台灣地區中高齡嚴重精神障礙症個案使用社區精神醫療資源概況：2002至2013年

Community Mental Health Service Use in Middle- and Old-aged Adults with Severe Mental Illnesses in Taiwan: A Preliminary Descriptive Analysis from 2002 to 2013

目的：面對社會快速高齡化，2016 年政府公布「十年長期照顧計畫 2.0」做為因應。然 當前政策中的「身心障礙者」，並未考量中高齡精神障礙者與因身體疾病導致障礙者需求 的不同。本研究旨在探索此一族群使用社區精神醫療資源的概況。方法：利用健保資料庫 重大傷病檔，本研究描述 2002 至 2013 年，三個不同年齡層（40-49 歲、50-59 歲及 60 歲以 上），嚴重精神障礙症個案使用四種社區精神醫療資源的情形。結果：不論年份、年齡層及 診斷，中高齡個案使用不同社區精神醫療資源的個別比例多在 5% 以下；最常使用的服務為 居家治療 （0.51%-6.18%），次為日間留院 （0.59%-4.88%）、康復之家 （0.07%-4.89%），再次則為 社區復健中心 （0.02%-3.51%）。整體而言，不同服務的使用比例逐年增加，而在不同年齡層 的利用型態和趨勢，也有所不同。高齡個案、診斷為情感障礙症者使用資源的比例較低。結 論：這是第一個針對台灣地區中高齡嚴重精神障礙症個案使用社區精神醫療資源概況的研 究，並進一步討論未來長期照顧政策及相關研究的方向。

Background: The 10-year long-term care 2.0 plan was launched in 2016 in responding to the challenge of a rapidly aging population in Taiwan. But the needs of middle- and old-aged adults with severe mental illnesses (SMI) may remain unmet because of vague universal umbrella of “people with physical and mentally disability.” In this study, we intended to investigate the pattern of community mental health care services (CMHS) use in Taiwan. Methods: Using the nationwide registered catastrophic illness dataset, we described the use patterns of four CMHS across three age groups – 40-49, 50-59, and 60+ years, from 2002 to 2013. Results: Relatively small proportions, mostly below 5%, of middle-aged and older SMI adults accessed different individual services, regardless of years, age groups, and diagnoses. The most frequently used service was home care (0.51%-6.18%), followed by day care hospital (0.59%-4.88%) and halfway house (0.07%-4.89%), and the least community rehabilitation center (0.02%-3.51%). The use had been increased over time with different patterns and magnitudes across age groups in each type of CMHS. Older SMI adults less frequently used CMHS. Furthermore, lower proportions of CMHS use in SMI patients with affective disorders was found as compared with non-affective psychotic disorders. Conclusion: The present report is the fi rst study to delineate the CMHS use in middle-aged and older SMI adults in Taiwan.