timeline looks like – I have read some, but there is an opportunity to elaborate on this in the answer – and partly what will happen moving forward. What happens with the financing?
Some of the criticism that has been received is that it is unreasonable. The financing is unreasonable when it comes to implementing such a large systemic change. How are we to distribute the money between municipalities and regions?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Thank you, Eva Lindh, for the interpellation and for the opportunity to discuss these important issues!
There are few things that engage me more than the shortcomings we see in Swedish psychiatry when it comes to people who end up in a kind of no man's land where they do not receive help. Wherever one turns, one perceives that one ends up in the wrong place. The issue of comorbidity is a central part of this.
That is why it is so urgent to reform in these areas, both when it comes to comorbidity – that is, people who have both harmful use or addiction and a psychiatric issue – and when it comes to ensuring that the regions take the responsibility they actually already have to provide coordinated care and treatment for these people. One should not have to be bounced around between different instances in the region or between municipality and region.
This is very urgent. Therefore, I also want to ask the member to be a bit careful with her words when she says that nothing has happened. We have just submitted a referral to the Council of Legislation where we clarify the regions' responsibilities. We are submitting legislation with requirements for regions and municipalities to cooperate regarding support and healthcare activities directed at the most vulnerable and fragile individuals. It is incredibly urgent to do this.
Furthermore, over five years we will provide funds so that the whole thing works in reality and so that we can also make some ambition increases. We have also decided on a major assignment for the National Board of Health and Welfare to help municipalities and regions make the trade-offs that are needed: Who should do what when we roll out this reform in practice, out in the operations? We must not again end up in a situation where we implement a reform that leads to new problems for these people. There must actually be conditions for this to work in practice. It is extremely important that we succeed with that task.
Now legislation is coming into place. Now the responsibility is clarified: It is the regions that have the responsibility both for coordinated care within the regions and also for care and treatment of both addiction issues and other psychiatric issues.
We are also legislating for a coordinated care and support activity, where we ensure that the most vulnerable do not end up in a no-man's land or between the chairs. It must not be the way it has been for a long time. For that has not been dignified. It has been deeply undignified and deeply problematic.
I know that many people, both those who are personally affected and their relatives, have struggled to get a reasonable order on this. Now we are trying to achieve it. I am very happy that we have now come this far. We will take this all the way to the finish, so that we give people an opportunity for a better life.
Eva Lindh (S)
Mr. Speaker! Yes, one must be careful with words. I said that nothing happened for quite a long time. That is my assessment, and it is also many others' assessment. There was an investigation that was finished. It had been out for consultation for quite a long time.
Even though the Minister for Social Affairs says that he has a great commitment, a long part of the mandate period has still passed without any clear proposal being presented. It is therefore not just me who has wondered about this. It is against this background that I said that nothing has happened for a while.
Now a proposal has been presented. But it is not particularly clear what it will exactly entail. The Minister for Social Affairs must nevertheless admit it. There is no clear proposal on how money is to be redistributed. The Minister for Social Affairs says that it will be done, but he does not say clearly how. It is also not clear exactly how the whole thing is to take place, as a new person has been appointed to lead the work. I have full understanding of this, because it is a huge systemic change. But the Minister for Social Affairs must understand that many are wondering what has happened during the mandate period.
This is about people. The need has been acute for a long time, and therefore political priorities are also required. I am asking my questions because there is a risk that we will make the same mistakes again if we do not collectively examine what is happening with this patient group.
Even though these groups, which are the most vulnerable in our society, have a great interest in what happens in politics, they are not as active when it comes to making contact or crying out for help or support. Therefore, we must be careful to see where priorities are needed most. This is a group that truly needs priorities.
One of the greatest frustrations for social workers is precisely when one encounters people with several different difficulties and problems. In those cases, one tends not to be so clear about who takes the primary responsibility. Here, one also ends up between two different systems, and it is not always so easy. Here, more coordination and more clarity were truly needed, as well as the systemic change that the investigation proposed.
The good thing about this is that we still seem to agree on what is needed. That is always good; it is like a good start. The Minister for Social Affairs says that he has a great commitment to people with mental ill-health, difficulties, and addiction. I do not distrust him in any way, but we know what the situation in psychiatry looks like right now. There is a risk. For example, the competence needs to be raised. It is already tough in psychiatry in different parts of our country. Does the Minister for Social Affairs assess that some competence reinforcements or other interventions are needed for this to truly become a good and successful change?
