Carolina Klockmo

Important components to create personal working alliances with clients in the mental health sector to support the recovery process.

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs’ work; it was the only ‘tool’ they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client’s needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client’s recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.

Moving toward a recovery-oriented approach in the Swedish mental health system : an interview study of Personligt Ombud in Sweden

Introduction: Personligt Ombud (PO) is a Swedish version of case management (CM) which was established with the Swedish Mental Health Reform in 1995. The main purpose of POs is to ensure that people with psychiatric disabilities receive the services needed to live an independent life in the community and to coordinate these services. Studies have shown that POs provide more support than this and it was interesting to investigate this further. Aim: The aim of the study was to explore what supportive strategies Personligt Ombuds (POs) use in their work with the clients who have PO support. Method: To obtain extensive descriptions of strategies that POs use in work, POs from different parts of Sweden were chosen and asked to participate in the study and 22 POs agreed to participate. The interviews were conducted over the telephone. The interviews were transcribed and analyzed using qualitative content analysis. Findings: The findings of the study were reflected in a main category where PO could be described as a facilitator of an active changing process, where the clients make their personal changes in life, based on personal active choices. POs used several strategies, such as defining goals, acting to push the client forward, acting as mentors, strengthening the client and mobilizing external resources. Conclusion: Many of the strategies POs used are similar to strategies in recovery-oriented services and, in particular, in Strengths Model Case Management. However, there are strategies that POs could develop to be even more recovery-oriented. There is a lack of systematic review of the strengths of a client, and this could be solved by using an already existing assessment instrument like the one in the Strengths Model Case Management.

Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.

The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs’ experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories – freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs’ role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or ‘reflective teams’. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other ‘target groups’ who are in need of co-ordinated rehabilitation services.