Presentation by Maths Jesperson on the occasion of the EESC SOC hearing on European year of mental health - Better work, better quality of life in Brussels on 30 October 2012

1. Maths Jesperson
Situation in the world of work
Presentation at the public hearing on the
European Year of Mental Health – Better Work, Better Quality of Life
European Economic and Social Committee (EESC), Brussels 30 October 2012
In the First Session I said that I find many parts in the working document excellent, but there
are also some parts which I think are a bit too vague and general in their descriptions and
recommendations.
One of those parts of the document I find a bit too vague and general is section 3.1 about “The
world of work”. The three paragraphs in this section enumerate various demands and
conditions in the modern world of work, which may cause distress. All this is true, but the
description is still too vague and general, and it’s hard to see how those distressing elements
are concretely linked to the increase of mental health problems.
It seems as the text is speaking mostly about the prevention of mental health problems, and
not so much about what to do when some of the employees already have that kind of
problems.
It’s also unclear if the text is referring only to stress and problems that almost all employees
experience more or less, or if this section of the document also includes persons with severe
psychosocial disabilities.
Anyway, as a representative of users and survivors of psychiatry, I will here talk of persons
with severe mental health problems - or what we call psychosocial disabilities – in connection
with the world of work.
In 1995 I took part in a project on “Training and Employment for People with a Psycho-
Social Disability. Although this was 17 years ago, the report is still the best I have ever seen
on this subject. The project was a joint effort by several international organisations, of which
the most important was the International Labour Office (ILO). I will quote some of the
principles and recommendations that the participants agreed upon. 1
About the work place:
“Workplaces should be encouraged to develop flexible work practices, make reasonable
accommodation and provide support structure which allows workers with psychosocial
1
Summary Report. Symposium on Training and Employment for People with a Psycho‐Social Disabilty ‐ The
report is not available on the web, but could be emailed by the office of Mental Health Europe, or by me
(maths.jesperson1@comhem.se).
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2. disabilities to partake in the workplace. Such measures should be non stigmatising and
available to all employees.”
“Employers should recognise that people with psychosocial disabilities have a wide range of
capabilities and all roles within the workplace, including management, should be open to
them.”
The report addresses ways to get out of the benefit trap and into the labour market:
“Work should make an improvement in, or at least not disadvantage people's economic status,
but yet not create the illusion of improvement through the lowering of benefits in order to
compel people to take low paid jobs.”
“Those who take up paid work should not risk losing benefits permanently. There must be a
substantial transitional period during which benefits can resume.”
The report stresses the importance of not mixing work and therapy:
“Health care and work are separate issues and should be dealt with as such, respecting for all
their civil and human rights. The issue of work for people with psychosocial disabilities must
be distanced from medical control and compulsory or coercive measures or treatments.”
“There is no place for therapies as a compulsory part of work schemes.”
The report also suggests how special labour market instruments could be used to further this
development:
“Labour market instruments should include measures for people with psychosocial
disabilities. These should include wage subsidies to compensate reduced productivity,
supported employment with special measures for the provision of psychosocial support to
people who are at risk of losing employment through mental health problems.”
But in my opinion it’s not enough with measures connected directly to the work. Even more
important are support offered to the person outside the working place.
Instead of just talking about principles, I will conclude this presentation by giving a concrete
example, a really good example, which has shown excellent results and really is one of the
solutions for the problems addressed here.
It is a Swedish service which is called Personal Ombudsman (PO), and is working all over
Sweden since more than 10 years. It has been well known all over the world, mainly because I
myself make presentations of it everywhere.
I made this presentation for the first time in January 2006 in the UN Headquarters in New
York for the UN Committee working on the Convention on the Rights of Persones with
Disabilities (CRPD) 2 . The World Health Organisation and the World Bank are furthering the
2
http://www.un.org/esa/socdev/enable/rights/ahc7sideevents.htm (see “Tuesday 17 January 2006”)
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3. PO model as a good example, and have written about it in their “World Report on
Disability" 3 . A more lengthy version is published in the book "Alternatives Beyond
Psychiatry" 4 .
The time is too short to present the PO model at this hearing, but to give you some idea of
what a Personal Ombudsman (PO) is, here is a short characteristic:
- 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 PO model is one of few existing, concrete examples of supported decision-making in compliance
with Article 12 of the CRPD . Article 12 of the CRPD does not only talk about the right to
“enjoy legal capacity on an equal basis with others in all aspects of life.” It also put an
obligation on the states to “provide the support disabled persons may require in exercising
their legal capacity”. What is referred to here is a paradigm shift from ‘substituted decision-
making’ (guardianship) to supported decision-making.
So one reason to implement the PO model in all states in EU, is the obligation for the states to
provide supported decision-making. But the Swedish PO model has been thoroughly
researched, and the results are fantastic, even in economical terms:
1. The PO reduces the need for psychiatric care dramatically immediately for the clients.
2. The PO empowers the clients, so they need almost no support after some years.
3. Every 1 Euro the government spends on the PO service it saves 17 Euros.
3
http://whqlibdoc.who.int/publications/2011/9789240685215_eng.pdf p. 138
4
Maths Jesperson, Personal Ombudsman in Skåne. A User‐controlled Service with Personal Agents. In
Lehmann, P. Stastny P. (Ed.), Alternatives Beyond Psychiatry, Peter Lehmann Publishing,
Berlin/Eugene/Shrewsbury 2007 (p. 299‐304). German version: Maths Jesperson. (2007), Der
Personenbezogene Ombudsman in Skåne. Eine nutzerkontrollierte Dienstleistung mit persönlichen Agenten. In
Lehmann, P. Stastny P. (Hg.), Statt Psychiatrie 2, Peter Lehmann Publishing, Berlin 2007 (S. 311‐316). A Greek
version oft he book has just been published, and next year there will also be a Hindi version. See also
http://www.peter‐lehmann‐publishing.com/books/without.htm
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4. Finally I want to sum up my two presentations during this hearing with the following
statement:
What is needed is a paradigm shift. Instead of allocating billions of Euros on main stream
psychiatry and its medical model, the governments should support a paradigm shift within
psychiatry and community mental health care, by redirecting the flow of money in new
directions. I know this couldn’t be done from one day to another, but the process must start
now, and continue step by step. And these steps must mean substantial reforms – not just
some projects in the periphery.
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