A study of community psychiatric rehabilitation service in a halfway house
康復之家 ； 社區精神復健服務 ； halfway house ； community psychiatric rehabilitation service
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康復之家的創設原意在於提供一個半保護性、暫時性、支持性的居住環境，在專業人員的協助與指導下，協助病情無須再接受住院治療的精神障礙者，能夠在康復之家建立自信、培養獨立生活能力、良好地適應於社區之中，解決在社區中住的問題。然而，國內康復之家卻面臨「轉換式機構化」服務型態的問題；意即，居住在康復之家的精神障礙者根本未曾真正經歷去機構化的歷程，其個人只是再度被機構化而已。因此，本研究目的在於 一、瞭解工作人員對康復之家社區精神復健服務的看法。 二、瞭解精神障礙者對康復之家社區精神復健服務的看法。 三、比較分析康復之家工作人員與精神障礙者兩者研究資料，提供國內康復之家、工作人員可以延續或改進的方法；以及未來相關政策上的修正參考。 為達到上述研究目的，本研究透過質化研究中深度訪談的方法，共訪問9位工作人員者以及10位精神障礙者後，得到以下研究結果。首先，康復之家目前在社區精神復健服務的定位上，不論在「服務規劃與需求評估」、「服務運作機制」等方面，多受到個人障礙模式觀點的影響，使康復之家看似淪為醫療服務體系下的延伸變體，而非協助精神障礙者邁向獨立生活於家庭與社區的中途站。 再者，康復之家在社區精神復健服務的定位上，也應該重視精神障礙者與環境因素的融合、消除不利精神障礙者的環境因素；然而，康復之家目前對於精神障礙者的社區精神復健服務的重點，仍偏重在個人疾病控制與社會功能的恢復，僅依照評鑑基準提供精神障礙者相關社區適應活動而已，而較為忽視協助精神障礙者應該如何與社區或家庭建立更多元漸進融入的管道；亦或只是將精神障礙者在康復之家的日常生活環境，成為阻礙精神障礙者能夠邁向獨立生活的環境，並非提供精神障礙者應該如何消除不利環境因素之處所。 另外，康復之家工作人員與精神障礙者在康復之家的社區精神復健服務體系下，同樣處於被動的地位，只能夠接受康復之家的安排，並無法直接促使康復之家在社區精神復健的定位上，予以調整或改變。惟工作人員相較於精神障礙者，其卻擁有執行社區精神復健服務的實際服務輸送權力，因此，不論工作人員的專業背景為何？其對於精神障礙者在康復之家接受社區精神復健服務的介入，最為首要的服務理念與服務策略，應該是對於精神障礙者必須持有正確的工作態度，協助其能夠在康復之家養成獨立生活的技能，進而再漸進影響康復之家著手調整或改變，而非被動配合康復之家執行社區精神復健服務的輸送。而精神障礙者雖面對個人係因病情的影響，所造成在認知與社會功能的必然缺損；但大型康復之家所突顯出的另外一個問題，卻是每個入住的精神障礙者，是否真得具備在康復之家接受社區精神復健服務介入的能力，而這樣的議題便牽涉到精神障礙者欲入住康復之家時的評估標準與篩選機制。 最後，根據研究發現，本研究分別針對政策、評鑑基準、康復之家、工作人員等方面提出相關建議。
The original creation of a halfway house is intended to provide a semi-protective, temporal and supportive living environment, with the assistance and guidance of professional personnel, to facilitate the mentally disabled people whose health conditions no longer require hospitalization and who are capable of establishing confidence, developing independent living skills, and well-adapt into the community, thereby solving problems living in the community. However, many of the domestic halfway houses are facing with problems in the service model of transinstitutionalization ; which implies that the mentally disabled people who habituate at the halfway houses have never really experienced the process of de-institution, and instead the patients have merely been re-institutionalized. For this reason, the purpose of this study emphasizes in the following: 1. Understand perspectives from the staffs on community psychiatric rehabilitation services of halfway house. 2. Understand the perspectives of mentally disabled people on community psychiatric rehabilitation services of halfway house. 3. Compare and analyze research data on staffs of halfway house and mentally disabled people, providing continuation or improvement methods for the domestic halfway houses and their the staffs; in addition to providing revision reference to the future relevant policies. To achieve the above study objective, the study employs the in-depth interview from qualitative research methods, consisting of a total of 9 staffs and 10 mentally disabled people to obtain the following study result. First the current orientation of halfway houses in community psychiatric rehabilitation service, regardless in the aspects of “service planning and needs assessment” or “service operating mechanism,” are mostly influenced by individual model and perspectives, consequently the halfway houses seemingly fall into an extended variant under the health care system instead of facilitating the mentally disabled people to move towards a halfway station for independent life in family and community. Furthermore, the positioning of halfway houses in community psychiatric rehabilitation services should also emphasize on the integration of mentally disabled people and environmental factors, eliminating environmental factors which threat on the mentally disabled people; however, the focus of halfway house on the community psychiatric rehabilitation service still give preference to individual disease control and social function restoration. As a result, only relevant community adaptability activities are provided to mentally disabled people according to baseline evaluation, neglecting more on facilitating mentally disabled people with how to establish a more diversified, gradual and integrating channel with the community and family; or simply turning the daily living environment of the mentally disabled people at the halfway house into an environment which could hinder mentally disabled people from moving towards an independent life instead of providing a location for helping the mentally disabled people in elimination of adverse environmental factors. Additionally, under the same passive position, the community psychiatric rehabilitation service system between the staff and mentally disabled people at the halfway house, can only accept arrangement from the halfway house instead of directly enhancing the halfway house with regulation or change in the position of community psychiatric rehabilitation. With the exception of comparing the staffs with the mentally disabled people, the staff can possess the delivery power of actual services in implementing community psychiatric rehabilitation services, and therefore the professional background of the staff is disregarded. For mentally disabled people to accept the intervention of community psychiatric rehabilitation service at the halfway house, the foremost important service concept and service strategy stress on the right working attitude on the mentally disabled people, facilitating them in developing skills for independent life a the halfway house, followed by gradually influencing the halfway house with adjusting or changing, instead of passively collaborating with the halfway house to implement the delivery of community psychiatric rehabilitation service. Although the mentally disabled people are facing with influence over individual condition, resulting in an inevitable defect in condition and social functions; However another issue of highlight for large-scale halfway houses is whether if every checked-in mentally disabled people could really possess the capability of accepting intervention from community psychiatric rehabilitation service at the halfway house, while this kind of issue will involve evaluation standards and filter mechanism for mentally disabled people who intend to check-in halfway house. Finally, according to the study results, the study proposes relevant recommendation on the aspects in policy, baseline evaluation, halfway house, and staffs.
社會科學 > 社會學