台灣精神醫療社會工作專業發展與危機

The Professional Development and Crisis in Psychiatric Social Work in Taiwan

台灣現代精神醫療制度與精神醫療社會工作幾乎同時發展，戰後台灣精神醫療專業的發展深受歐美影響，強調從生物心理社會(biopsychosocial)層面的評估治療，發展精神醫療團隊，提供完整的疾病醫療照護。精神醫療社工的發展，提供專業與慈善服務，開啟台灣現代社工專業的濫觴。政府推動精神醫療政策，帶動大量專業人員投入醫療體系服務，促成相關專業的專業化發展，全民健保及總額制度衝擊醫療專業，影響專業合作。醫院重視經營績效，專業以證照區隔，積極爭取收費與增加服務項目，社會工作從精神醫療相關專業漸漸偏向醫療行政。本文將介紹精神醫療社工的服務內容、精神醫療團隊發展，從專業、專業化角度探討國內醫療專業化的過程，非醫師的醫療專業人員形成醫療體系中的階層，專業化對醫療體系的影響。接著，分析精神醫療社工專業與行政特質。面對專業競爭壓力，作者認為精神醫療社會工作的專業化與證照，將是未來在醫療體系服務必須具備的，同時，社工應積極建構與發展有實證基礎的服務模式、參與法規與政策擬定，強化專業角色。

In 1950s the modern psychiatry and psychiatric social work were almost established at the same time in Taiwan. The social work was first adopted by psychiatric system as the professional. The psychiatric teams provide the comprehensive service for improving the mental health of the Taiwanese.This article will discuss the development of the psychiatric social work and psychiatric team. What are the professional and the process of the professionalization in the psychiatric? The psychiatric social workers are defined as medical administrative staffs, which are providing both administrative and professional service. The mental health policy by the government was separate and custodial before 1900. There is expanding need for social workers after enactment of Mental Health Act and related acts on social welfare in 1990's. The professional developmental were flourish in psychiatric teams.National Health Insurance (NHI) is changing the medical system. However, due to the facts that, psychiatric social worker, the service charge is low and limited, the manpower to number of hospital beds is too high, and half of social workers aren't licensed, the development of professional psychiatric social work in the future is troublesome.In the meanwhile, the high thresholds in the license test were impact the social work identification. The author suggest: Psychiatric social work must emphasis the professional role and establish the psychiatric social work license, to establish the accountability and evidence-based service, to involve the policy advocacy.