成為照顧者: 慢性精神病患之手足照顧者的決定與因應

本研究旨在探討影響慢性精神病患之健康手足承擔照顧責任之決定與因應方式，以半結構式訪談來自九個家庭之十位手足照顧者的照顧經驗，以主題式分析方法進行分析，研究發現有三: 第一，慢性精神病患者之家庭系統與互動受到其他手足投入照顧協助與否、手足成長過程中主要照顧者偏愛或共同面對困境、對精神疾病遺傳的擔憂與特殊家庭境遇的影響。第二，手足照顧者在承擔照顧責任方面，看重家庭責任與對精神疾病知識認識較豐為手足照顧者承擔照顧的主因；經濟困境、因症狀起伏而生的行為與情緒壓力與無助感，為照顧過程中主要的困境；應對經濟困境的主要方式為申請社福補助、應對症狀起伏而生行為的主要方式為與醫療單位合作、紓解情緒壓力與無助感的主要方式為病友互助及回顧對照子女照顧經驗。第三，手足對未來的照顧安排與想像受居住地區的資源可近性的影響。根據研究發現，研究者針對家庭系統對手足照顧意願的影響、家庭責任的助力與阻力、照顧因應與資源應用進行討論，對實務工作、社區倡議與研究方向提出建議。

關鍵字

手足照顧者；慢性精神病患；照顧困境

並列摘要

The purpose of this study is to explore decision-making and coping strategies by the chronic mental illness sibling caregiver. The semi-structured interviews are performed with 10 sibling caregivers from 9 families. Following by the thematic analysis methodology, three points are concluded in this study: First, family system and interaction of the patients with chronic mental illness are affected by the other siblings care involvement, parental bias or hardness during growing up, worries about mental illness inheritance and special family type. Second, the sibling considering family responsibility or with well mental illness knowledge tend to take role as caregiver. For them, economic problems, behaviors caused by mental symptoms, emotional stress and sense of helplessness are the main predicaments. The way to mitigate the economic problem is to file for the social welfare. The way to eliminate the behaviors caused by mental symptoms is to cooperate with medical institutions. For the relief of emotional stress and the sense of helplessness, attending patients’ mutual aid group, and reviewing caring child experience are highly recommended. Third, the care arrangement is limited by the resource of the living areas. Based on the findings, family system’s influence toward siblings care willingness, boost and resistance of the family responsibility, and care resources and coping plans are discussed. For the social work, social advocacy and the research direction, some practical suggestions are provided in this study.