成為我生命中的貴人:社會連結對慢性精神障礙者就業歷程的影響初探

Become a Mentor in My Life: A Qualitative Study of Social Ties and Employment Process of Persons with Chronic Mental Illness

王昱翔(YU-HSIANG WANG)

指導教授 ： 劉素芬

國立臺北大學/社會科學學院/社會工作學系/碩士(2016年)

摘要

本論文主要探討社會連結對慢性精神障礙者就業歷程的影響。目前相關外文文獻指出，精障者歷經各個不同的就業時期，精障者發病初期，強連結（如：家人、朋友）是精障者主要的倚靠，直至精障者進入職場後，社會連結將逐漸擴增，弱連結（如：老闆、職場同事）將逐漸給予協助。而我國目前相關文獻皆指出正式就業服務對精障者就業有益處。然而，目前研究卻鮮少以精障者為主體，讓精障者訴說社會連結在其就業歷程中的影響。

本研究以精障者為主體，運用質性研究法對七位已就業的精障者進行半結構式質性訪談，並書寫田野筆記及研究日誌，以補充研究參與者脈絡資料。研究發現，精障者在就業前期，社會連結逐漸萎縮，強連結與精神醫療專業為主要連結，目標在於穩定病情；精障者疾病穩定後，通常採用三種方式進入職場，包括：就業服務、人際關係、自行就業。若精障者在進入職場過程中，有就服員、家人、朋友等社會連結協助，則可更順利地進入職場，且亦有利於往後穩定就業。最後，當精障者逐漸穩定就業後，社會連結將逐漸產生重組、擴張與回饋效應。當精障者開始逐漸與他人建立關係後，社會連結將有機會產生正向回饋循環，幫助精障者逐漸邁向更好的復原狀態。

本研究提出四點建議，（一）對精障者：穩定就醫與服藥，主動求助，並嘗試社會參與（二）對實務工作者：建立以社會連結與優勢觀點並重之服務模式（三）對政府政策：衛政、社政、勞政合力促進精障者就業；促進國民心理健康，邁向精神衛生社區化；培植企業建立員工協助方案（四）對社會大眾：降低對精神病的恐懼；陪伴與傾聽疑似有精神疾病的家人與朋友。對未來研究之展望，建議納入不同性別之已就業精障者，探討社會連結對其就業之影響；亦建議以精障者之社會連結（如：家人、朋友、專業工作者）為主體進行深入探究，以補足本研究不足之處。

關鍵字

就業歷程 ； 社會網絡 ； 社會連結 ； 慢性精神障礙者 ； 復原力

並列摘要

The purpose of the study is to investigate the effect of social ties on the employment process of persons with chronic mental illnesses. Some foreign research has pointed out that the strong ties of those with chronic mental illnesses pose a great influence on their employment processes. After entering the workforce, they receive more and more help from the weak ties. Besides, some previous studies in Taiwan found that psychiatric rehabilitation service, including community psychiatric rehabilitation, may help persons with chronic mental illnesses obtain employment. However, only a few studies have explored how social ties influence the employment process of those with chronic mental illnesses with a quantitative approach. Therefore, the current study adopts a qualitative method to investigate the influence of social ties on the employment process of those with chronic mental illnesses.

There are seven persons with chronic mental illnesses who are currently employed have participated in the study. Three major findings have found in this study. First, the strong ties (e.g. family, friends) and the psychiatry professionals (e.g. psychiatrists) are the main social ties in early onset psychosis. Second, when their symptoms are controlled, three ways were employed to find a job, including employment services, social relationship, and finding a job by themselves. Helping by different social ties (e.g. friends, employment specialists), persons with chronic mental illnesses have better choices to obtain a job and smoothly adapt themselves in the employment environments. Finally, when their jobs are getting stable, the social ties will undergo three stages：restructuring, expansion, and feedback. The social ties will show a “Positive feedback circle”, and facilitate the recovery processes of the chronic mental illnesses.
This study proposes four suggestions. (1) For those with chronic mental illnesses, stable medication and social participation are recommended. (2) For social services workers, using the strength perspective to assess and treat the clients, and improving the “relationship-based skills” in the service are recommended. (3) For social policy makers, three advices are proposed: the collaboration of mental health system, social welfare system, and labor system; the building of community mental health system; and the encouragement of the establishment of employee assistance program (EAP) by the enterprises. (4) For the public, eliminating the fear of psychosis is encouraged. And, listing and company to families and friends who have chronic mental illness is very important.

Finally, two recommendations are given to future studies: (1) Opinions from genders should be included. (2) In order to get comprehensive phenomena of the employment process of persons with chronic mental illnesses, social-tie-based qualitative approaches are suggested.

並列關鍵字

Employment Process ； Social Networks ； Social Ties ； Chronic Mental Illness ； Recovery

參考文獻

于若蓉（2009）。社會網絡與勞動市場表現：台灣資料的分析。台灣社會學，18，頁 95-137。

任麗華 （2011）。影響精神障礙者就業之重要因素分析。中華心理衛生學刊， 24（1），頁1-23。

吳秀照（2007）。台中縣身心障礙者就業需求: 排除社會障礙的就業政策探討。社會政策與社會工作學刊，11（2），頁148-197。

沈詩涵、林萬億（2012）。精神障礙者在就業服務中的復原與復健。東吳社會工作學報，24，頁 79-116。

范珈維、張彧、潘璦琬（2007）。精神障礙者重返工作之因素探討：文獻回顧。臺灣職能治療研究與實務雜誌，3（2），頁 61-71。