賦能精神病人邁向復元──以克服內在汙名化為例

Empowering Persons With Mental Illness to Begin the Recovery Journey: An Example of Overcoming Internalized Stigma

精神病人之內在汙名化是邁向復元的重大阻礙之一，賦能照護服務可克服此困難，然而台灣之精神健康照護依然偏重醫療與復健模式。本篇藉由闡述精神病人之內在汙名化的相關影響與心理效應機轉，以及實證介入措施，佐以臨床經驗倡議專業人員積極運用賦能模式。自我效能與賦能可以中介內在汙名化對生活品質或憂鬱之影響，社會網絡或同儕支持亦有緩和效果。實證之介入包含心理教育、增強動機、自助介入或同儕支持、運用認知行為策略以及目標導向之技巧訓練。賦能照護奠基於科學證據，實踐於自我決定，建構於環境支持。建議專業人員在評估精神症狀與病識感時，可同時評估自我汙名化議題，接著鼓勵病人自我決定並參與治療。而在心理教育或技巧訓練中，可善用復元者同儕之親身經歷，以找出生活上可行之技能與策略，並在連結社區資源時，倡議共同參與者支持病人以實踐自我決策。

Internalized stigma is a significant obstacle encountered on the journey to recovery for persons with mental illness. Services provided through the empowerment model of care have been shown to be effective in overcoming this obstacle. However, the mental health care system in Taiwan continues to focus on providing care using the medical or rehabilitation model. In this article, the related consequences and psychological effect mechanism of internalized stigma in persons with mental illness are presented and evidence-based interventions for internalized stigma are demonstrated. Next, we share the clinical experiences to advocate for the use by professionals of the empowerment model. Self-efficacy and empowerment may mediate the psychological effects of internalized stigma on quality of life and depression, while social networks and peer support may buffer its negative consequences. Related evidence-based interventions include psycho-education, motivation enhancement, self-help or peer-delivered services, and cognitive behavioral model and goal-oriented skill training. Empowerment model services are based on scientific evidence that are practiced under the rubric of self-determination and constructed in supportive environments. When examining psychiatric symptoms in persons with mental illness, professionals may concurrently evaluate for issues related to internalized stigma and encourage those patients with internalized stigma to self-determine and participate in therapy. In psycho-education and skill training therapies, professionals may also apply the lived experiences of peers with recovery to identify and share important knowledge and life skills. When connecting patients to community resources, professionals should encourage stakeholders to help persons with mental illness put their decisions into practice.