精神病人長期照顧需求、困境與政策建議

Needs, Dilemmas, and Policy Suggestions Related to Patients With Mental Health Long-Term Care

盧美柔(Mei-Jou LU) ； 王助順(Chu-Shun WANG) ； 許倍甄(Pei-Chen HSU) ； 黃芷苓(Chih-Ling HUANG)

《護理雜誌》 68卷2期 (2021/04) Pp. 25-31

https://doi.org/10.6224/JN.202104_68(2).05

摘要

國人平均餘命增加，精神病人也面臨老化，其所需要的長期照顧議題更顯重要。精神病人在長期照顧方面有幾點需求：（一）抗拒污名化；（二）降低照顧者身心與經濟負荷等需求；（三）建構完整長期照顧服務體制；（四）發展合適精神病人長期照顧評估工具。因此在滿足精神病人的需求時，其長期照顧困境有以下幾點：（一）缺乏醫院到社區的連續性照護模式及資源的整合平台；（二）社區復健機構不足及良莠不齊；（三）需以精神病人與其家庭的需求為中心；（四）污名化與誤解仍存在；（五）家屬仍承受長期照顧精神病人的責任重擔；（六）身心障礙評估銜接後續需求的制度尚未建立完整。對應提出幾點政策建議：（一）設置專屬精神長期照顧資訊平台並作資源整合；（二）設置精神病人為主的長期照顧中心部門；（三）培訓足夠的精神長期照顧服務人力；（四）增進精神病人社區融合。期望政府未來政策可以針對精神病人需求，提供長期照顧服務無縫接軌，整合精神社區長期照顧資源，提供合適長期照護評估工具與建置各類精神長期照顧專業人才，邁向精神長期照顧新紀元。

關鍵字

精神長期照顧 ； 需求 ； 政策建議

並列摘要

In Taiwan, The increase in life expectancy in Taiwan has increased the incidents of age-related problems among patients with mental illness. Therefore, the needs related to long-term care in mental health are significantly important. These needs include: (1) reducing stigmatization; (2) reducing the physical and economic burden of caregivers; (3) constructing a comprehensive, long-term care service system; and (4) developing assessment tools suitable to the long-term care of patients with mental illness. Moreover, six dilemmas in meeting long-term care needs were identified. These dilemmas include: (1) lack of a model of continuous care and of a platform for integrating hospital and community resources; (2) poor / inadequate service quality provided by certain community rehabilitation institutions; (3) the needs of patient/family centered care; (4) the persistence of stigma and misunderstanding; (5) the heavy burdens borne by family members providing long-term care; and (6) the disconnect between subsequent needs and the disability assessment system. Policy suggestions provided in this article include: (1) establish an inclusive platform for mental health long-term care information and resource integration; (2) construct long-term care centers for patients with mental health conditions; (3) train adequate manpower to provide long-term care services to these patients; and (4) promote community inclusiveness for these patients. In order to enter the era of long-term mental health care, government policy should target long-term care programs to meet the needs of patients with mental health conditions. These programs should include seamlessly integrating services into the long-term mental health care system and the care resources of community mental health, developing suitable assessment tools, establishing a multidisciplinary team of long-term care professionals to provide mental health care.

並列關鍵字

long-term care in mental health ； needs ； policy suggestion

參考文獻

徐瑀謙、黃莉萍、徐敏芳（2016）．社區精神病人家屬照顧負荷及其預測因子．健康與建築雜誌，3（2），64–71。[Hsu, Y.-C., Huang, L.-P., & Hsu, M.-F. (2016). Burden and predictors among caregivers with mental illness in community. Journal of Health and Architecture, 3(2), 64–71.] https://doi.org/10.6299/JHA.2015.3.2.R7.64

陳伶珠（2011）．雙重老化智能障礙者家庭照顧經驗初探．台灣高齡服務管理學刊，1（1），138–165。[Chen, L.-C. (2011). Phenomena of care experiences of two-generation-elderly families with adults with intellectual disabilities. Journal of Senior Citizens Service and Management, 1(1), 138–165.] https://doi.org/10.29745/JSCSM.201104.0005

劉玟宜、戎瑾如、李坤黛（2012）．社區精神病人之照護需求—系統性文獻回顧．精神衛生護理雜誌，7（2），1–13。[Liu, W.-I., Rong, J.-R., & Lee, K.-T. (2012). A systematic review on care needs of mentally-ill patients in the community. The Journal of Psychiatric Mental Health Nursing, 7(2), 1–13.] https://doi.org/10.6847/TJPMHN.201212_7(2).0002

葉人豪、葉玲玲、黃光華、陳快樂、邵文娟、陳宏（2009）．社區精神分裂症照顧者之需要與負荷探討．精神衛生護理雜誌，4（1），1–8。[Yeh, J.-H., Yeh, L.-L., Huang, K.-H., Tan, H. K.-L., Shao, W.-C., & Chen, H. (2009). Exploring the needs and burdens of caregivers of patients with schizophrenia in the community. The Journal of Psychiatric Mental Health Nursing, 4(1), 1–8.] https://doi.org/10.6847/TJPMHN.200906_4(1).0001

陳姿廷、吳慧菁、鄭懿之（2015）．臺灣精神障礙者手足照顧經驗之初探：以父母照顧經驗做對照．臺大社會工作學刊，31，55–103。[Chen, Z.-T., Wu, H.-C., & Cheng, I.-C. (2015). Preliminary study exploring the middle-age mental illness siblings' caretaking experience in Taiwan: Caring experience compared between parent caregivers and sibling caretakers in families with severe mental illness. NTU Social Work Review, 31, 55–103.] https://doi.org/10.6171/ntuswr2015.31.02