Swedish Personal Ombudsman service (PO) for people with mental health problems

Summary

The Personal Ombudsman (PO) is a model for supported decision-making which is independent from all authorities. In Sweden, several independent NGOs are offering this service. A PO is a highly skilled person who works on the commission of the person needing services. The Personal Ombudsman helps his/her client with a wide range of issues, ranging from family-matters to housing, accessing services or employment.

Issue addressed

The model of Personal Ombudsman is based on relationship of trust. It is a long-time engagement for both the PO and the clients. It is a model designed mainly for people who are hard to reach, isolated or left without support.

Background information

The Personal Ombudsman (PO) System is a Swedish innovation which has grown out of the Swedish psychiatric reform of 1995.

Description of practice

The PO does not work Monday to Friday, or out of an office, like most other services. Although working 40 hours a week, the PO has a flexible schedule , adapted to the needs and wishes of his/her clients. The PO does not have an office, as coming to an office could deter clients from taking up by creating the impression that the PO is in a position of power. The PO works from his own home with the help of telephone and internet, and meets clients in their homes or at neutral places in town. The PO works primarily according to a relation model. As many clients are very suspicious, or may be hostile or hard to reach, the PO has to go out and establish a dialogue through several different steps:

1. Making contact

2. Developing a communication

3. Establishing a relationship

4. Starting a dialogue

5. Getting commissions

Each of these steps can take a long time to realize. Just getting in contact with a client can sometimes take several months. It could mean going out and talking with a homeless person with a mental health problem in a park, or talking through the mail drop with someone who lives barricaded. Not until a relation is established and a dialogue has started can the PO starts getting commissions from the client. There should be no bureaucratic procedure to get a PO. If a form had to be signed or an admission note been necessary, many psychiatric patients would back out and not get a PO – and it would probably be the patients who need a PO most. Geting a PO from PO-Skåne does not involve any formal procedure. After a relation is established, the PO just asks the client if they would like them to become their Personal Ombudsman. If the answer is a positive one, the assistance process can then proceed. The PO should be able to support the client in all types of issues. The priorities of the client are usually not the same as the priorities of the authorities or the relatives. According to experience, the clients first priorities are usually not related to housing or employment, but to existential matters, such as why should I live, why has my life become a life of a mental patient, is there any hope for change, as well as sexuality and problems with relatives. A PO must therefore dedicate a lot of time discussing such matters. A PO should also have sufficient skills to be able to argue effectively for the client’s rights in front of various authorities or in court. All POs of PO-Skåne have an academic degree and work experience. Most of them are trained social workers, but some are lawyers or have other specialised training. The client should have the right to be anonymous in front of authorities. Should the client wish so, the PO will not inform anyone in the community that he/she is working with a particular client.

Analysis

This model has been designed for people with psychosocial disabilities and is not “transferable”,  as it is, to people with intellectual disabilities. However, it contains a number of interesting features, which should be taken into consideration for people with intellectual disabilities. Also, because it is designed for people who are very isolated and have few or no relations at all, it is also interesting for people who have been institutionalized for many years, have lost family contacts or have been excluded from the community for long periods of their life. The important features we would like to highlight are:

  • PO Skane is not a professional from psychiatry or social services but a person who establishes a relation with another person and offers his/her support based on a relationship of trust.
  • it is based on a natural relationship and not a bureaucratic and administrative procedure – the PO provides support where the person needs and requires support.
  • it is not working as a traditional service or administration support with working hours, but it is simply available human support.
  • it is person-centered and completely independent from any authority or service.
  • the PO is also an advocate for the supported person.

 

The system has a number of limitations from the perspective of people with intellectual disabilities, mainly because it does not work with the community, the family and the other services supporting the person. However, we can imagine that the role of the PO could be combined with other types of services, ensuring that people are not isolated and are properly supported in the community.

Further reading: http://www.personligtombud.se/

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