Suicide among foreign adoptees - an ignored tragedy

In Sweden, there are about 60,000 people who are adopted from other countries. This makes us the country in the world that has arranged the most adoptions in terms of population. The risk of suicide for foreign adoptees is greatly increased compared with the normal population, which has been demonstrated in several Swedish studies [1-3], where the relative risk increase is stated to be between 2.33 and 3.6. The risk is also significantly higher for eating disorders, obsessive-compulsive disorder and anxiety, inpatient care for alcohol and drug abuse and suicide attempts in foreign adoptees than in the normal population [4, 5].

When I started in psychiatry as an assistant doctor, I noticed that there was a clear over-representation of the patient group of adults adopted. Common to many was that they had a complex problem with several different and sometimes contradictory diagnoses, and that they were tossed between several levels of care and units. At the same time, there was no reception to refer patients to and no competence center to consult about further treatment. Neither during my education nor earlier in my professional life had I learned that adoptees abroad are an extra vulnerable and complex group of patients. Despite the unequivocal scientific evidence regarding mental illness in patients, there is a lack of specialist care and competence in adult psychiatry.

In 2017, I contacted a number of bodies: the Ministry of Social Affairs, the National Board of Health and Welfare, the Swedish Agency for Family Law and Parental Support, the Stockholm Region and the Swedish Agency for Medical and Social Evaluation (SBU). The intention was to sound the alarm about the acute and very serious situation in psychiatry for the patient group, with widespread and great suffering, lack of specialist care and largely non-existent competence in appropriate care and treatment. Responses and actions were completely absent.

Unfortunately, the situation is unchanged. In the absence of sufficient competence and "holistic thinking", patients adopted abroad are still moved around between different clinics without receiving adequate help based on the underlying trauma and shortcomings in early care.

The Swedish Agency for Family Law and Parental Support has procured special conversational support for adoptees [6], which is mainly offered via digital solutions. The conversational support is described as "a complement to the regular health care" and does not aim to medically investigate and treat illnesses and injuries. The agency's support is far from sufficient to provide adoptees with the care they need and are entitled to.

We can no longer passively watch when too many foreign adoptees end their lives prematurely each year, let down by the Swedish healthcare system. We need to set up specialist clinics and competence centers for adult adoptees. The Netherlands has recently decided to do just that, following a government inquiry into the need. Sweden must act before more adoptees take their lives. Behind every number in the statistics is a personal tragedy.

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