伴我路遙遙－－家屬及公衛護理師照護社區精神病患之現況與困境

A Long Way Home: The Current State of Care Provided by Family Caregivers and Public Health Nurses to Persons with Mental Illness in the Community

思覺失調病患為全世界所有疾病中排行第六的高負擔疾病，根據台灣衛生福利部統計，至2013年12月底止領有身心障礙手冊之慢性精神個案者共有122,538人。本文以兩篇真實思覺失調症家庭照顧情境故事為前引，參照國外公衛護理的他山之石指出國內社區精神衛生仰賴公衛護理人員的困境；再以醫院精神科居家護理的實踐經驗分析精神疾病家庭的照顧困境與社區精神衛生照護長久以來只以「疾病照顧取向」為觀點的不足；並從第一個面向—體制性因素及第二面向—社區精神衛生的生活性經驗與體制性服務斷層來討論社區精神復健的推展現況。最後，建議社區中的精神疾病家庭照顧者、疾病經驗者及公衛人員（體制）彼此有一個開放性的對話機會，期待能為疾病經驗者和精障家庭帶來希望與更多的可能性，進而正視社區精神患者的回家之途。

According to Taiwan's Health and Welfare Ministry statistics, Taiwan had a total of 122,538 people who were officially registered as mentally disabled at the end of December 2013. Worldwide, schizophrenia ranks as the sixth most burdensome disease in terms of total expenditures. The present paper uses the two actual care stories of the families of mental illness patients and compares and contrasts these with the community mental illness care models used in other countries. The hospitalbased psychiatric and community-based mental illness care that is practiced in Taiwan presents dilemmas and has long focused on ＂disease-orientated care＂ rather than holistic care. The gap between institutional and community mental rehabilitation services in Taiwan are examined. We recommend that policy makers create an open space for mental illness family caregivers and public health nurses to engage in dialogue in order to effectively integrate the care resources available to community mental illness patients and to break down the care barriers that currently separate community mental illness patients, family caregivers, and public health nurses.