賦能精神病人邁向復元－以克服內在汙名化為例

精神病人之內在汙名化是邁向復元的重大阻礙之一，賦能照護服務可克服此困難，然而台灣之精神健康照護依然偏重醫療與復健模式。本篇藉由闡述精神病人之內在汙名化的相關影響與心理效應機轉，以及實證介入措施，佐以臨床經驗倡議專業人員積極運用賦能模式。自我效能與賦能可以中介內在汙名化對生活品質或憂鬱之影響，社會網絡或同儕支持亦有緩和效果。實證之介入包含心理教育、增強動機、自助介入或同儕支持、運用認知行為策略以及目標導向之技巧訓練。賦能照護奠基於科學證據，實踐於自我決定，建構於環境支持。建議專業人員在評估精神症狀與病識感時，可同時評估自我汙名化議題，接著鼓勵病人自我決定並參與治療。而在心理教育或技巧訓練中，可善用復元者同儕之親身經歷，以找出生活上可行之技能與策略，並在連結社區資源時，倡議共同參與者支持病人以實踐自我決策。

關鍵字

賦能；自我烙印；復元

並列摘要

Internalized stigma is a significant obstacle encountered on the journey to recovery for persons with mental illness. Services provided through the empowerment model of care have been shown to be effective in overcoming this obstacle. However, the mental health care system in Taiwan continues to focus on providing care using the medical or rehabilitation model. In this article, the related consequences and psychological effect mechanism of internalized stigma in persons with mental illness are presented and evidence-based interventions for internalized stigma are demonstrated. Next, we share the clinical experiences to advocate for the use by professionals of the empowerment model. Self-efficacy and empowerment may mediate the psychological effects of internalized stigma on quality of life and depression, while social networks and peer support may buffer its negative consequences. Related evidence-based interventions include psycho-education, motivation enhancement, self-help or peer-delivered services, and cognitive behavioral model and goal-oriented skill training. Empowerment model services are based on scientific evidence that are practiced under the rubric of self-determination and constructed in supportive environments. When examining psychiatric symptoms in persons with mental illness, professionals may concurrently evaluate for issues related to internalized stigma and encourage those patients with internalized stigma to self-determine and participate in therapy. In psycho-education and skill training therapies, professionals may also apply the lived experiences of peers with recovery to identify and share important knowledge and life skills. When connecting patients to community resources, professionals should encourage stakeholders to help persons with mental illness put their decisions into practice.

並列關鍵字

empowerment ； self-stigma ； recovery

參考文獻

李錦彪、蔡欣玲（2017）．台灣精神衛生護理的展望—復元觀點之再思．護理雜誌，64（3），5–11。[Li, J.-B., & Tsai, S.-L. (2017). The development of psychiatric and mental health nursing in Taiwan: Reflection from the perspective of recovery. The Journal of Nursing, 64(3), 5–11.] https://doi.org/10.6224/JN.000034

曾秋蓉、邱政元、顏文娟、蘇惠珍、蕭秋月（2012）．社區復健中心之精神分裂症患者其污名感受、污名因應與生活品質相關因素之探討．護理雜誌，59（4），62–70。[Tseng, C.-J., Chiou, J.-Y., Yen, W.-J., Su, H.-C., & Hsiao, C.-Y. (2012). Associations between stigma perception and stigma coping behavior and quality of life in schizophrenic patients treated at a community rehabilitation center. The Journal of Nursing, 59(4), 62–70.] https://doi.org/10.6224/JN.59.4.62

黃佑詢、戎瑾如、林式穀、劉玟宜、劉介宇（2015）．探討思覺失調症病人社區生活技能中介疾病烙印對生活品質之影響．精神衛生護理雜誌，10（1），1–8。[Hang, Y.-H., Rong, J.-R., Lin, S.-K., Liu, W.-I., & Liu, C.-Y. (2015). The mediating effect of community living skills on stigma perception and quality of life for the patients with schizophrenia. The Journal of Psychiatric Mental Health Nursing, 10(1), 1–8.] https://doi.org/10.6847/TJPMHN.201511_10(1).0001

黃耀輝、林幼喻、李世凱、李明峰、林靜蘭（2018）．精神病患復元歷程之相關性研究．護理雜誌，65（2），64–74。[Huang, Y.-H., Lin, Y.-Y., Lee, S.-K., Lee, M.-F., & Lin, E. C.-L. (2018). A correlational study of the recovery process in patients with mental illness. The Journal of Nursing, 65(2), 64–74.] https://doi.org/10.6224/JN.201804_65(2).09

廖于萱、連盈如（2020）．臺灣思覺失調症患者自我污名及其相關因素之探討．職能治療學會雜誌，38（2），244–259。[Liaw, Y.-S., & Lien, Y.-J. (2020). Self-stigma and its correlates among patients with schizophrenia in Taiwan. Journal of Taiwan Occupational Therapy Association, 38(2), 244–259.] https://doi.org/10.6594/JTOTA.202012_38(2).0006

被引用紀錄

郭宇恒（2024）。監護處分之病人家屬賦能理論與實務。護理雜誌，71(1)，99-104。https://doi.org/10.6224/JN.202402_71(1).12

國際替代計量

賦能精神病人邁向復元－以克服內在汙名化為例

全文下載

主題瀏覽