英國精神衛生政策改革與服務輸送

Mental Health Policy Reform and Service Delivery in England

雖然已經有許多文獻論述英國精神衛生政策的改變，相對地僅有少數的研究呈現精神衛生實務人員於政策執行與服務輸送的第一手經驗。透過質性訪談，本文試圖以質性資料呈現當前英國精神衛生照顧的細節及其運作實況。本研究主要發現可歸納為三項主題：第一，在政府經費與夥伴關係的面向上，英國政府試圖提供整合的服務，但實際上精神衛生服務仍然過度強調疾病治療，相對地忽視服務使用者的社會需求。第二，就精神衛生團隊及專業人員的角色而言，跨專業的工作同時帶來了正向與負向的結果。第三，研究參與者認為，英國精神衛生照顧的未來願景在於服務的個別化與服務責信。根據研究發現，作者認為權力的移轉與資源的重分配是兩個重要的關鍵因素，足以實質影響政策改革的結果，並且根本地改變英國服務系統運作的方式。最後，本文也提出四點對臺灣的政策建議。

Although there have been much literature arguing the transformation of mental health policy in England, relatively few studies present mental health practitioners' firsthand accounts of policy implementation and service delivery. Using qualitative interviews, this article intends to qualitatively disclose the details of contemporary mental health care in England and how it actually works in practice. The main findings of the research can be summarised into three themes. Firstly, in the aspect of government funding and partnership, the British government tried to provide integrated services, but it was found that mental health services have over-emphasised illness treatment and relatively ignored service users' social needs. Secondly, in terms of mental health teams and professionals' roles, there are positive and negative sides of interdisciplinary working. Thirdly, visions of mental health care that research participants propose are personalisation of services and service accountability. Based up the research findings, the author argues that power shift and resource redistribution are two critical factors that can substantially influence the result of policy reform and fundamentally change the way the service system operates in England. Finally, four policy implications are also proposed for Taiwan.