「旋轉門效應」指精神疾患者在短期間反覆進出醫院的行為。本文目的為探討該現象之影響因素,檢視現有台灣的社區照顧服務能否回應此現象。研究方法採用文獻方法,資料來源為研究文章、社福組織網站、政策法規、政府統計報表等。結果發現精神疾患者再住院的原因可從人口特性因素、個人情境因素與環境制度因素來了解。進一步回顧台灣自八○年代迄今已達45個以上的精神疾患者社福組織陸續設立,整體服務主軸涵蓋有個案管理、功能復健、居住與安置、就業服務、家庭支持、生活支持與社會參與、宣導與倡導等,而精神疾患者的服務使用仍有相當困境,來自於:1.服務體系對「旋轉門現象」觀點的歧視。2.疾病追蹤與社區照顧服務的二分,未能橋接兩者服務網。3.社區照顧服務供給量患寡不均,且為短期任務導向的服務關係。4.旋轉門精神疾患者的長期研究資料有限,服務網絡待累積更多實證資料。本文分別就政府層面、服務提供單位與後續研究議題提出建議。本文結論:1.服務系統對「旋轉門現象」觀點的歧視。2.疾病追蹤與社區照顧過度二分,未能橋接兩者服務網。3.社區照顧服務供給量不足不均,且為短期服務導向的服務關係。4.旋轉門精神疾患者的長期研究資料有限,服務網絡仍有待累積更多實證資料。此外本文提出建議為:政府層面,落實學齡期學生心理健康教育政策,以及主動培力社區組織;在服務單位層面方面,應努力的重點為:1.服務設計應增加網絡關係元素,2.精神醫療單位與民間社福單位應建立策略聯盟,3.服務對象應增加,並回應對次群體現象需求之滿足。
The term "Revolving Door Effect" describes a subpopulation of mental disorder frequently readmitted to psychiatric units. The purpose of this article was to explore why they re-hospitalized frequently and review the community care services. The method was reviewed papers, contained research articles, the non-profit organization websites, the policy and regulations, and statistics reports from government. We could realize possible reasons from population characteristics, personal circumstances and environmental system. It was found that about forty-fifth organizations developed from the 1980s to the present. Even though these services provided from organizations including case management, functional habilitation, housing and resettlement, employment services, family supports, independence and social participation, promoting and advocacy. Psychiatric patients still encounter many difficulties in using services. First, the service system discriminates against the "revolving door phenomenon" view. Second, Disease tracking and community care services systems were separated, failing to bridge the two-service network. Third, the supply of community care services was insufficient, uneven, and the service relationship was short-term, task- oriented. Forth, lacking long-term research data on revolving- door patients, service network should accumulate more empirical data. The study gives suggestions on government, service providers and further research topics.