How do some of the happiest people on Earth care for their mental health?

It is no secret that Sweden, and the Nordic countries in general, are known for their focus on, and acceptance of, mental health. But before we dive into how Sweden addresses mental health, let’s be sure we are on the same page in defining it. According to mentalhealth.gov,

Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood.

Over the course of your life, if you experience mental health problems, your thinking, mood, and behavior could be affected. Many factors contribute to mental health problems, including:

-Biological factors, such as genes or brain chemistry.

-Life experiences, such as trauma or abuse.

-Family history of mental health problems.

Now let’s dig into Sweden’s take on mental health.

Sweden has multiple ways to approaching mental health issues: prevention, treatment, and de-stigmatization. Let’s look at each one in turn.

Prevention

Most employers in Sweden offer their employees personal care benefits (Personalvårdsförmån) for wellness and exercise. This is known commonly here as friskvård, or wellness, and often is used to describe a wellness allowance. For this, employers offer employees an annual sum of money that the employee can use for different wellness activities. These activities include gym memberships, massages, physiotherapy, and acupuncture (find a comprehensive list here). The sum offered to employees ranges by employer, but seems to tap out at 5,000 SEK (~$600 USD) annually. 3,000 SEK (~$365 USD) is a pretty common allowance, but my employer has me at 5,000SEK. For context, this pays for about 10 months of unlimited yoga classes at my favorite local studio.

The employers are refunded for this money by the Swedish Tax Agency (Skatteverket). Essentially this means that some what I pay in income taxes comes directly back to benefit me. This is one of the things I love most about living in Sweden, and fear not, I’ll have a whole blog post on taxation in Sweden in the future. (Spoiler: It isn’t as bad as you think).

Friskvård is really meant to help employees maintain a focus on their health and wellness while working. It helps decrease burnout and relieves some of the financial burden that often comes with physical wellness, such as paying for gym memberships. Who wouldn’t want to cash in on some free money?

Many companies also offer a wellness hour to employees each week. Employees can take this hour at their discretion to workout, go to a therapy appointment, leave early on a Friday, etc. My partner splits his wellness hour into four 15-minute chunks and tacks them onto the end of his lunch hour four days a week. Instead of 60 minutes for lunch, he has 75 — just enough time for him to go to the rock climbing gym (paid for by his wellness allowance!) and get a workout in midday.

My employer offers me summer hours as a benefit, meaning from June 15th to September 15th I work from 8-16 (7 hours) without going down in pay. It is a wonderful perk!

Curious to know more about work-life balance in Sweden? Read my full post here. I also have a whole post on healthy habits seen all around Sweden.

Treatment

The friskvård does not cover psychotherapy, but the vårdcentral, or care centers, do. To take part in this service, you register a request with 1177.se, Sweden’s healthcare site. From there, a psychotherapist will reach out to you via phone and assess your mental health situation. Currently, in 2021, the mental health profession is highly under-resourced in Sweden and supply of available psychotherapists is low. This means that only the most critical of mental health situations are treated by the public health agency. For those that receive treatment, they only need to pay for sessions until their reach their high-cost limit (similar to a deductible in the US). This high-cost protection differs from county to county, but is typically around 1,200 SEK (~$145 USD) annually. Once you reach that amount, your care is free. One keeps track of their high-cost limit on their high-cost card (högkostnadskort).

If you are unable to receive mental health help from a vårdcentral, you can search for treatment privately. While some private clinics have agreements with the landstinget (the county council) and will honor a high-cost card, most do not. This makes private treatment quite expensive in Sweden, often about 1,500 SEK (~$182 USD) for a single consultation (1 hour).

If you are employed in Sweden and become “burnt out” at work, many employers here will offer you paid time off and cover the cost of a set number of psychotherapy sessions (maybe 5-10). While this is highly specific to each situation, it is great to know that getting help from your employer is often an option here.

If you are on a budget, need help quickly, or are not in need of in-person psychotherapy, then you might consider online therapy options. Mindler is a video call therapy service that is only 100 SEK (~$12 USD) per session. It is funded publicly and is available only to those with a Swedish personnummer (social security number).

An option that I personally have utilized was to visit a my university’s psychotherapy department. Many universities offer psychotherapy to their students for free, and also have options for the community for a small fee. As a student, you can visit a university psychotherapist for free on an individual session basis (rather than a reoccurring, consistent schedule). If you are looking for a longer term relationship with a psychotherapist as I was, consider seeing if a nearby university offers graduate student sessions for the length of their school term. In these sessions you meet with a graduate student that is working as a trainee psychologists for the university. While they are not yet licensed, it is a great option to find affordable help that is on a longer-term basis. Here is a link to Lund University’s resources of this type – which after using for the last year, I can really recommend.

De-stigmatization

Because there are so many resources available to people living and working in Sweden, and because employee wellness is widely discussed at the workplace, the topic of mental health does not carry the same taboo here as it does in the US. People here will easily share that they are on burnout leave from work, going through a workplace rehabilitation program, or leaving early to get some rest or sunlight. Mental health is just as important as our physical health, yet not nearly as talked about or promoted. I appreciate that Sweden is trying to spotlight it and provide support and resources to it citizens and residents. And the more we talk about mental health, the more normalized it will become.

One criticism I do have of Sweden’s stance toward mental health benefits and resources is that they are very focused toward employed citizens and residents. The prevention piece that I mentioned above highlights this exactly, as those are workplace benefits that protect mental health. This is somewhat ironic because it may be when you are unemployed and in an unstable financial position that you most need mental health support. However, it is the income taxes from that job that support the mental health benefits one can receive while working. Does Sweden have a perfect system and solution? Absolutely not, but it is a great step in the right direction to a happier and healthier society.

• According to Sweden’s Public Health Agency, the group which has the lowest risk of suffering from mental health problems is Swedish-born, heterosexual men with a strong financial situation. No surprises there, am I right?!

• We all have different mental health concerns, but I can personally attest to the effect being an expat has on one’s mental health. And I’m not alone in this opinion. I’ll go into being an expat in Sweden in future posts, but for now, check out this article: Foreign-born people in Sweden are more likely to experience mental health issues than native Swedes, a new report from Sweden’s Public Health Agency shows.
• The key takeaway is that foreign-born people are most likely to be unemployed and have a weaker financial position than native Swedes. And as I noted above, if you are unemployed you are missing out on a lot of wellness benefits.

• The Public Health Agency of Sweden
• mentalhealth.gov
• Personnel care benefits, exercise and wellness – Skatteverket
• Vårdcentral psychotherapy
• HEALTHCARE IN SWEDEN
• Lund University – Student health counselling
• Lund University – Psychotherapy office
• Rehabilitation in Sweden
• Foreigners experience more mental health problems than native Swedes: