Personal Ombudsman

1. Introduction

Version followed: the Swedish national personligt ombud (PO) model as defined by Förordning (2013:522) on state grants to municipalities running PO services (amended by SFS 2019:1094, in force 1 Jan 2020), Socialstyrelsen's Meddelandeblad 5/2020 and its December 2009 PO document, and Socialstyrelsen's 2025 and 2026 status reports. The user-run variant PO-Skåne (founded 1995 by RSMH-Skåne and other organisations of former psychiatric patients) is described wherever it differs (no offices, outreach, no forms). [source: Socialstyrelsen 2020; SFS 2019:1094; Socialstyrelsen 2009; CoE 2021; Zero Project]

What it is. The Personal Ombudsman (Personal Ombud) is not a therapy. It is a Swedish social-welfare service and, in Socialstyrelsen's words, a new social profession. A PO is a professional, often a social worker, sometimes a lawyer, with a health-care or other academic background. They work only on the client's commission, outside the line organisation of the authorities, so that adults with severe, long-term psychiatric disability get the care, support and services they want and are entitled to. The service began as one of ten state-funded pilots in 1995–1998, went national in 2000 and has had permanent grant funding since 2013. In 2025 there were 351 POs in 116 services, covering 252 of 290 municipalities, and they supported 10,561 clients. [source: CoE 2021; Zero Project; Socialstyrelsen lägesrapport 2025/2026]

How change happens. The change does not happen inside the person through treatment. It happens in the fit between the person and the welfare system. A trusted agent who stands wholly on the client's side does three things:

• turns the client's own wishes into concrete demands on authorities;
• coordinates the bodies involved so that support arrives in the right order;
• strengthens the client's own capacity, or egenmakt, to handle their situation.

The resulting access to housing, money, care and occupation, together with a stronger network, drives recovery. The PO also feeds the system failures it sees back to a steering group, so that individual cases change structures. Sweden's model is cited internationally (OHCHR, Council of Europe) as a form of supported decision-making that is an alternative to guardianship and coercion. [source: Socialstyrelsen 2009; SFS 2019:1094 §3; CoE 2021]

Who this guide is for. It is written for (a) a psychotherapist or other clinician working in Sweden who refers clients to a PO or works alongside one, and (b) a clinician employed as, or setting up, a PO or a PO-like service elsewhere. Oslo and Helsinki have PO services, according to Zero Project. Sections 4–5 describe what the PO does. Clinician-facing procedures that are not in the sources are marked [synthesis].

2. Framework

Eligibility (referral criteria). The client must be 18 or older and have a psychiatric disability with significant difficulty carrying out activities in several life areas. Their needs are complex and extensive, and they need long-term contact with social services, primary care, specialist psychiatry and other authorities. Eligibility is decided on need; diagnosis is not required. The 2009 document lists people with co-occurring substance misuse or homelessness, and people the system considers it "cannot help", among the typical sub-groups. The service is voluntary and is not a statutory right, so a PO service may decline or put people on a waiting list. [source: Socialstyrelsen 2020; Socialstyrelsen 2009; Göteborg leaflet]

Access. There is no formal referral procedure.

• Anyone may make contact: the client, a relative, social services, psychiatry, a user organisation, a landlord or the enforcement authority (Kronofogden).
• Municipal services may ask the client to apply themselves (Täby). PO-Skåne uses no forms at all and starts and ends contact verbally.
• Waiting lists were reported by 64% of services in 2025. Priority usually goes to households with children under 18, people at risk of eviction or homelessness, young adults, and people with needs but no other authority contact or network. The steering group decides priority rules.

[source: Socialstyrelsen 2009; SocialPolitik 2012; Täby manual; Socialstyrelsen 2026]

Phases. The 2009 document describes six phases. Täby condenses them into three overlapping phases: start-up, work and closure.

[source: Socialstyrelsen 2009; Täby manual; Göteborg leaflet]

Format and dose.

