The acute shortage of space at forensic psychiatric clinics in Sweden has been ongoing for many years. Nationwide, occupancy is often above 100 percent; according to the most recent situation report, it was 109 percent, says Forssmed.
There are several problems, but a recurring problem is very heavy occupancy. This leads to consequential problems, such as people who should be admitted not being able to come in. Some are allowed to remain in the detention centre, some simply walk around the city. And that is a security problem.
Affects mainstream psychiatry
It is also difficult to maintain proper security when occupancy is so high, he says. In addition, there are crowding effects for regular psychiatry.
Some people who are sentenced to forensic psychiatric care take up places that should be for people in regular psychiatry, says Forssmed.
Furthermore, the current system, where the regions are responsible for forensic psychiatry, results in inequality in care across the country. The government has previously tasked the National Board of Health and Welfare with developing forensic psychiatry, and has provided funds to regions and municipalities to work more with discharges to free up places.
But that hasn't been enough, and now we are preparing for the biggest reform ever in forensic psychiatry, says Jakob Forssmed.
Healthcare Responsibility Committee
The investigation, which will be appointed on Thursday, will "analyze and propose how full or partial state responsibility for forensic psychiatric care can be made possible." Forssmed is taking as its starting point, among other things, the Healthcare Responsibility Committee from last year, which pointed out that the state needs to take greater responsibility.
Now we are appointing an investigation into how it should work, should the state take over completely, or partially? By partially, we mean taking over the financing of it, while the regions provide the places.
Both the Healthcare Responsibility Committee and the Swedish Association of Local Authorities and Regions have pointed to the risks of a complete state takeover, which could lead to forensic psychiatry moving even further from regular psychiatry. However, Forssmed sees that the current system is so flawed that a complete state takeover must be considered.
This is such a special type of healthcare activity, which is therefore a criminal penalty, that there is reason to investigate whether the state should take over responsibility completely.
Anyone who suffers from a serious mental disorder and commits a crime shall be sentenced to forensic psychiatric care. For most people sentenced to forensic psychiatric care, a so-called special discharge assessment (SUP) is also decided.
SUP means that the administrative court, not the chief medical officer, decides when a patient is discharged. In such cases, the court must make a comprehensive assessment of the person's situation, taking into account in particular the risk of recidivism.
In 2025, just over 1,900 patients were cared for in inpatient care under the Forensic Psychiatric Care Act, according to the National Board of Health and Welfare. Of these, 85 percent were men and 15 percent were women.
