社區精神衛生護理的實踐與挑戰

Community Psychiatric Mental Health Nursing: Practice and Challenges

近年社會風險事件頻傳，精神衛生法已修正落實精神疾病病人之社區治療及社區支持，將社區心理衛生中心新增精神病人追蹤照護之公部門角色，以個案管理為整合性服務模式。在此修法契機下，應定位並發展社區精神衛生護理的獨特角色及任務。國家衛生研究院論壇提倡應以復元導向個案管理為整合照護之精神衛生政策。為銜接此政策，筆者國科會計畫發展護理師執行之需求裁量式復元照護方案，執行後對病人復元有顯著成效。隨後亦發展輔助之行動照護平台評估社區精神病人之照護需求、執行復元照護措施及評量成效，可作為具實證基礎之社區精神衛生護理指引。為協助社區精神衛生護理之實踐，本文將闡述主要社區護理情境：精神居家治療護理及社區心理衛生中心、需求裁量式復元導向個案管理模式、社區精神衛生護理師之能力與認證，描繪精神衛生護理學會規劃之社區精神衛生護理師認證；最後提出未來的挑戰及對策，具以促進社區精神衛生照護品質並協助病人邁向復元。

Due to the rising incidence of social risk incidents, the Mental Health Act was amended to provide community treatment and community support for patients with mental illness. Community mental health centers have added a public sector function to follow-up with the care of mentally ill patients using case management as an integrated service model. Under this amendment, the unique role and task of community psychiatric mental healthcare should be framed and developed. The National Health Research Institutes have advocated recovery-oriented case management as a mental health policy. Thus, in line with this policy, the authors developed a need-tailored recovery program led by nurses that has demonstrated significant effectiveness with regard to the recovery of mentally ill patients. Also, a mobile-care platform was subsequently developed to assess the care needs of community-dwelling patients with mental illness, implement recovery-oriented care, and evaluate its effectiveness, which may be incorporated into evidence-based community psychiatric mental healthcare guidelines. To improve the practice of community psychiatric mental health nursing, this article addresses key community nursing contexts, including: psychiatric home treatment and care, community mental health centers, the needs-tailored recovery-oriented case management model, and the roles and certification of community psychiatric mental health nurses promoted by the psychiatric mental health nurses association. Finally, future challenges and strategies are proposed to improve the quality of community psychiatric mental healthcare and to assist patients move from mental disorder to recovery.