• Meetings: usually in the client's home, or in town or a café. PO-Skåne deliberately has no offices, because an office signals authority.
• First meeting: often two ombuds attend, for safety and so the client can choose.
• Caseload: about 15 clients per ombud per year (range up to 25). Contact is often long-term. Some leaflets describe help as time-limited.
• Session count: none is defined [uncertain: no published standard number of contacts].
• Availability: in Täby, phone and email on weekdays plus SMS and voicemail. PO-Skåne staff plan their 40-hour week flexibly. There was no organised weekend service at the time of the 2012 article.

[source: Socialstyrelsen 2009; SocialPolitik 2012; Zero Project; Täby manual]

Organisation.

• The municipality is responsible for the service, which sits within social services but should be organisationally and physically separate from it. 6 of 116 services are contracted to NGOs, such as PO-Skåne.
• A steering group (ledningsgrupp) is mandatory. It includes the municipality, the region's primary care and psychiatry, Arbetsförmedlingen and Försäkringskassan. Patient, user and relative organisations must be offered seats.
• The steering group receives the PO's system-failure reports. Its members should not themselves hold operational responsibility for the client's support.

[source: SFS 2019:1094 §5; Socialstyrelsen 2020, 2026; Socialstyrelsen 2009]

Training and "certification". No licence or certification is required to work as a PO, and there is no specific PO degree. Socialstyrelsen runs an introductory course. Grant applications must describe how training and supervision (handledning) will be provided. The 2009 core themes are:

• the role and its ethics;
• public systems and regulations;
• network and conversation methods;
• negotiation and conflict handling;
• law, legal certainty and confidentiality.

The national association YPOS organises a yearly conference. [source: Socialstyrelsen 2020; Socialstyrelsen 2009; Socialstyrelsen 2026]

3. Guiding principles

• The client is the commissioner (uppdragsgivare). Act only on what the client asks; take no initiative the client does not stand behind. Jesperson (PO-Skåne): the PO "only carries out what the client tells him or her to do". [source: Socialstyrelsen 2009; Zero Project]
• Represent the client and no one else. Do not act for relatives, the municipality, neighbours or psychiatry, even when they press you. [source: SocialPolitik 2012]
• Independent position (fristående ställning). Stay outside the authorities' organisation. Never combine the PO role with a social-services caseworker post; Socialstyrelsen flags this as a threat to independence. [source: Socialstyrelsen 2009, 2026]
• No authority, no decisions, no treatment. The PO makes no official decisions, gives no treatment under the Social Services Act (SoL) or the Health and Medical Services Act (HSL), and has no medical responsibility. The client applies for support, and the PO helps them apply. [source: Socialstyrelsen 2020]
• Not a substitute decision-maker. The PO is not a guardian (god man), administrator (förvaltare) or trustee. Support the client's decisions; never make decisions for them. [source: Socialstyrelsen 2020]
• Do not replace other services. Push the responsible body to deliver; do not quietly fill gaps yourself, although in practice this happens. [source: Socialstyrelsen 2009]
• Need, not diagnosis. Start from the client's experienced needs and possibilities. Help obtain a diagnosis only if the client needs one to access support. [source: Socialstyrelsen 2009; SocialPolitik 2012]
• Low threshold, minimal bureaucracy. In PO-Skåne there are no forms, no offices and verbal start and end, because many clients fear administration. In municipal services, record nothing in official files and do not register the client (Täby). [source: SocialPolitik 2012; Täby manual]
• Time for trust. Expect suspicion and build contact step by step: open a channel, build a relationship, start a dialogue, earn trust. [source: Zero Project]
• Consent before every contact. Contact authorities only with the client's consent. Share information with doctors and others only with consent. Represent the client only with a commission plus a time-limited power of attorney. [source: Täby manual; SocialPolitik 2012; Socialstyrelsen 2009]
• Values in the 2009 document. These are respect, attentiveness, a holistic view, a horizontal relationship, a focus on possibilities and health, a rehabilitative perspective and reciprocity. In practice: sit beside, not above; look for what works. [source: Socialstyrelsen 2009]
• Personal but not private. Closeness is the tool, and handling it requires reflection and peer supervision. [source: Socialstyrelsen 2009]
• Empowerment (egenmakt). Each piece of help should leave the client more able to act alone next time. [source: Socialstyrelsen 2009; SFS 2019:1094 §3]
• Build the network from day one. The aim is a network that can take over. Respect that many clients want few, lasting contacts. [source: Socialstyrelsen 2009]
• Make demands (kravställare) and turn individual cases into structural feedback. Report system failures to the steering group. [source: Socialstyrelsen 2009, 2026]
• Confidentiality. The PO has a duty of confidentiality. Records are returned to the client or destroyed when contact ends. [source: Göteborg leaflet]

4. Intervention inventory

The procedures below are those the PO sources describe. Clinician-side procedures for therapists who refer to or work alongside a PO appear at the end (4.17–4.19) and are marked [synthesis]. Example wording is illustrative unless quoted.

4.1 Low-threshold intake and first contact

• Purpose: Make contact possible for people who avoid authorities.
• When to use: For every new contact.
• Steps:
  1. Accept contact from anyone: the client, a relative, a landlord, Kronofogden, social services, psychiatry or a user organisation.
  2. If someone else made contact, reach the client directly and confirm that they want a PO, because the client must commission the work.
  3. Check eligibility against need (section 2), not diagnosis. If the person is outside the target group, guide them on to the right body; PO-Skåne describes this as "lotsar vi dem vidare" (we pilot them onward).
  4. Use no forms where possible. PO-Skåne starts verbally; some municipal services ask the client to apply themselves.
  5. Explain the queue and the priority rules honestly.
• Example language (illustrative): "I'm not from social services or psychiatry. I work only for you, and only on what you ask me to do. You don't need to fill anything in to get started."
• Watch for:
  • Whether the referrer's agenda differs from the client's. Name this openly and follow the client.
  • It is working if the client agrees to a first meeting on their own terms.

[source: Socialstyrelsen 2009; SocialPolitik 2012; Täby manual; Socialstyrelsen 2026]

4.2 Outreach and trust-building

• Purpose: Earn the trust of isolated, suspicious or poor clients before any task work.
• When to use: In phase 1, and again whenever trust drops.
• Steps:
  1. Meet where the client is comfortable: at home, in town or over coffee. Some services do outreach at housing projects and meeting places.
  2. At the first meeting, often go as two ombuds, for safety and so the client can choose which ombud they want.
  3. Listen to the client's own account of their situation without steering it towards services.
  4. Build contact in steps: open a channel, build a relationship, start a dialogue, earn trust.
  5. Show you are on their side through small, quick, concrete acts the client has asked for, delivered reliably [synthesis on "quick wins"].
• Example language (illustrative): "You decide what we talk about. If you just want to tell me how things have been, that's a fine start."
• Watch for:
  • Wariness, often about whether the PO can actually help. Expect it and do not push.
  • Trust can form quickly, and clients may tell a PO things they tell no one else. Handle that disclosure carefully.
  • It is working when the client starts naming what they want.

[source: Socialstyrelsen 2009, 2026; SocialPolitik 2012; Zero Project]

4.3 Client choice of ombud and formulating the commission (uppdrag)

• Purpose: Establish that the client directs the work and agree its scope.
• When to use: At the end of phase 1.
• Steps:
  1. Let the client choose their ombud, for example after a two-ombud first visit.
  2. Agree in the client's words what the PO is commissioned to do.
  3. Explain the limits: no decisions, no treatment, no money, no acting against the client's will, and no replacing other services.
  4. Explain confidentiality and what happens to notes at the end: returned or destroyed. In Täby nothing is entered in a case file and the client is not registered.
  5. Agree how the client can reach the PO: phone, SMS or email, and on which hours.
• Example language (illustrative): "So the job you're giving me is to help you get the housing-support decision looked at again, and to come with you to the meeting. Have I got that right?"
• Watch for: Commissions that are really someone else's wish, such as a relative wanting the client to take medication. Do not accept these.

[source: Socialstyrelsen 2009, 2020; Täby manual; Göteborg leaflet]

4.4 Needs mapping (kartläggning)

• Purpose: Help the client put their needs into words across all life areas.
• When to use: In phase 2, and again at re-planning.
• Steps:
  1. Start from the client's experienced needs. Many have felt that no one listened, so allow time.
  2. Use a needs-based (not diagnosis-based) structure. The 2009 document gives the Camberwell Assessment of Need (CAN) as an example, used without reproducing items here; local checklists or interview guides are also used.
  3. Cover the areas most often raised: authority contacts, finances and debt, health-care contacts, work, housing, daily structure, someone to talk to, and existential questions.
  4. Ask the client to rank the needs. The client's priorities rule even when social services would rank them differently.
• Example language (illustrative): "If we could sort out just one thing first, what would make the biggest difference to your week?"
• Watch for:
  • The PO's own priorities creeping in.
  • It is working when there is a short list the client recognises as theirs.

[source: Socialstyrelsen 2009; Socialstyrelsen lägesrapport 2025; SocialPolitik 2012]

4.5 Joint action plan

• Purpose: Turn the ranked needs into concrete actions.
• When to use: In phase 3.
• Steps:
  1. For each need, write down together what is to be done, who does it (client, PO or which authority) and by when.
  2. Put the actions on a timeline so they happen in the right order. For example, income must be in place before a housing application, and a medical certificate is needed before an insurance claim [synthesis example].
  3. Mark which actions the client will do alone, to build egenmakt.
  4. The client keeps the plan.
• Example language (illustrative): "You'll ring Försäkringskassan on Tuesday; I'll be there next to you. I'll ask the psychiatry clinic for the certificate if you're happy for me to."
• Watch for:
  • Plans that are too long. Keep them short and achievable.
  • Progress is shown by actions ticked off and by the client doing more of them alone.

[source: Socialstyrelsen 2009]

4.6 Consent and power of attorney (fullmakt)

• Purpose: Give the PO a legitimate mandate to contact authorities or represent the client.
• When to use: Before any contact with a third party.
• Steps:
  1. Get the client's consent for each contact. Only cooperation the client agrees to takes place.
  2. Where the PO is to represent the client, draw up a written, time-limited power of attorney that names the body and the matter, for example contact with social services.
  3. Share information with doctors and others only with consent.
  4. Renew the power of attorney when it expires or the matter changes, and let the client withdraw it at any time [synthesis on withdrawal].
• Example language (illustrative): "This paper lets me speak to the social-services office about your housing support, for three months. You can tear it up any time."
• Watch for: Agencies refusing to talk to the PO without a power of attorney. Prepare it in advance.

[source: Socialstyrelsen 2009; Täby manual; SocialPolitik 2012]

4.7 Practical help with applications, appeals and complaints

• Purpose: Make sure the client actually applies for, receives and if needed contests support.
• When to use: In phase 4. This is the most common work: authority contact for 53% of clients and finances for 41%.
• Steps:
  1. Help the client complete applications and forms. The client is the applicant.
  2. Help with requests for review (om­prövning), appeals and complaints when decisions are unfavourable. One example is appealing a housing-support decision.
  3. Help with practical problems, such as a benefit paid into the wrong account, applications to charitable funds, debts or a dental bill.
  4. Help with digital barriers, such as access to BankID and e-services.
  5. Help clients with children apply for parenting support, and check that a child-rights perspective is applied. The PO does not work directly with the children.
• Example language (illustrative): "The decision says no. You have the right to ask for it to be reviewed. Do you want to? I can help you write it."
• Watch for:
  • Doing it for the client when they could do it with you.
  • It is working when decisions change and the client knows the route for next time.

[source: Socialstyrelsen 2009, 2026; SocialPolitik 2012]

4.8 Accompanying the client to meetings and debriefing afterwards

• Purpose: Support the client in meetings with psychiatry, social services, Försäkringskassan and other bodies, and prevent misunderstandings.
• When to use: For any meeting the client finds hard.
• Steps:
  1. Before the meeting, agree the client's goals and what role the PO will play: silent support, prompting or speaking.
  2. In the meeting, keep the client's agenda on the table.
  3. Afterwards, go through what was said and decided in plain language.
  4. Clear up misunderstandings that arose because the client was anxious or suspicious. The 2012 article notes this builds trust on both sides.
• Example language (illustrative): "Before we go in: what's the one thing you want them to hear? Do you want me to say it, or remind you?"
• Watch for:
  • Professionals addressing the PO instead of the client. Redirect them to the client.

[source: SocialPolitik 2012; Socialstyrelsen 2009]

4.9 Network and coordination meetings (the "broker" role)

• Purpose: Get the authorities to cooperate around the client's wishes, and get support delivered in the right order.
• When to use: When several bodies are involved, contributions are uncoordinated, or the client is "falling between chairs".
• Steps:
  1. With the client's consent, invite the relevant bodies to a network or coordination meeting. These may include social services, psychiatry, primary care, Försäkringskassan, Arbetsförmedlingen, probation services or a school counsellor.
  2. Prepare the client's agenda with them beforehand.
  3. Where the client wants it, take part in a samordnad individuell plan (SIP, the statutory coordinated individual plan).
  4. Make sure each body leaves knowing its task and deadline.
  5. Afterwards, follow up with each body "like a lobbyist" until the agreed contributions arrive.
• Example language (illustrative): "Anna wants to move into her own flat by spring. What does each of you need to do, and by when?"
• Watch for:
  • Meetings that end without named responsibilities.
  • The PO being treated as the coordinator who takes over the bodies' duties.
  • It is working when contributions start arriving in sequence without the PO chasing every step.

[source: Socialstyrelsen 2009, 2020; SFS 2019:1094 §3]

4.10 Negotiation and making demands (kravställare)

• Purpose: Press authorities to deliver the help the client is entitled to.
• When to use: When a body is slow, inflexible, treats the client badly, or the rules of different bodies contradict each other.
• Steps:
  1. Clarify with the client what the law or the decision entitles them to. This draws on the PO's training in public systems and legislation.
  2. Make the demand clearly, in writing where needed, citing the client's rights.
  3. Negotiate, and escalate to a manager, a review request or a complaint if needed.
  4. Stay on the client's side even when other professionals disagree.
  5. Look for unconventional solutions. Independence from the line organisation permits this; one example is a PO booking a hostel bed in the client's name after a discharge with no housing.
• Example language (illustrative): "My client has asked me to say clearly that she does not accept discharge without somewhere to live. What is your plan?"
• Watch for:
  • Escalation the client has not approved.
  • Damaging relationships the client will need later. Weigh this with the client.

[source: Socialstyrelsen 2009; Zero Project]

4.11 Conflict mediation

• Purpose: Resolve conflicts that block the client's support or housing.
• When to use: For conflicts with neighbours, family, psychiatry or social services.
• Steps:
  1. Ask the client what outcome they want.
  2. Meet or contact the other party with consent, presenting the client's view.
  3. Look for a workable agreement that the client accepts. One example: suggesting that a client with Asperger's tell support staff about themselves, which improved the staff's understanding.
• Example language (illustrative): "Would it help if staff heard from you how you like things done?"
• Watch for: Being pulled into representing the other party. You represent the client only.

[source: Zero Project; Socialstyrelsen 2009]

4.12 Strengthening egenmakt (empowerment)

• Purpose: Leave the client more able to manage alone.
• When to use: Throughout.
• Steps:
  1. In each task, move from the PO doing it, to doing it together, to the client doing it with the PO in the background [synthesis on the graded sequence].
  2. Explain how the systems work so the client understands why things happen.
  3. Point to the client's strengths and successes. This follows the 2009 focus on possibilities and health.
• Example language (illustrative): "Last time I made the call. This time you could start and I'll jump in if you want."
• Watch for:
  • Growing dependence on the PO.
  • It is working when the client starts contacts on their own.

