精神病社區關懷照顧計畫：東部地區關懷訪視員的經驗與觀點

Community Care Plan for People with Mental Illness: Care Visitors' Experiences and Perspectives in Eastern Taiwan

王金永(Jin-Yong Wang)

《臺大社會工作學刊》 37期 (2018/06) Pp. 1-46

https://doi.org/10.6171/ntuswr2018.37.01

摘要

為協助社區精神病患定期服藥及減低症狀復發所造成的自傷傷人事件，衛生福利部自2006年開始實施「精神病社區關懷照顧計畫」，但計畫執行的成效仍未有足夠的實證研究探討。本研究藉由東部地區關懷訪視員的經驗調查，試圖瞭解此計畫的執行情形與服務成效。研究結果歸納有以下四點發現：第一，有關關懷訪視員扮演的角色、服務內涵與工作對象，關懷訪視員對於專業角色的認知相近，角色功能以疾病相關之醫療問題處置為優先，工作對象與服務期程在東部三縣有所差異。第二，在關懷訪視服務的價值與成效上，關懷訪視員彌補了社區精神病患服務人力的缺口，也提供了家屬許多協助。第三，計畫構想與實務之間存在落差，服務輸送過程中亦發現幾項窒礙難行之處。第四，關懷訪視員在服務過程中可能面臨包含如何兼顧案量與品質的兩難，以及人身安全威脅等挑戰。根據上述研究發現，本研究針對相關議題提出進一步的討論與建議。

關鍵字

個案管理 ； 精神病患 ； 關懷訪視員

並列摘要

To help mentally ill patients in the community take their medication regularly and reduce the incidences of self-harm and injuries caused by the relapses of mental illness, the Department of Health and Welfare launched the 'Care Scheme for Community Mentally Ill Patients' and started to employ community care visitors in 2006. There hasn't yet been a thorough investigation on the cost-effectiveness of this scheme. This study explored care visitors' experiences in Eastern Taiwan in seeking to find the scheme in actual practice, as well as its cost-effectiveness. The research results are summarized into four points. First, regarding care visitors' roles, services and target population, the interviewed care visitors share similar perceptions concerning their roles, with illness-related medical problems as their service priority. The target population and service period in these three counties differ. Second, in terms of value and cost-effectiveness of the visiting service, care visitors make up for the shortage of service staff for community mentally ill patients and offer their family members a lot of help. Third, there are gaps between service planning and service implementation. Also, some problems were found in the process of service delivery. Fourth, care visitors face the dilemma of balancing service quantities and quality, and the potential threat to their personal safety also causes care visitors' concern. Further discussions about relevant issues and suggestions are proposed according to the research results mentioned above.

並列關鍵字

case management ； mentally ill patients ； care visitors

參考文獻

立法院（2007）。〈立法院第96 卷第41 期（3564）公報〉。取自http://lci.ly.gov.tw/LyLCEW/communique/final/pdf/96/41/LCIDC01_964101_00010.pdf【Legislative Yuan. (2007). Communique Vol. 96, No. 41 (3564). Retrieved from http://lci.ly.gov.tw/LyLCEW/communique/final/pdf/96/41/LCIDC01_964101_00010.pdf】

全民健康保險署（2017）。〈全民健康保險重大傷病證明有效領證統計表〉。取自https://www.nhi.gov.tw/DL.aspx?sitessn=292&u=LzAwMS9VcGxvYWQvMjkyL3JlbGZpbGUvMC80NzE0LzEwNjEw6YeN5aSn5YK355eFLm9kcw%3d%3d&n=MTA2MTDph43lpKflgrfnl4Uub2Rz&ico%20=.ods【National Health Insurance Administration. (2017). Statistical tables of major illnesses/injuries certificates in the National Health Insurance. Retrieved from https://www.nhi.gov.tw/DL.aspx?sitessn=292&u=LzAwMS9VcGxvYWQvMjkyL3JlbGZpbGUvMC80NzE0LzEwNjEw6YeN5aSn5YK355eFLm9kcw%3d%3d&n=MTA2MTDph43lpKflgrfnl4Uub2Rz&ico%20=.ods】