Socialministern Jakob Forssmed (KD)
Mr. Speaker! The needs of psychiatry are very great. That is why this government is now implementing historical and uniquely large investments in psychiatry. No other government has ever been anywhere near allocating the funds to psychiatry that we are now doing. Psychiatry has, for far too long, seen cuts. Places have disappeared. Capacity has decreased despite the fact that the needs have increased. It is unsustainable at the stage we are in and with the needs that exist. That is why we are now adding 1.5 billion to create more places in psychiatry and more places for voluntary admission, as well as to increase the possibility of expanding capacity.
We are now doing this in a multi-year initiative. It is incredibly urgent given the needs that exist. It is also, of course, about the possibilities for such a reform to function well in practice.
I am also glad that for five years we are allocating special extra funds to ensure that we actually manage to carry out a comorbidity reform in a good way and to stimulate what is needed in terms of skills supply and skills development in a good way.
Why has it taken some time? Well, that is because this investigation partially needed to be supplemented in light of the referral comments that came in. I believe Eva Lindh, who has studied the referral outcome, will agree with this. We therefore appointed a delegation specifically to work out this referral to the Council on Legislation and to continue working on anchoring the process. It has done a solid job of anchoring the content out in municipalities and regions. It will also continue to work on the changes that need to occur in the legislation – this concerns the compulsory legislation, which is very different today in the Act on Compulsory Psychiatric Care and the Act on Care of Substance Abusers. It does not function well enough today. We need to supplement and review this to make it function in a good way. No one is served by a reform that does not work in reality.
It is incredibly important that this vulnerable and fragile group of people, for whom we have not done enough, should get a better life and a better situation. That is what we are concerned about. That is why we have needed to supplement and work through the proposals properly in order to now be able to present the first parts of this – a plan for how this is to be done. Not least, Socialstyrelsen receives significant funds to also help with the practical work on the ground: What is to be done in which context for this to work in practice?
I think it feels very good that we, now that we are finally launching this, do it in a way that creates the conditions for it to actually be able to work.
Eva Lindh (S)
Mr. Speaker! I want to begin by commenting that we perhaps have somewhat different views on what sufficient resources for healthcare and psychiatry are and how it functions. In many parts of the country, the queues are very long and the difficulties are great.
But I interpret it as that the Minister for Social Affairs' assessment is that a reform will be launched where there is sufficient funding and sufficient resources allocated for skills supply. I really wonder if the assessment is that it will be so. It would be nice to hear.
Let me conclude – for this is my final speech – with what this is about. I am pleased that the investigation was initiated, that it was presented, and that there is strong support for this. I am pleased, even though I may think it has taken too long, that there is now a proposal in place. I believe it is good that there is also a delegation following this. I am a little concerned about whether the funding and the supply of competence will be sufficient. But what was really needed is to keep in mind which people it is about. We need reforms and improvements that meet the people who are particularly vulnerable in Sweden today, who have both mental ill health and addiction. They have, after all, been affected and fallen between the cracks for far too long.
Socialministern Jakob Forssmed (KD)
Mr. Speaker! Thank you, Eva Lindh, for an opportunity to speak about very important issues!
As I began with, there is far too much no-man's-land in and around Swedish psychiatry where people do not receive the right help and the right support. There are few tasks more important than trying to close these gaps and ensuring that people are not bounced around in an undignified way, where they do not receive help wherever they turn. It is about ensuring that we create the conditions for people to receive help.
The mental health reform, which we are now implementing, is an important step toward achieving this. But we need to do more than that. We need to ensure that we get legislation around psychiatry that actually works for people who need it, that works for their relatives, and that works so that psychiatry, social services, police – different authorities – can cooperate better to help, protect, and support people. The conditions are not there one hundred percent today.
But now we do this. We will investigate legislation that improves the opportunities. I am also pleased that we are allocating historical resources to actually improve the situation for those who may be in greater need of society's help than others. It feels very urgent. I am glad that we have come this far. We will take it all the way to the finish line and ensure that we get something in place that works better than it has historically. Because it has not been worthy. It has not been good. It has not been reasonable. Now we change this, and I am very happy about that.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.