[source: Socialstyrelsen 2009; SFS 2019:1094 §3]

4.13 Joint evaluation

• Purpose: Learn from each goal pursued and re-plan.
• When to use: When a goal is reached or has stalled, and periodically.
• Steps: Ask together, sometimes with colleagues present:
  1. What did you want to achieve?
  2. What happened?
  3. Why?
  4. What conclusions do we draw?
  5. How do we act next time? Then update the action plan.
• Example language (illustrative): "What did we hope would happen with the debt office, and what actually happened?"
• Watch for: Evaluation turning into a judgement of the client. Its purpose is learning.

[source: Socialstyrelsen 2009]

4.14 Closure (avslut) and handing over to the network

• Purpose: End the contact while leaving the client with lasting support.
• When to use: When goals are met, the network can take over, or the client wants to end.
• Steps:
  1. From the start, build a network (professional and social) that can take over.
  2. Plan the ending with the client. Respect that many clients do not want to be "handed over" and prefer fewer, lasting contacts.
  3. Close verbally (PO-Skåne) or as local routines require.
  4. Give any notes to the client or destroy them. Nothing was entered in an official file during the contact.
  5. Tell the client how to come back.
• Example language (illustrative): "You've got the housing support and the new contact at the clinic. Do you feel ready for me to step back? You can call if things change."
• Watch for: Abrupt endings caused by waiting-list pressure [synthesis].

[source: Socialstyrelsen 2009; Göteborg leaflet; SocialPolitik 2012; Täby manual]

4.15 Reporting system failures (systembrister)

• Purpose: Turn individual problems into structural change.
• When to use: Continuously. 113 of 116 services have routines for this.
• Steps:
  1. Note the system failures you meet in casework, without identifying the client.
  2. Classify each by level:
     • caseworker level, such as how staff treat clients or their competence;
     • local level, such as staff continuity, duties to inform, or coordination and SIP;
     • central level, such as legislation, regulations or resources.
  3. Report them to the steering group. In Täby they first go through a preparatory group that includes user and relative organisations, and both groups meet twice a year.
  4. Central-level failures go via the county administrative boards to Socialstyrelsen's yearly report.
• Example language (illustrative, to the steering group): "Three clients this half-year were discharged without housing; this is a local coordination failure."
• Watch for: Reports that could identify a client.

[source: Socialstyrelsen 2009, 2026; Täby manual]

4.16 Peer supervision and ethical reflection

• Purpose: Keep the role clean and handle ethical dilemmas.
• When to use: Regularly, and after any boundary dilemma.
• Steps:
  1. Take part in supervision (handledning). The 2009 document recommends doing this in a group with other POs, not with other professions. One county used collegial exchange instead.
  2. Bring cases where you acted outside the principles for reflection. The 2009 examples include lending money, collecting medicine against the client's will, and breaking confidentiality over threats.
  3. Use written ethical guidelines; Socialstyrelsen recommends having them.
• Watch for: Feeling like the client's only lifeline. Take this to supervision.

[source: Socialstyrelsen 2009, 2020, 2026]

4.17 For the referring therapist: assessing fit and referring [synthesis]

• Purpose: Connect an eligible client with a PO in a way that keeps the client in charge.
• Steps:
  1. Consider a PO when a client with severe, long-term psychiatric disability is stuck because of authority contacts, money, housing or care coordination. These are problems therapy alone cannot solve.
  2. Explain what a PO is: independent, on the client's side, not a guardian and not treatment.
  3. Let the client contact the PO themselves, or contact it with the client's consent. Contact details are on the municipality's website.
  4. Do not set the PO's agenda. The client commissions the work.
• Example language (illustrative): "There's a service called personligt ombud. They work only for you, help you deal with Försäkringskassan and the rest, and don't report back to me unless you want them to."

