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Appendix 2 – Personal ombudsperson in Skåne (Sweden)

2020 Ethical issues linked to legal capacity and decision making (full report)

Information by Maths Jesperson kindly reproduced from (2015)[1]

A service which offers supported self-decision for persons with severe psychosocial disabilities

I will tell you a little about our service PO-Skåne, which is a concrete example of supported decision-making for persons with mental health problems of the most difficult sort (living entirely in a symbolic world of their own, living barricaded in their apartment or living homeless in the streets).

As the time is short I will make this presentation in brief paragraphs.

  • It’s hard to translate our Swedish word ‘personligt ombud’ into English, but I translate it here as ‘personal ombudsperson’ but will henceforth use the abbreviation PO.
  • A PO is a professional, highly skilled person, who works to 100 % on the commission of his client only. The PO is in no alliance with psychiatry or the social services or any other authority, and not with the client’s relatives or any other person 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.

The social model of disability says that the problem is not within the individual, but in the society which does not meet this person in such a way that he can function. This applies also to problems with legal capacity. It’s not a problem inside the individual – which should be met by forced intervention or guardianship – but society must relate in another way to this person, so that his disabilities regarding legal capacity diminishes.

Supported decision-making is an example of this. If some persons have heard to express and communicate their wishes, the solution is not to put in a guardian, but to develop a relation and ways, which make it possible for this person to express and communicate what he wants.

In our service with personal ombudspersons the most important thing has been to develop ways to work which are adjusted to this special group of persons with mental health problems of the most difficult kind. In other projects it is usually the clients who have to adjust themselves to a bureaucratic system, but we work in the opposite way. The PO’s have to be very flexible and creative and unconventional in finding ways to work with this group.

I will here give you some examples of conditions which we think are necessary if you really want to reach these persons and practise supported decision-making with them:

  • The PO doesn’t work Monday-Friday at office hours only. 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 to work 40 hours a week but 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 psychotic person 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 start getting commissions from his client.
  • There should be no bureaucratic procedure to get a PO. If a form had to be signed or an admission note was necessary, many psychiatric patients would back out and not get a PO – and it would probably be the persons 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 asks “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 kinds of matters. The priorities of the client are usually not the same as the priorities of the authorities or the relatives. According to 10 years of experience the clients first priorities are usually not housing or occupation, but existential matters (why should I live? why has my life become 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 kinds 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.
  • There should be PO’s of various ethnic backgrounds to secure that psychiatric patients of ethnic minorities also get PO’s. It’s hard to develop a personal relation if the PO and the client have language-problems. PO-Skåne has for example one PO who was born in Somalia (and raised in the United Arab Emirates) and one from Iran and one from Romania.
  • The client has 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.
  • The PO doesn’t keep any records. All papers belong to the client. When their relation is terminated, the PO has either to give all papers to the client or burn them together with the client. No paper and no notes will remain with the PO.



Last Updated: Tuesday 09 March 2021