精神醫療團隊於莫拉克颱風災後心理重建之在地實踐經驗：兼論精神社工專業角色的省思

The Experience of Local Service of a Psychiatric Medical Team to Execute the Project of Psychological Rehabilitation after Typhoon Morakot, and Reflection on the Role of the Psychiatric Social Worker

衛生署以「在地服務」作為規範衛生局和醫事機構執行莫拉克颱風災後心理重建計畫工作項目的原則，然計畫中對於在地服務內涵的說明卻極為有限。本研究一方面藉由文獻耙梳災後心理重建在地服務原則的意涵，另一方面，分析某精神醫療團隊參與莫拉克風災心理重建工作之經驗，以瞭解該團隊實踐在地服務的困境，並反思精神社工扮演的角色。本研究資料分析包括：服務計畫檔案資料、醫療團隊成員和在地工作者的訪談資料。研究發現包括：第一，醫療專業者進入災區服務時，無法調整已習慣的專業視角和服務方式；第二，中央規劃的重建政策將個人創傷與集體創傷分開處理，著重提供物質和短期救助，忽視社區共同體的修補，無助平復集體創傷，更造成二度災難現象；第三，精神社工是協助醫療團隊進入社區的重要橋樑，隨著重建工作進展，在團隊中居於主導角色。本研究建議有二：一是，精神社工將生態和優勢觀點引介給醫療團隊成員，共同思索非傳統醫療場域中的團隊合作模式；二是，加強整合聯繫政府各部門的重建工作，重視集體創傷與個人創傷的關聯性。

Following Typhoon Morakot, the Taiwan Executive Yuan regulated the Department of Health at local authority and hospital level to execute the project of psychological rehabilitation, following the principle of ‘local service'. However, the concept of ‘local service' was illustrated in a somewhat limited fashion. This research study has two aims: on one hand, to clarify the principle of ‘local service' in the project of psychological rehabilitation after the disaster dependent on exploring the documentation; and on the other hand, to analyze the service experience of mental health work teams engaged in the project of psychological rehabilitation following the Typhoon and then recognize the difficulties of providing local services and reflect on the role of the psychiatric social worker. The documents of the service project and interviews with medical team members and local partners were utilized to conduct this research. There were three major findings: firstly, when these medical professionals entered the disaster area, they were unable to adjust their familiar vision and service model; secondly, the central government reconstruction policy treated individual and collective trauma separately, focusing on providing material and short-term assistance and neglecting to repair connections with the community, so that the policy could not in fact contribute to rehabilitation of collective trauma and resulted in a secondary hazard; and thirdly, the psychiatric social worker plays an important role in being the bridge that helps the medical team enter the community, and also take the role of team leader following the progress of reconstruction. This study makes two suggestions: firstly, psychiatric social workers could introduce the ecosystem and strength perspectives to medical team members and assist them in rethinking the teamwork model in non-traditional medical fields together; and secondly, enhance the integration between the various government departments and take the correlations between individual and collective trauma seriously.