A new reform proposal for school health: what will it take to succeed?

Mental health problems among children and young people are on the rise, while Sweden’s school health and wellness teams struggle with chronic understaffing and an unclear mandate. Now that the government commission on improving school health has put forward its proposals, the question is no longer what needs to be done, but how it will be carried out in the everyday life of schools. On May 5, the Karl-Adam Bonnier Foundation gathered decision-makers, researchers, and key stakeholders for an in-depth conversation on the path forward.

Why this question matters

Schools reach every child. That makes the school health and wellness team one of society’s most important arenas for catching mental health problems early and giving young people the conditions they need to develop. When school health services fall short, students slip through the cracks, often with consequences that follow them well into adult life.

Schools also play a decisive role in shaping the talent of tomorrow. A well-functioning school where students thrive and reach their potential is therefore not only a question of individual well-being. It is a fundamental precondition for a competitive business community over the long term. That is precisely why broader societal development is increasingly in focus for the Karl-Adam Bonnier Foundation. A dynamic business community depends on a functioning society.

The seminar was held in partnership with the Karl-Adam Bonnier Center for Governance and the Center for Educational Leadership and Excellence at the Stockholm School of Economics.

The challenges today

Josef Milerad, Associate Professor at Karolinska Institutet, opened the evening with a historical overview that set today’s situation in perspective. Sweden’s school health services emerged around the turn of the last century as an ambitious public health project, drawing international attention. The Education Act of 2010 changed the field fundamentally: the health mandate was tied more tightly to academic outcomes, and the National Board of Health and Welfare’s national guidelines were replaced with a non-binding guidance document. In hindsight, Milerad argues, more attention should have been paid to what school health services were actually meant to do.

The numbers speak for themselves. There are roughly 32,500 high school students per school doctor, and around 450 students per school psychologist. Psychosomatic symptoms have risen markedly since 2010, and girls fare worse than boys. On top of this, 15.5 percent of every cohort leaves compulsory school without passing grades, with no systematic follow-up to understand why.

Resources alone are not enough

Rebecka Persson, PhD in Psychology, presented a new analysis of investment in school health services across the municipalities of the Stockholm region between 2006 and 2024. The pattern is paradoxical: as the mental health of children and young people has declined, per-student spending on school health has risen.

Drawing on a two-factor model that distinguishes between psychiatric symptoms and well-being, students are sorted into four groups. Just over half are in full health, while 6 percent are classified as severely affected and 17 percent as vulnerable. The vulnerable group is large and easily overlooked. These are students who are not in acute distress, but who are not thriving either.

The analysis shows that an increase of 1,000 SEK per student in school health spending reduces the severely affected group by 16 percent. Resources do have an effect, but the evidence base is thin when it comes to what actually makes the difference. What is it about school health resources that makes them work? And what does school health need beyond money?

The commission’s proposals and insights from the discussion

The government commission An Improved School Health Service (SOU 2025:113) proposes a broader mandate, more structured health check-ups with guaranteed access, clearer organization, better information for students, and strengthened training for school principals. The proposals point in the right direction, but implementation will determine the outcome.

Several themes recurred in the discussions. One concerned the clarity of the mandate itself: school health is interpreted in different ways today. Some equate it with the medical school health service, while others argue that the entire school staff is part of it. Participants raised the risk that resources flow to students who act out and make themselves heard, while quiet and introverted students remain invisible. They also stressed the importance of early intervention, since many problems are visible already in preschool. Staffing came up repeatedly: a school counselor available a few hours a week is not enough, and a regional back-up function was floated as a way to support schools when time or expertise runs short. At the same time, several participants pointed out that the talent shortage is itself an acute challenge as qualified staff are simply hard to find. Digital school health was raised as a viable option for small schools and rural municipalities. And throughout, the importance of strong school leadership was emphasized as a precondition for school health resources to translate into real impact.

For The Karl-Adam Bonnier Foundation, this is new territory. The Foundation’s seminars more often address questions of corporate governance, internationalization, and innovation. But a competitive business community depends on a functioning society, and the society and economy we build tomorrow are shaped in the schools we have today.