精神病人長期照顧需求、困境與政策建議

Needs, Dilemmas, and Policy Suggestions Related to Patients With Mental Health Long-Term Care

國人平均餘命增加，精神病人也面臨老化，其所需要的長期照顧議題更顯重要。精神病人在長期照顧方面有幾點需求：（一）抗拒污名化；（二）降低照顧者身心與經濟負荷等需求；（三）建構完整長期照顧服務體制；（四）發展合適精神病人長期照顧評估工具。因此在滿足精神病人的需求時，其長期照顧困境有以下幾點：（一）缺乏醫院到社區的連續性照護模式及資源的整合平台；（二）社區復健機構不足及良莠不齊；（三）需以精神病人與其家庭的需求為中心；（四）污名化與誤解仍存在；（五）家屬仍承受長期照顧精神病人的責任重擔；（六）身心障礙評估銜接後續需求的制度尚未建立完整。對應提出幾點政策建議：（一）設置專屬精神長期照顧資訊平台並作資源整合；（二）設置精神病人為主的長期照顧中心部門；（三）培訓足夠的精神長期照顧服務人力；（四）增進精神病人社區融合。期望政府未來政策可以針對精神病人需求，提供長期照顧服務無縫接軌，整合精神社區長期照顧資源，提供合適長期照護評估工具與建置各類精神長期照顧專業人才，邁向精神長期照顧新紀元。

In Taiwan, The increase in life expectancy in Taiwan has increased the incidents of age-related problems among patients with mental illness. Therefore, the needs related to long-term care in mental health are significantly important. These needs include: (1) reducing stigmatization; (2) reducing the physical and economic burden of caregivers; (3) constructing a comprehensive, long-term care service system; and (4) developing assessment tools suitable to the long-term care of patients with mental illness. Moreover, six dilemmas in meeting long-term care needs were identified. These dilemmas include: (1) lack of a model of continuous care and of a platform for integrating hospital and community resources; (2) poor / inadequate service quality provided by certain community rehabilitation institutions; (3) the needs of patient/family centered care; (4) the persistence of stigma and misunderstanding; (5) the heavy burdens borne by family members providing long-term care; and (6) the disconnect between subsequent needs and the disability assessment system. Policy suggestions provided in this article include: (1) establish an inclusive platform for mental health long-term care information and resource integration; (2) construct long-term care centers for patients with mental health conditions; (3) train adequate manpower to provide long-term care services to these patients; and (4) promote community inclusiveness for these patients. In order to enter the era of long-term mental health care, government policy should target long-term care programs to meet the needs of patients with mental health conditions. These programs should include seamlessly integrating services into the long-term mental health care system and the care resources of community mental health, developing suitable assessment tools, establishing a multidisciplinary team of long-term care professionals to provide mental health care.