行政院衛生署（2012）。〈行政院衛生署100 年度施政績效報告〉。取自http://ws.ndc.gov.tw/Download.ashx?u=LzAwMS9hZG1pbmlzdHJhdG9yLzEwL3JlbGZpbGUvNjExMC8xMTc5Mi8wMDI3NDUxXzE0LmRvYw%3D%3D&n=MjU5MTkyNzEyNzEuRE9D&icon=..doc【Department of Health, Executive Yuan. (2012). 2011 Taiwan public health report. Retrieved from http://ws.ndc.gov.tw/Download.ashx?u=LzAwMS9hZG1pbmlzdHJhdG9yLzEwL3JlbGZpbGUvNjExMC8xMTc5Mi8wMDI3NDUxXzE0LmRvYw%3D%3D&n=MjU5MTkyNzEyNzEuRE9D&icon=..doc】

行政院衛生署（2009）。〈行政院衛生署99 年度「精神病社區關懷照顧計畫」申請作業說明書〉。取自http://www.doh.gov.tw/CHT2006/DisplayFile.aspx?url=http%3a%2f%2fwww.doh.gov.tw%2fufile%2fdoc%2f99%e7%b2%be%e7%a5%9e%e7%97%85%e7%a4%be%e5%8d%80%e9%97%9c%e6%87%b7%e7%85%a7%e9%a1%a7%e8%a8%88%e7%95%ab%e9%9c%80%e6%b1%82%e8%aa%aa%e6%98%8e%e6%9b%b8.doc&name=99%e7%b2%be%e7%a5%9e%e7%97%85%e7%a4%be%e5%8d%80%e9%97%9c%e6%87%b7%e7%85%a7%e9%a1%a7%e8%a8%88%e7%95%ab%e9%9c%80%e6%b1%82%e8%aa%aa%e6%98%8e%e6%9b%b8.doc【Department of Health, Executive Yuan. (2009). Instructions of application for community psychiatric care plan in 2010, Department of Health, Executive Yuan. Retrieved from http://www.doh.gov.tw/CHT2006/DisplayFile.aspx?url=http%3a%2f%2fwww.doh.gov.tw%2fufile%2fdoc%2f99%e7%b2%be%e7%a5%9e%e7%97%85%e7%a4%be%e5%8d%80%e9%97%9c%e6%87%b7%e7%85%a7%e9%a1%a7%e8%a8%88%e7%95%ab%e9%9c%80%e6%b1%82%e8%aa%aa%e6%98%8e%e6%9b%b8.doc&name=99%e7%b2%be%e7%a5%9e%e7%97%85%e7%a4%be%e5%8d%80%e9%97%9c%e6%87%b7%e7%85%a7%e9%a1%a7%e8%a8%88%e7%95%ab%e9%9c%80%e6%b1%82%e8%aa%aa%e6%98%8e%e6%9b%b8.doc】

行政院衛生署（2006）。〈行政院衛生署公開徵求辦理「精神病社區關懷照顧」計畫（95-96 年度）申請作業說明〉。取自http://www.google.com/search?q=%E7%82%BA%E4%BD%BF%E7%B2%BE%E7%A5%9E%E7%97%85%E5%87%BA%E9%99%A2%E5%BE%8C%E8%83%BD%E6%8C%81%E7%BA%8C%E8%A6%8F%E5%89%87%E5%B0%B1%E9%86%AB&rls=com.microsoft:zh-tw:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7GGLL_en【Department of Health, Executive Yuan. (2006). Instructions of application for community psychiatric care plan in 2006-2007, Department of Health, Executive Yuan. Retrieved from http://www.google.com/search?q=%E7%82%BA%E4%BD%BF%E7%B2%BE%E7%A5%9E%E7%97%85%E5%87%BA%E9%99%A2%E5%BE%8C%E8%83%BD%E6%8C%81%E7%BA%8C%E8%A6%8F%E5%89%87%E5%B0%B1%E9%86%AB&rls=com.microsoft:zh-tw:IE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7GGLL_enIE-SearchBox&ie=UTF-8&oe=UTF-8&sourceid=ie7&rlz=1I7GGLL_en】