社區化精神照顧服務之下多重科別就醫現象之研究

The research of medical treatments in different fields under the community mental health care system.

曾盈薰(Yin-Hsun Tseng)

指導教授 ： 蘇文彬

長榮大學/人文社會學院/社會工作學系(所)/碩士(2017年)

摘要

社區化精神照護服務輸送因醫療專科化、精神疾病社會排除等因素，因而造成有關就醫方面的服務提供僅以精神專科醫療照護為主要，而忽略精神康復者多重科別就醫現象全人照護的整合性服務建構。本研究以質性研究進行方式，蒐集精神康復者家屬、社區照護機構中社會工作者及其機構主管訪談資料，勾勒出現有社區化精神照護是以照護「疾病」而不是照護「人」服務模式，無法滿足現今少子化、雙老化、離婚等家庭結構鬆散之下的照顧責任轉移，當服務提供者(照護市場) 因精神康復者的多重科別就醫照護需求複雜，欲將照顧責任轉移至一般護理之家、養護機構或者家庭時，常會發生有如燙手山芋般的人球現象。

最後，研究建議除了對家屬做了積極的行動建議有懂得運用社區資源求助、主動積極參照護計畫、建構家屬社會支持網絡之外；同時對服務提供者服務模式，除了給予建構多重科別就醫共同照護專業知能，也要提供彈性多元服務與運用優勢觀點模式服務等的建議，最後建構多重科別就醫的整合服務有「陪同就醫」、「協調服務資源」走動式服務、提升服務使用可近性與合理性、精神醫療網發揮全人照護功能等。

關鍵字

多重科別就醫現象ㄤ社區化精神照護 ； 精神康復者

並列摘要

The delivery of community-based psychiatric rehabilitation services mainly pays attention to psychiatric care and overlooks comprehensive health care of clients is a result of the specialization of health care and the ostracization of psychiatric illnesses in our society. This study uses a qualitative approach, collecting information from caregivers, social workers and their supervisors at the community-based psychiatric rehabilitation facilities. The data collected indicates that the community-based psychiatric care is disease-centered rather than person-centered, which can not meet the need of our society with low birth rate, high divorce rate and a rapid aging population where young generation becomes the main caregivers of their aging parents and grandparents. Apparently, the family structure is getting loose and the responsibility of the care is shifting in our changing society, service providers tend to refer clients with complicated medical needs to other care facilities or discharge them, dropping them like a hot potato.

Lastly, the study not only offers proactive suggestions to caregivers in the families, such as seeking help, actively involving in service planning, and building family support network, the study also offers suggestions to service providers regarding service modality, such as providing holistic care, as well as flexible and dynamic services, adopting strength-based perspective, and establishing comprehensive care system that includes multiple medical services, including escorting to doctor’s appointments, coordinating service resources, mobile health service, enhancing service accessibility, sensibility, and the psychiatric care network to the maximal function.

並列關鍵字

medical treatments in different fields ； community mental health care system ； people with mental illness

參考文獻

林靜蘭、溫偉鈞、姜喬慧、薛競秀(2010)。難以承受之「礙」:出院精神病患重返 社區所面臨之阻礙。弘光學報，61，26-39。

王育瑜(2002)。障礙者生活想像:照顧與社區生活理念及政策探討。聯合勸募論 壇，1(1)，1-24。

夏曉鵑(2002)。流離尋岸-資本國際化下的「外籍新娘」的現象。台北：唐山出版。

張如杏(2006)。台灣精神醫療社會工作專業發展與危機。台灣社會工作學刊。6， 119-145。

吳淑瓊，江東亮(1999)。台灣地區長期照護的問題與對策，中華衛生公共雜誌。 14(3)，246-255。