4.18 For the therapist: working alongside a PO [synthesis]

• Steps:
  1. Share information with the PO only with the client's consent.
  2. Attend network meetings or a SIP when the client invites you.
  3. Provide medical certificates and statements promptly. A shortage of certificates is a commonly reported system failure.
  4. Keep the roles clear: you hold treatment responsibility, and the PO holds none.
  5. Accept that the PO may advocate against your clinical view.
• Watch for: Asking the PO to persuade the client about adherence. That conflicts with the PO's mandate.

[basis: Socialstyrelsen 2020, 2026]

4.19 Adapting the model outside Sweden [synthesis]

• Steps: Keep these core features:
  1. The client is the commissioner.
  2. The service is independent of the bodies whose services it chases.
  3. Access is low-threshold, with home or café meetings.
  4. Documentation is minimal and returned or destroyed at the end.
  5. A multi-agency steering group receives system-failure reports.
  6. Ombuds have peer supervision.
• Watch for: Local reporting duties and data-protection law, which may override the Swedish no-file practice.

[basis: features named in sources above; Oslo and Helsinki services per Zero Project]

5. Handling problems

• Suspicious client who keeps refusing contact. Do not push, and keep the door open. Meet on the client's ground, offer two ombuds so they can choose, and let them talk without an agenda. Move in steps from a channel, to a relationship, to dialogue, to trust. [source: Socialstyrelsen 2009; Zero Project] Offer one tiny, low-stakes task, such as reading a letter together, to show you are useful [synthesis].
• Client who cannot yet name any needs. This is common, because many have felt unheard. Give it time. Use a needs-based structure such as CAN, or a local checklist, as a prompt rather than a test. [source: Socialstyrelsen 2009]
• Others push their agenda (relatives, psychiatry, the municipality, neighbours). Restate that you represent only the client. Decline to pass on others' messages as your own. Bring their concerns to the client only if the client wants to hear them. [source: SocialPolitik 2012]
• Client asks for something you think is unwise or harmful.
  • The principle is not to act against the client's will. The 2009 document openly discusses an ombud who collected medicine for an infected client against their wishes and knew this broke the principle.
  • Response: state your concern honestly, decline to act on things outside the role, and take the dilemma to peer supervision.
  • [source: Socialstyrelsen 2009] Where life is at immediate risk, standard emergency duties apply [synthesis].
• Threats, violence risk or suicide risk.
  • The PO has a duty of confidentiality. The 2009 case of a client who uttered threats, where the ombud informed a mobile psychiatric team, is presented as an open dilemma with no rule. [source: Socialstyrelsen 2009] [uncertain: no published national rule]
  • Synthesis: agree at the start of contact what you will do if there is serious risk to life. Use standard risk assessment, or link to the client's psychiatric contact or emergency services. Break confidentiality only within the law. Never visit alone when risk is known; go as two. [synthesis]
  • For suicide risk, encourage safe storage or removal of means and same-day contact with psychiatry. [synthesis]
• Children at risk. The 2009 document notes that, like other officials, POs must report concerns about children to social services. It records this alongside a statement that POs have no reporting duty, without resolving the tension. Follow current law. [source: Socialstyrelsen 2009] [uncertain: the relevant provision is now in the new socialtjänstlag (2025:400); its exact chapter]
• Requests for money. The PO gives no financial support. The 2009 document discusses an ombud who lent a destitute client a small sum and questioned whether that was right. Response: help with emergency assistance or fund applications instead, and bring any exception to supervision. [source: Socialstyrelsen 2009]
• Housing emergency at discharge. Use the independent position to find unconventional solutions. The 2009 example is booking a hostel in the client's name. Demand a discharge plan from psychiatry, and report it as a system failure. [source: Socialstyrelsen 2009]
• Rupture: the client feels let down.
  • Clients may expect the PO to fix everything. Name honestly what was and was not achieved, and use the joint evaluation questions (4.13). [synthesis built on Socialstyrelsen 2009]
  • Offer a change of ombud. Client choice is a principle. [source: Socialstyrelsen 2009]
• Non-adherence to the plan (missed calls, missed meetings). Shrink the plan, and do more together for a while before handing tasks back. Check whether an action really was the client's priority. [synthesis]
• Overwhelm (too many authorities and letters). Triage with the client to one or two items. Use the timeline (4.5) and coordination meetings (4.9) to cut the number of contacts. [synthesis built on Socialstyrelsen 2009]
• Dependency and reluctance to close. Build the network from the start and work through the empowerment sequence (4.12). Accept that some clients want long, few contacts. Close gradually and keep re-entry open. [source: Socialstyrelsen 2009] Taper contact frequency before closing [synthesis].
• Role creep (being asked to act as caseworker, guardian or therapist).
  • The PO makes no decisions, gives no treatment, does not replace other services and is not a substitute decision-maker. Refer back to the responsible body and report the gap as a system failure. [source: Socialstyrelsen 2009, 2020]
  • If your post combines PO and caseworker duties, raise it with management. Socialstyrelsen sees this as a threat to independence. [source: Socialstyrelsen 2026]
• Authorities stonewall or exclude the PO. Bring a written, time-limited power of attorney. Ask for decisions in writing so they can be appealed. Escalate through review requests and complaints. Report the pattern to the steering group. [source: Socialstyrelsen 2009, 2026]
• Waiting list pressure. Apply the steering group's priority rules: children in the household, eviction or homelessness risk, young adults, and no other contacts. In the meantime, guide others to the right bodies. [source: Socialstyrelsen 2026]
• Digital exclusion (no BankID, e-services). Help the client get identification and access, or arrange alternatives, and report this as a central-level system failure. [source: Socialstyrelsen lägesrapport 2025]
• Ombud fatigue and boundary drift. This arises from home visits, closeness and being "on call". Use regular peer supervision and written ethical guidelines. Hold a clear rule on out-of-hours contact. [source: Socialstyrelsen 2009, 2020] Using the rule as a boundary is [synthesis].
• Therapist and PO disagree. The PO advocates for the client even against professional views. Meet together with the client present, rather than negotiating over the client's head. [synthesis built on Socialstyrelsen 2009]

