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Demokratiskolan
The Mental Health card from MethodKit for Society and Politics
Card 70 of 128 · MethodKit for Society & Politics
  • AreaWelfare & health
  • Centre of gravityThe region
  • Points of influence3 on the journey
  • Decisive electionThe regional election
Welfare & health

Mental Health

Stress, loneliness & depression (or worse)

Stress, anxiety, depression and loneliness are among our biggest public-health problems, and the path to help goes through several systems at once. The region owns the care, from health centre to psychiatry, while the municipality meets how you feel in the school, the social services and housing support. How well it works is to a large extent decided in the regional election.

Where does the power lie?1

  • Municipality · pupil health, social services & housing support · approx 25 %
  • Region · health centre, psychiatry & child psychiatry · approx 45 %
  • State · laws, guidelines & oversight · approx 25 %
  • EU · small role, some coordination · approx 5 %

Care weighs heaviest, and it is governed by the region. For children and young people the municipality's pupil health also decides, so two elections share the responsibility.

How it works: the breakdown

The municipalityThe school & the support
The regionThe care · centre of gravity
Central governmentThe framework
Who decides?
The education committee, the social welfare committee and the pupil health team at each school.
The regional council (regionfullmäktige), the healthcare committee, the health centres, psychiatry and child and adolescent psychiatry (BUP).
The Riksdag, the Government, the National Board of Health and Welfare (Socialstyrelsen), the Public Health Agency (Folkhälsomyndigheten) and IVO.
What do they decide?
Pupil health with a counsellor and psychologist, the social services' support, housing support and outreach work among the young.
First assessment at the health centre, talking therapy, specialist psychiatry and child and adolescent psychiatry BUP.
The Health and Medical Services Act, national guidelines for care of depression and anxiety, suicide prevention and oversight.
Where are decisions made?
In the committees and in the school's pupil health team.
In the regional council and in the care services. The queues to BUP are a standing political question.
In the Riksdag and at the agencies.
Who pays?
The municipal tax: pupil health, the social services and housing support.
The regional tax, with targeted central government grants for mental health.
Central government grants to regions and municipalities for work on mental health.
Fastest way in?
Municipal election The parents' council, a citizen's proposal (medborgarförslag), contact with the committee's politicians.
Regional election Email to the committee's politicians, the patients' committee, the region's dialogues.
General election Referral responses (remiss), a complaint to IVO, involvement in patient and relatives' associations.
EUThe EU's role is small: some coordination of public-health work and research money. The decisive decisions are Swedish.

Read the table by column to understand one level, or by row to compare the levels. The green level is the area's centre of gravity.

How it works: follow the decision

The case A first conversation becomes the right support
  1. State

    The law promises care according to need

    The Health and Medical Services Act applies to how you feel too: care should be given according to need, and the care guarantee also covers mental ill-health. The National Board of Health and Welfare's guidelines point out which treatments care should offer.

    Point of influence

    The general election steers the law and the central government grants. New guidelines go out for referral (remiss).

  2. Region

    The health centre is the first line

    The first step is usually the health centre or a contact through 1177, for the young often a youth clinic. There an assessment is made, and many get talking therapy directly in primary care.

    Point of influence

    You can choose and change health centre. The patients' committee helps you if care falls short.

  3. Region

    The specialists take over

    If the first line is not enough you are referred to specialist psychiatry, for children and young people to BUP. How long the queues are depends on the region's budget and staffing.

    Point of influence

    The regional election decides psychiatry's resources. The waiting times are public and can be examined.

  4. Municipality

    Everyday support is built around you

    The municipality can provide housing support, occupation and the social services' efforts, and for pupils there is the pupil health counsellor at school. Care and the municipality should coordinate around the person who needs both.

  5. Your everyday life

    An appointment that comes back every Wednesday

    One conversation a week, a plan that holds and an everyday life that slowly brightens. The path there went through a law, a regional budget and a municipal committee.

The journey looks the same in reverse: what has been built came the same way, through the same decisions. Whoever knows where the decisions are made also knows where they can be changed.

Questions to discuss

  1. Why does it often feel easier to seek care for the body than for the mind, do you think?

  2. What should exist in your municipality for someone who feels bad but is not ill enough for psychiatry?

  3. The queues to BUP look different across the country. What would be a reasonable waiting time for a child who is struggling?

  4. What role should the school have for pupils' mental health, and where is the limit for what teachers should manage?

  5. What can neighbours, associations and workplaces do about loneliness that no agency can?

Glossary

BUP
Child and adolescent psychiatry, the region's specialist care for young people who are struggling mentally.
Första linjen
The first level of care for mental ill-health, usually the health centre or a youth clinic.
Boendestöd
Municipal support at home for someone who needs help to make everyday life work.
Elevhälsa
The school's combined team with a nurse, counsellor, psychologist and doctor.
Remiss
Healthcare's referral of a patient on to a specialist.

Go further

Footnotes

1) This is an estimate of how decision-making power over the issue is split between the municipality, the region, central government and the EU, based on how responsibility is divided in legislation. A teaching guide, not an exact measurement.