美國與台灣精神科居家治療服務與團隊的角色功能比較

A Comparison between U S and Taiwan Psychiatric Home Care and Interdisciplinary Role Function

謝伶瑜(Ling-Yu Hsieh) ； 王靜枝(Jing-Jy Wang)

《精神衛生護理雜誌》 2卷2期 (2007/09) Pp. 64-69

https://doi.org/10.6847/TJPMHN.200709_2(2).0008

摘要

慢性精神病患者急遽增加且多數從急性醫療院所出院後仍回歸家中，目前這些患者雖可由地區衛生單位列管，仍有部分為社區醫療無法涉及。因此，銜接醫院與社區差距的居家治療服務之發展勢在必行。台灣因醫療資源的分配不均及相關政策問題與大眾對精神疾病的烙印，使得居家治療服務仍較偏「以醫院為基礎」的服務型態。比起現行美國許多社區精神醫療機構強調以社區為基礎，並廣泛應用積極式社區治療(Assertive Community Treatment, ACT)計畫，我國在推廣及實施以社區為主的精神醫療上仍存相當進步空間。本文的目的為從比較美國與台灣在精神科居家治療服務的發展與現況，融以筆者於精神科居家治療之實務經驗，進而分析兩地區治療團隊中醫師、護士及社工的角色功能差異，期可由先進國家經驗作為借鏡，導引我們思考此領域未來的展望及實務方向。

關鍵字

精神科居家治療 ； 團隊角色功能 ； 積極式社區治療

並列摘要

The number of patients with chronic mental disorders is increasing rapidly and a majority of them return home after being discharged from acute medical settings. Although these patients can be managed by local health offices, some are unable to be integrated as patients of community medical services. Psychiatric home care services, which serve to diminish the gap between hospital and community services, have therefore become crucial. In addition, the stigma attached to psychiatric illness, the uneven allocation of medical resources, and the incomprehensiveness of medical policies constrain the development of psychiatric home care services. The community-based Assertive Community Treatment (ACT) practiced in the United States (US) has become a role model for psychiatric nurses in Taiwan. This study aimed to review the development of psychiatric home care services in Taiwan, and current trends in those services, in comparison with the system in the USA and the progress that it has made. From this comparison, we analyzed the differences in the roles and functions of doctors, nurses and social workers in psychiatric home care services. This article seeks to help Taiwan, through the experiences of the US, to gain hope and direction in developing an integrated system of psychiatric home care services for the future.

並列關鍵字

psychiatric home care service ； team role function ； assertive community therapy