Sources

Sources:

• Council of Europe: Personal Ombud Programme – Sweden (2021)
• Socialstyrelsen (2009-12-16), document on personligt ombud: target group, phases, ethics, case examples [uncertain: exact title not captured; the extract was cut off mid-ethics chapter]
• Socialstyrelsen Meddelandeblad 5/2020: state grants for personligt ombud
• SFS 2019:1094, amendment to Förordning (2013:522)
• Socialstyrelsen: Statsbidrag personligt ombud – lägesrapport 2025
• Socialstyrelsen (2026): Lägesrapport om verksamhet med personligt ombud, bidragsår 2025
• [Täby kommun: Manual för personligt ombuds arbete (2022)](https://doc.taby.se/handlingar/Socialnämnden/2022/2022-12-07/Handlingar/8.4 - Bilaga 3 Manual för Personligt ombuds arbete i Täby kommun Redovisning av verksamhet med personligt ombud för år 2022 och.pdf)
• Göteborg: Personal Ombudsman leaflet (English)
• Johansson L. (2012), Personligt ombud, SocialPolitik 1/2012 (PO-Skåne interviews)
• Zero Project: Personal Ombudsmen in Sweden
• ENUSP: RSMH-Skåne, Sweden

Further reading (not drawn on) [uncertain]:

• the Cambridge University Press chapter "Swedish Personal Ombudsman: support in decision-making and accessing human rights" (in Mental Health, Legal Capacity and Human Rights);
• CRD (2021), Kartläggning: Utbildning och stöd till personliga ombud;
• Socialstyrelsen's Kunskapsguiden PO pages;
• PO-Skåne's own published texts by Maths Jesperson.

The Camberwell Assessment of Need is referenced only, not reproduced.