What practices can we point to to respond to the challenges of mental health crises? How can we do this in a human rights compliant way?
We need practices so that governments and local communities can put human rights into practice. This is no where more evident than when it comes to mental health. People with psychosocial (mental health) disabilities are among the most discriminated against groups in society. This is reflected not just in the lack of services, or in the stigma faced by people with mental health problems, but also in laws, which apply discriminatory restrictions on their rights. Such restrictions are typically based on scientifically erroneous and unfounded views about risk but are often maintained because people with psychosocial disability are scapegoated as ‘dangerous’ by politicians and others.
But rather than focus on the problem we need to point to solutions. What practices are working? How can we use these practices to transform policy and practice?
In today’s blogpost we want to focus on an innovative supported decision-making practice from Sweden: the ‘PO Skåne’ program.
In its Handbook for Parliamentarians, the CRPD Committee described the ‘PO Skåne’ program in Sweden as a supported decision making program specifically for persons with psychosocial disability. Under the program, a legal mentor or personal ombudsman is judicially appointed to assist a person to make legal decisions. The PO Skåne English website states that personal ombudsmen must be ‘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.’ Personal ombudsmen generally comprise trained social workers or lawyers who must be able to ‘argue effectively for the client’s rights in front of various authorities or in court,’ as required.
The PO functions as a sort of legal mentor or personal ombudsman, and are often referred to as ‘assistants’ or ‘advocates’. The PO scheme is both social service and legal structure, and provides for a range of support relationships for people with disabilities and other disadvantaged people.
The defining features of the PO model, according to a report by the Swedish National Board of Health and Welfare report, are as follows:
- “The client’s experienced needs and wishes are in focus, not the diagnosis and the treatment;
- The work is based on the client’s health and his/her potential, rather than on symptoms, problems and limitations;
- The client chooses the PO, not the other way round;
- The client, and not the PO, sets the agenda and controls the process.” (pp.16-17)
A useful snapshot of the work of POs is set out in the same report:
After a stay in hospital, a client wanted to live in a flat of his own. Since this was the client’s wish, he was supported by the PO, while many other professionals involved with the client advised against it, saying that it would not work out. This in fact turned out to be the case: the client eventually moved into housing with special support and was very happy there. Professionals in the social services and psychiatric services thought that this was an unnecessary failure, while the PO’s view was that the reason why the client was so happy in the special housing was that he had been given the chance to live in his own flat. (p.14)
As well as providing a good practice from a human rights perspective, the scheme is reported to provide fiscal gains. The Swedish National Board of Health and Welfare report savings up to 17 times the cost of the service itself [pp. 23-24]. The saving is explained by a reduction in the number of crises and by the POs facilitative role in co-ordinating between services and highlighting weaknesses in service provision.
For a sense of the program you may wish to watch this short video that was created by Mental Health Europe.
This document has been produced with the financial assistance of the European Union. The contents of this document are the sole responsibility of PERSON (Partnership to Ensure Reforms of Supports in Other Nations) and can under no circumstances be regarded as reflecting the position of the European Union.