精神障礙者在職業復健中之復元經驗

即使精神疾病普遍被認為無法完全康復，但近年許多研究發現精神障礙者具有「復元」潛力，代表即使持續患病，個體往後的個人發展仍值得期待。職業復健服務能協助精神障礙者成為工作者，加上近年許多研究指出慢性精神障礙者能透過職業復健邁向復元，故了解其在職業復健中的復元經驗為復健諮商之重要議題。本研究旨在探討精神障礙者參與職業復健中的復元經驗，以及了解影響復元的促進與阻礙因子。本研究採取立意取樣，選取十位已參與職業復健6個月以上之精神障礙者，以深度訪談蒐集其主觀復元經驗，最後以主題分析法進行資料分析與探討。本研究發現精神障礙者在職業復健中的復元經驗包含五大核心主題，分別為：（一）「重起獨立」，包含構築生活、為己負責等方面；（二）「重繫連結」，包含增加社交機會、強化社交自信、建立正向關係、維護人際關係等內容；（三）「重獲意義」，包含定義生活重心、擔負角色等面向；（四）「重燃希望」，包含萌生希望、自我激勵、積極踏路等層面；（五）「重建自我」，包含鞏固自尊、調整認同、重拾尊嚴等範疇。　　復元影響因子分別有(一)個人支持，包含自助信念、動力源頭；(二)家庭支持，包含心理支持、日常生活支持、疾病處理、鼓勵或協助就業；(三)職業復健系統專業人員支持，包含職能治療師、就業服務員；(四)職場自然支持，包含督導者、同儕和其他工作人員；以及(五)社會層面支持，包含就業相關資源可近性佳、醫療資源可近性佳等項目是復元的促進因子。復元阻礙因子可分為(一)個人阻礙，包括精神病況起伏、生理疾病與相關症狀、自我汙名；(二)家庭阻礙，包括家人不認同職業復健、不被家人信任；(三)職場阻礙，包括對職業復健人員信任度低、職場人際壓力；(四)職業復健系統阻礙，包括薪資水準低於市場、庇護性就業服務人力比要求、工作人員服務疏漏；以及(五)社會阻礙，主要為汙名化現象等層面。最後，本研究根據研究結果，對增進精神障礙者透過職業復健邁向復元提出實務、家庭及政策方面的建議，以及未來研究建議。

關鍵字

精神障礙者；復元；職業復健；主題分析

並列摘要

Even though mental illnesses are generally seen as unable to fully recover, many studies in recent years have found that people with psychiatric disabilities have the potential to reach "recovery", which means that even if they continue to suffer from illness, the individual's development is still worth looking forward to. Vocational rehabilitation services can help people with psychiatric disabilities be capable workers. In addition, many studies in recent years have pointed out that vocational rehabilitation help people with psychiatric disabilities to recover. Therefore, understanding the recovery experiences of people with psychiatric disabilities in vocational rehabilitation is an important issue in the field of rehabilitation counseling. The purpose of this study is to explore the recovery experiences of people with psychiatric disabilities who participated in vocational rehabilitation, and to understand the positive and negative factors affecting recovery. The study adapts intentional sampling strategy. We invited ten people with psychiatric disabilities who have more than 6 months vocational rehabilitation experience participated in this study. In-depth interviews were used to collect their recovery experience. The narrative information was analyzed via thematic analysis. Our study found that the recovery experience of people with psychiatric disabilities in vocational rehabilitation includes five core themes: (1) "Resume Independence", which includes building life and being responsible for oneself. (2) "Reconnection with others", which includes increasing social encounter opportunities, strengthening social confidence, establishing positive relationships, and maintaining interpersonal relationships. (3) "Regaining meaning", which includes defining the center of life and assuming roles. (4) "Rekindling hope", which includes gaining hope, self-motivation, and explore actively. (5) "Rebuild self", which includes strengthen self-esteem, adjusting identity, and regaining dignity. The positive factors of recovery: include (1) personal support, including self-help beliefs and motivation sources; (2) family support, including psychological support, daily life support, disease management, encouragement or assistance in employment; (3) professional support , including support from occupational therapists and employment specialists; (4) natural support in the workplace, including supervisors, peers and other staff; and (5) social support, including good accessibility of employment-related resources and good accessibility of medical resources. The negative factors of recovery include (1) personal barriers, including mental illness, physical illness and related symptoms, and self-stigma; (2) family barriers, including family members’ disagreement with vocational rehabilitation and not being trusted by family members; (3) workplace barriers, including low trust in staffs of vocational rehabilitation and interpersonal pressure in the workplace; (4) barriers of vocational rehabilitation system, including wages lower than the market, the ratio of manpower requirements for sheltered employment services, and staff service omissions negligence; and (5) society barriers, stigmatization. Finally, based on the results of the research, this study proposes practical, family and policy recommendations for the recovery of people with psychiatric disabilities through vocational rehabilitation, as well as recommendations for future research.