精障個案社區整合照顧模式

Community Integrated Services for Persons with Mental Illness

1950年代後因精神科藥物的進步，對待精神病人的方式不再只能是被拘禁隔離，而有許多社區支持方案應運而生，然而對精神疾病的污名化卻是古今中外皆然，也造成社區模式推展的困難。國家對防治精神疾病制度的設計及如何創造出一個友善的、支持的社會環境，是在「精神衛生法」及「身心障礙者權益保障法」重新修正通過的今天，全民將共同面對的挑戰。本文從檢討20多年來精神醫療服務的發展及和病人與家屬需求間的落差，醫療資源的配置、法令對精神醫療服務體系模式的界定及執行策略，來看政府應如何落實照顧80%在社區生活的病人，達到「支持並協助病人於社區生活」的目標。

Anti-psychotic medications have changed the lives and treatment of persons with mental illness for the better since the social isolation of the 1950s and earlier. Community support programs break down barriers surrounding mental patients, but the stigma and negative attitudes about mental illness continue to block the development of community-based services. Individuals struggling to overcome a mental health issue find themselves facing a constant series of rejections and exclusions. Now that the Mental Health Law and Physically and Mentally Disabled Citizens Protection Act have been amended by The Legislative Yuan, the government will need to review the design of the Mental Health Care Network Project and to promote and facilitate friendly supportive communities for the mentally ill. All of us have to face these challenges to find a new balance between the civil rights of the public and the mentally ill. This paper examines issues concerning the gap between the development of the mental health system and the needs of patients and their families in the last two decades. The system often falls short of meeting needs. To meet the mental health needs of the people and make effective use of resources, changes must be made in the way services are designed, organized and delivered. The process of reforming mental health services, moreover, must not take money away from other services. Instead, changes must be made by reallocating funds. Following the revised Mental Health Law, the government should begin now to develop implementation planning guidelines to establish a comprehensive and integrated mental health services system, especially for the 80% of patients with mild or moderate mental health problems who live in the community. We will monitor the process carefully, and ensure that patients and their families get the services they need, and help them remain in their communities as far as possible.