憂鬱症受刑人在監處遇與適應情形之分析

The Analysis of Depression Inmates Treament and Adaptation to Prison Life

黃承章(Chang-Cheng Huang)

指導教授 ： 許春金

國立臺北大學/社會科學學院/犯罪學研究所/碩士(2010年)

摘要

近年來憂鬱症人數激增，醫院門診量與憂鬱症藥物使用量大幅攀升，但是我國刑事司法體系並未對於憂鬱症被告與受刑人提出刑事政策，因此本研究旨在探討憂鬱症受刑人在監處遇與適應之情形，包括配業與作業內容對受刑人的正負面效應；受刑人對教化內容之認同程度與教化對於受刑人之影響如何；戒護是否成為受刑人在監適應之負面因素；憂鬱受刑人接受藥物與心理治療的成效等。並自監所教化，作業，戒護與衛生等科室訪談資料，檢驗受訪之七位受刑人的說法，並參酌文獻資料，以三角檢定法增加內容效度與信度。
研究發現，矯正單位對於憂鬱症受刑人的瞭解不足，憂鬱症病犯問題未受到重視。分析七名受刑人之適應，尚在憂鬱症觀察的個案有五名(其中三位無須服藥，兩位服藥控制不佳)，另外兩名疑似詐病。無服用藥物的兩位適應情形同樣不佳。
目前監獄行政單位認為憂鬱症是醫療問題，教化處遇反而被忽略，而藥物控制依流行學數字檢視也只有50至80%之間，這種藥物治療的成果在醫學上稱為<藥物化人格>。運用認知行為療法改變人格的技術在實務上卻無人力去執行。矯正單位非醫院，憂鬱症受刑人兼具病人與罪犯身分，在解決精神異常的同時，犯罪人格與認知扭曲的問題應該被一併處理。
研究發現，教化課程不符實際需求，也無針對憂鬱症等病犯設計教化課程；藥物治療效果不佳，門診醫師看診人數過多與專任醫師不足；作業內容無助復歸社會，部分作業可能產生負面效果；戒護單位缺乏足夠醫護知識以第一時間解決精神病發作問題。七位受刑人有一人以上詐病取得診斷證明，通過檢審階段，並避過監所調查分類科的心理鑑衡，值得進一步研究防範之道。
根據研究發現建議，調查科與戒護科應落實接收分類調查工作，與建立精神病處置標準作業流程；醫療部分，應在監禁與去機構化之間取得平衡，收容人須全面納入健保問題；作業科部分，職訓應結合作業科，教化科與心理師共同規劃病犯之具有精神復健的作業，監獄將憂鬱症更生人納入全國職業銜接系統，讓國家專業單位統整資源；教化部分，訓練受刑人成為傾聽者協助憂鬱症受刑人對抗憂鬱症，成立匿名憂鬱症治療團體，增編監所心理師與社工師法定員額，以符合先進國家精神衛生標準。
後續研究建議：進行大量憂鬱症受刑人個案研究，並進行量化研究，以釐清憂鬱症病犯在監適應之不利與有利因素。

關鍵字

憂鬱症 ； 做假 ； 精神鑑定 ； 在監適應 ； 受刑人 ； 處遇

並列摘要

Due to the rapid increase in the number of depression patients recently, the load from hospital outpatient clinical service and use of depression drugs have drastically increased. A proper criminal policy has yet to be proposed by the domestic criminal justice system for depressive defendants and inmates. The study is conducted to investigate the in-prison treatment and adaptability of depressive inmates, including the positive and negative effects of job assignment and job content on inmates; the degree at which the inmates identify themselves with the indoctrination and the impact of indoctrination on inmates; whether cuffing will impose a negative effect on the in-prison adaptability for inmates; outcome of medical and psychological treatments for depressed inmates. A triangulation approach was adopted by incorporating information from in-prison indoctrination, assignment, cuffing, and health departments and offices, the testimonies from 7 inmates who were interviewed, as well as relevant literature references to increase the validity and reliability of the content.
It was discovered in the study that the correction facility lacked a profound understanding of depressive inmates and that the Ministry of Justice failed to tackle the issue of depressive criminals. The adaptability of 7 inmates was analyzed in which 5 individuals were still under observation for symptoms of depression (3 of them were not medicated while the other 2 were poorly-controlled by medication) and the remaining 2 individuals were suspected of faking the illness. The other 2 patients who were not under medication also showed poor adaptability.
The prison administration considered depression a medical problem. The issue of treatment was often neglected in the indoctrination. Based on the review of epidemiology figures, drug control was only between 50 to 80%. The medical term for the result of such medical treatment was known as “drug personality”. The first choice of cognitive-behavioral treatment to change the personality of depressive patients was, however, crippled by the lack of manpower. Correction facilities are not hospitals. Depressive inmates are both patients and criminals at the same time, and when being treated for psychological abnormalities should also be corrected for their criminal personality and twisted sense of perception.
The study found that the indoctrination curriculum failed to meet the practical needs and that no specific curriculum was designed for depressive inmates. It was also discovered that, on top of the poor medical treatment outcome, service doctors took on too many patients and the number of specialized doctors was insufficient; the content of the assignments did not assist inmates to re-adapt to society and part of the assignments may have a negative impact on the inmates; the Guard and Control Unit lacked sufficient medical care knowledge and was incapable of treating psychological episodes. Out of the 7 inmates, at least 1 individual faked their illness in order to obtain a diagnosis certificate. The patient(s) passed the preliminary review and avoided the psychological assessment conducted by the facility’s Investigation and Classification Section. A preventive precaution should be further studied in order to avoid the same incident.
According to the study, it was recommended that the Investigation Section and the Guard and Control Section should establish the reception of classification investigation tasks and a standard operation procedure for handling psychological illness. In terms of medical treatments, a balance should be achieved between imprisonment and deinstitutionalization. The National Health Insurance should cover all inmates. In terms of the Assignment Section, job training should work with the Assignment Section, Indoctrination Section and psychiatrists to plan an assignment with psychological rehabilitation function. The penitentiary should include depressive and rehabilitated inmates into the national job bridging system to allow a comprehensive integration of resources by national professional units. As for the indoctrination, train inmates to become a listeners and help depressive inmates fight depression. An anonymous depression treatment group should be established while the quota for in-prison psychiatrists and social workers should be expanded in order to conform to the psychological health standard of advanced countries.
Follow-up research suggestion: An extensive case study of depressive patients and a quantification study should be conducted in order to clarify all unfavorable and favorable factors for in-prison adaptability of depressive inmates.

並列關鍵字

Depression ； Deception ； Prison adaptation ； Mental Insanity ； Inmate ； Treament

參考文獻

邱憶惠，1999，《個案研究：質化取向》。國立高雄師範大學教育系教育研究7期：113-127。

李佳玟，2005，《近年來性侵害犯罪之刑事政策分析》，41-112。

李明濱，2005，《從公共衛生及精神醫療談自殺防治》。

柯慧貞，2002，《憂鬱症的心理因素》，國立成功大學行為科學研究所學生輔導80期，38-51。

許春金，2006，《人本犯罪學》。台北：三民書局。