Swedish user-run service with Personal Ombud (PO) for psychiatric patients.

Swedish user-run service with Personal Ombud (PO)for psychiatric patients.

The system with Personal Ombud or Ombudsmen (PO) for psychiatric patients is a Swedish innovation, which has grown out of the Swedish psychiatric reform of 1995. It came as a solution to a problem that existed, but which no one so far had any idea of how to handle.

A PO is a professional, highly skilled person, who works to 100 % on the commission of the psychiatric patient only. The PO is in no alliance with psychiatry or the social services or any other authority, and not with the patient's relatives or others in his surroundings.

The PO does only what his client wants him to do. As it can take a long time - sometimes several months - before the client knows and dares to tell what kind of help he wants, the PO has to wait, even though a lot of things are chaotic and in a mess.

This also means that the PO has to develop a long-time engagement for his clients, usually for several years. This is a necessary condition for developing a trustful relation and for coming into more essential matters. It is the total opposite to traditional services, where the psychiatric patient is either sent around from one person to another all the time, or has almost no support at all.

The PO is especially focused on supporting the psychiatric patients who are most hard to reach and who usually are left without support, because no one knows how to reach and how to help them. This means psychiatric patients with severe psychic disorders (mainly psychosis) and who are homeless or live very isolated and barricaded - and who are hard to communicate with or are very hostile towards authorities. And this means that the PO cannot sit and wait for them, but has to go out and try to find them in their place of living, and to use all kind of creativity in finding ways to get in touch with them.

To make this possible it is necessary that the PO is independent from all authorities. In some places in Sweden PO's are employed by the community, but that causes various troubles and makes it impossible for the PO to reach psychiatric patients who are suspicious or hostile against representatives of the authorities. There should be no suspicion about the PO having "double loyalties". An independent NGO as principal is to prefer.

An example of this is

PO-Skåne - Independent Personal Ombud. (= Personal Ombud in Skåne)

Skåne is the most southern province of Sweden. It has about 1,1 million inhabitants. One third of them lives in Malmö, which is the third largest city in Sweden.

Most of the PO's in Skåne are employed by PO-Skåne, which is an independent NGO run by the user organisation RSMH (The Swedish National Association for Social and Mental Health) and the family organisation IFS (The Schizophrenia Fellowship Association). Only local groups of RSMH and IFS can be members of PO-Skåne. At the annual general meeting representatives of these groups elect the board of PO-Skåne, who is the employer of the managing director and the 17 PO's. This means that the organisation is totally user-controlled and that the PO's are working according to the users' guidelines. Some of these guidelines are:

• The PO doesn't work Monday-Friday at office hours like most other services. The week has 7 days and each day 24 hours - and the PO must be prepared to work at all these various hours, because their clients' problems are not concentrated to office hours and some clients are more easy to contact in evenings and weekends. The PO has 40 working-hours a week and makes up a flexible working-scheme every week according to the wishes of their clients.
• The PO hasn't got any office, because "office is power". The PO works from his own home with the help of telephone and internet - and he meets his clients in their home or at neutral places out in town.
• The PO works primarily according to a relation-model. As many clients are very suspicious or hostile, or hard to reach because of other reasons, the PO has to go out and find them where they are - and then he has to try to reach them through several steps: 1. Making contact, 2. Developing a communication, 3. Establishing a relation, 4. Starting a dialogue, 5. Getting commissions. Each of these steps can take a long time to realize. Just to get contact can sometimes take several months. It could mean going out and start talking with a homeless psychiatric patient in a park or talking through the mail drop with someone who lives very 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. To get a PO from PO-Skåne doesn't involve any formal procedure. After a relation is established the PO just ask "Do you want me to be your PO?". If the answer is "Yes" the whole thing is settled.
• The PO should be able to support the client in all kind of matters. The priorities of the client are usually not the same as the priorities of the authorities or the relatives. According to 8 years of experience the clients first priorities are usually not housing or occupation, but existential matters (why should I live? why has my life became a life of a mental patient? have I any hope for a change?), sexuality and problems with relatives. A PO must be able to spend a lot of time talking with their client also about these kind of issues - and not just fix things.
• A PO should be well skilled to be able to argue effectively for the client's rights in front of various authorities or in court. All PO's of PO-Skåne have some kind of academic degree from the university or some similar education. Most of them are trained social workers, but some are lawyers and some have other specialised training.
• The client should have the right to be anonymous for the authorities. If he doesn't want his PO to tell anybody that he has a PO this must be respected. PO-Skåne gets money from the community for the service, but there is a paragraph in the contract that says that the PO could deny to tell the name of their clients to the community.

PO-Skåne started in 1995 as a project with 2 PO's. 2000 it became a permanent user-run service and today it has 17 PO's working full-time. The service is financed by the state to 2/3 and by the local community to 1/3.

For more information see www.po-skane.org (still in Swedish except this page) or
Maths Jesperson, maths.jesperson1@comhem.se
Member of the board of PO-Skåne.
Ann-Christine Engdahl Olesen, ann-christine.olesen@po-skane.org
Managing director of the organisation PO-Skåne.