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26 May 2025 | Country Update
A national strategy for mental health and suicide prevention
5.11. Mental health care
Mental health care is an integrated part of the health care system and is subject to the same legislation as other health care services with the exception of compulsory and forensic mental care, which have separate legislation (see section 2.7.2 Regulation and governance of provision). While general public health is good and improving in Sweden, mental health deviates from this development. Costs related to mental illness were estimated to account for almost 5% of Sweden’s GDP in 2015, and almost one fifth of the population was estimated to suffer from a mental health issue if substance abuse and addiction are included. Out of the costs for society, 61% were direct costs for health care and social benefits and the rest were indirect costs such as consequences of ill health in the labour market (OECD/European Union, 2018). Of ongoing cases of sick leave in December 2021, just under half were due to a psychiatric diagnosis such as depression and anxiety (SIA, 2022).
There is a growing concern with mental health issues of children and adolescents. In 2021, around 6% of the population aged 0–17 years had been in contact with child and adolescent psychiatry, about one third of them for attention deficit hyperactivity disorder (Mission Mental Health, 2022a). There are a number of national initiatives in the area of psychiatry, mental illness and mental health with different objectives and target groups. However, because of short time horizons and varying objectives, coherent evaluation of the effect of interventions has been perceived as difficult (SOU, 2021:6).
The general areas of mental health care in Sweden are child and adolescent psychiatry, adult psychiatry and forensic psychiatry. Responsibility for most mental health care falls within the regions, such as PCCs, specialized care and child and adolescent psychiatry. However, many parts of mental health care also fall within the responsibility of municipality health care, such as care for elderly and people with mental disabilities, as well as treatment for substance abuse and addiction.
The first point of contact for most patients with mental health issues is primary care. There is concern about the lack of established structures for care and follow-up of mental health disorders within primary care, and knowledge support and national guidelines are often based on the logic and working methods of specialized psychiatry (SOU, 2021:6). At the same time, a majority of adults suffering from mental health issues such as depression or anxiety receive care within primary care, and only about 20% are referred to specialized psychiatry (NBHW, 2021c). There have also been issues with the coordination between primary and specialist care regarding patients with mental health issues concerning, for example, a lack of diagnosis and referral in primary care and coordinated planning (Läkartidningen, 2017). Clarifying the role of primary care in commonly occurring mental health care needs is also part of the reform “Good and close care” (see also Box5.3). For children and adolescents, first-line care can also be child and adolescent psychiatry and student health.
Box5.3
In 2021, approximately 5% of the adult population were in contact with adult specialist psychiatric care, the large majority as outpatients (Mission Mental Health, 2022b). The most common diagnoses in outpatient care were substance abuse and addiction, mood disorders, anxiety syndrome and hyperactivity disorder and behavioural disorders, although many patients lack diagnoses. Even more than somatic care, mental health care has become more outpatient directed over the past 50 years. There has been a large decrease in psychiatric hospital beds over the years. In 2021, there were about 34 beds per 100 000 inhabitants. In inpatient care, the most common diagnoses were abuse and addiction, psychosis, mood disorders and anxiety syndrome. In 2021, 21% of outpatient consultations and 3% of available hospital beds were in the private sector. There are also psychiatric emergency departments for adults and for children and adolescents. On average, about 2600 visits are made each week to psychiatric emergency care in the country (NBHW, 2020b).
Regions are responsible for mental health care, but the municipalities are responsible for the care of people with substance abuse. In practice, the shared responsibility has proven to be unclear and results in patients being referred away from psychiatric emergency departments to municipal addiction clinics, and vice versa, which creates issues in the care of people with co-morbidity of both mental disorders and substance abuse. A government investigation in 2021 proposes that the responsibility should be transferred to the regions so that one organization provides all types of care related to mental health issues, including harmful use and addiction. It should also be clear from the Health and Medical Care Act that treatment for harmful use and addiction must be coordinated with treatment for psychiatric conditions (SOU, 2021:93; 2023:5).
Digital consultations are becoming increasingly important for mental health care, for example e-health services, telephone services or traditional treatment methods offered via the Internet. Apart from traditional health care, a large number of associations and organizations offer advice and support free of charge run by volunteers for mental illness via chats and over the phone with different orientations depending on for example age and needs. Some of these are supported by government agencies such as PHA and NBHW, but also by the regions. There is a guide at the national service 1177 (see section 2.8.1 Patient information) with support lines sorted into different categories of mental illness.
Both nurses and specialist nurses play important roles in primary care’s work with mental illness. However, there are large shortages of specialist nurses in psychiatric care, and shortages are expected to become worse following expected retirements. Several regions also report a shortage of psychologists (see section 4.2 Human resources).
The government has introduced a national strategy for mental health and suicide prevention covering the period 2025 to 2034. Mental illness and suicide remain major public health and societal challenges. Through this strategy, the government aims to create conditions for coordinated, long-term efforts to promote mental well-being across all stages of life. The strategy focuses on promoting mental well-being, preventing mental illness and suicide, and improving the living conditions of people with various psychiatric conditions.
The goals of the strategy are
- Improved mental health across the entire population.
- Fewer lives lost to suicide.
- Reduced preventable and treatable differences in mental health.
- Reduced negative consequences due to psychiatric conditions.
To support the implementation of these goals, the government plans to present an action plan for the period 2025–26. As part of this, relevant authorities will be tasked with coordinating, supporting and following the strategy in collaboration with other involved organizations.