「感情鍊」與社區照顧： 台灣民間機構的精神障礙者政府方案之個案研究

基於心智障礙者去機構化理念影響下所發展的社區居住政策，為一套適用於精神障礙者以及智能障礙者兩種族群，由政府與民間機構合作之方案制度。「心智障礙者社區居住與生活服務補助辦法」從2005（民國94）年實施至2013（民國102）年的八年後，受政府部分補助的民間機構中智能障礙的家園機構成果豐碩、示範家園相對較多，但是單純針對精神障礙族群的部分卻是家園機構寥寥無幾、缺乏一個示範家園。　　為了尋找出造成這般方案產出之原因，本個案研究使用了民族誌的研究方法，由筆者於2013年擔任某精神障礙者社區家園的方案教保員，進行了為期八個月的參與觀察，發現了該制度辦法的內部觀點主要包括以下三點：（一）去機構化理念的社區機構設置模糊了精神障礙者工作人員與病患在Erving Goffman戲劇論中指出台前與台後的界線，而與病患非理性、長時間的對話不時造成作為員工生活一大部分的工作過程之心理耗竭；（二）在精神障礙者的社區居住與生活服務補助辦法形成時，不同於一樣適用該辦法的智能障礙者族群，官方的成效評估報告中相關本土科學證據不足，但是卻成為外包方案裡政府與民間機構社工依法行政的憑據；（三）至於研究者在匿名為亞衲協會所從事的、機構最低階層的職位角色則是輕易的於受官僚影響的日常生活中，在機構文件紀錄裡成為任何不幸事件的替罪羔羊（Scapegoat）。　　本個案研究於是將此精神障礙者社區照顧中，各類型行動者超越理性邏輯但卻需要日日面對的權力關係名為，一個賦有本土文化意義且是衍生自龍發堂先前開發的概念─「感情鍊」。

關鍵字

社區居住；社區家園；精神障礙者；智能障礙者；心智障礙者；民間機構；政府方案；社區照顧；本土心理；心理照顧

並列摘要

The community living policy for the mentally ill is an institutional program which allows government and NGO collaboration. Such program applies to both groups of people with chronic psychiatric patients (CPP) and people with mental retardation. The Subsidies Act for Community Living and Living Service for the Mentally Ill has been execute since 2005 to 2013, during such period the community living institutes service people with mental retardation ran by NGOs have significant outcome along with their numerous demonstrative institutes. Yet the ones that served CPP is comparatively, rather poor. To investigate such poor outcome for the CPP group, ethnographic research method was used. The researcher worked as educare giver in one of the community living institute for CPP. During eight and a half months of participatory observation, the insider views relating to such outcome are mainly as follows: (a) the de-institutionalization concept has blurred the boundaries what Erving Goffman’s Dramaturgy divided as front stage and back stage between psychiatric staffs and patients, thus their long working hours are causing them server psychological burn-outs; (b) When the government’s program subsidies act was formed, there was a lacking of scientific evidence for the CPP group’s outcome evaluation, yet the regulations written in the act was followed blindly by law abiding social workers in both local government and NGO sectors, (c) Actors/worker of the lowest social rank within institute as such are thus accused as scapegoat in their documentation when any unfortunate event occurred. This case study has named the irrational power relationship which all types of actors have to face on a daily basis in the CPP community care institute, “Chains of Emotional Attachment”, a concept previously developed locally by the famous CPP shelter, Hall of Dragon Metamorphoses (Lun-Fa Tang).

並列關鍵字

community living ； community care ； social care ； chronic psychiatric patients ； NGO ； social policy ； mental illness ； applied anthropology ； social work