精神醫療照護的變革：以口述歷史探討玉里醫院的推動經驗

Using Oral Historical Study to Explore the Changes of Psychiatric Medical Care Model in the Yuli Hospital

張淑兒(Shu-Erh Chang) ； 戎瑾如(Jiin-Ru Rong) ； 張達人(Ta-Jen Chang)

《精神衛生護理雜誌》 10卷2期 (2015/12) Pp. 5-18

https://doi.org/10.6847/TJPMHN.201512_10(2).0001

摘要

伴隨精神科藥物的發明及應用，精神病人的症狀得以控制，有關病人生活功能、照護品質、去疾病污名化及病人人權議題也備受各界重視。政府於1957年由國軍退除役官兵輔導委員會成立了玉里榮民醫院，收治大量榮民及榮眷之精神病患者。1966年玉里榮民醫院協助台灣省政府成立省立玉里養護所。精神病人在台灣東部地區形成機構化與邊緣化的問題，引起精神醫療照護專業人員之重視，開啟精神醫療與照護模式的變革。本研究將衛生福利部立玉里醫院及其前身玉里養護所之歷史事件串連，並以口述歷史研究法探討自1966年至2010年精神醫療照護模式之變革，含推動制度與改革之歷程。本研究邀請9位參與部立玉里醫院從事精神醫療照護制度規劃與工作推動之領導者、執行者進行個別訪談，並進行訪談資料之敘事分析（narrative analysis）。探討以上40餘年期間部立玉里醫院發展精神醫療照護模式之脈絡，有一、開啟窮苦弱勢精神病人的收容養護；二、由照管過度至照護；三、開拓精神醫療照護之思維與行動；四、精神醫療專業主導治療與照護；五、精神治療與復健照護並進；六、融滲社區之復健照護模式；七、持續強化整體性精神衛生照護模式等變革歷程。根據玉里醫院領導者、參與執行者工作推動的經驗，可以看出部立玉里醫院照護模式隨著時代脈絡前進變化的歷程，藉此持續推動社區化精神衛生照護模式之發展。

關鍵字

精神衛生照護模式 ； 口述歷史 ； 敘事分析

並列摘要

This study is to explore the policy's development and the changes of psychiatric mental health care model in which 9 subjects of this study invited and interviewed individually were the leaders and the participating executives who actually have engaged in planning and promoting the psychiatric mental health care model at the Yuli Hospital through an oral history method. The subjects would state their experiences while working at the Yuli Hospital, and their interviewed contents would be transcribed into verbatim and narratively analyzed.The development of Yuli Hospital included seven policy- advocating programs. Each of them was described as follows: 1. Starting to take care of patients with mental illness who are in poor economic conditions; 2. From discipline control to psychiatric care; 3. Performing innovative thinking and acts while providing with psychiatric mental health care; 4. Acknowledging psychiatric and related expertise which will lead the direction of treatment and care; 5. Using paralleled development of mental health treatment and rehabilitation care; 6. Incorporating the community into rehabilitation care model; 7. Continuing to build an integrative psychiatric mental health care model. According to the experiences of leaders and participating executives from this propaganda, the progress in psychiatric medical care model at the Yuli Hospital has changed as times moves forward and it will be visible. The early life style of patients is at the stage of building hope, but nowadays hospitals put more emphasis on their functionality rehabilitation to help them return to their communities.

並列關鍵字

Psychiatric mental health care model ； Oral history ； Narrative analysis

參考文獻

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