「精神疾病強制鑑定審查會」運作之探討：以社工委員為例

Dilemma and Reflection on Social Workers in the Mandatory Hospitalization Review Committee for People with Serious Mental Illness

依據2007年所修訂的「精神衛生法」第四十一條規定，嚴重病人經評估後有全日住院治療的需要但不接受時，經由中央主管機關精神疾病強制鑑定審查會審查有全日住院治療之必要者，將強制住院治療。而2007年「精神衛生法」第十五條規定，精神疾病強制鑑定審查會成員（以下簡稱審查會）包括專科醫師、護理師、職能治療師、心理師、社會工作師、病人權益促進團體代表、法律專家及其他相關專業人士。由於此一審查會的設置，使得社工專業得以有一合法發言位置，表達社工專業考量。然而值得關注的是，在審查過程當中，權衡「嚴重病人」以及「自傷傷人之虞」的審查要件經常使得社工委員面臨違反案主自決等原則是可被接受的境況。因此，本文旨在了解社會工作委員在參與審查會過程中所面臨的倫理立場兩難、社工委員在跨專業團隊合作的審查會機制裡所扮演的專業角色以及精神疾患強制就醫實務面的省思，進一步對目前審查會的審查準則提供更完備的建議。

Involuntary admission and treatment for patients with severe mental illness is usually based on the dangerousness to oneself or others. According to Article 15 of Mental Health Act Amendment, 2007 in Taiwan, the decision regarding to involuntary placement of severe psychiatric patients is subjected to review by the Psychiatric Disease Mandatory Assessment and Community Care Review Committee （hereinafter the Review Committee）. The committee members including seven specialists, namely psychiatrists, professional registered nurses, legal experts, occupational therapists, psychologists, psychiatric social workers, and caregiver representatives advocating for patients' rights are involved in this court-like body to check and ensure the criteria for involuntary placement is met. For verifying the responsibilities as a psychiatric social worker committee representative, the purpose of this research is to find out the roles of social worker in the Review Committee and their perspectives on involuntary admission and treatment of severe psychiatric patients. Despite the fact that decision-making process of involuntary psychiatric admission and treatment is a struggle since it is against the patient's will. This study would be important in finding social worker roles on contribution to a full-picture of psychosocial consideration for severe psychiatric patients in the Review Committee.