校園心理健康照護之現況與展望：學校衛生護理人員觀點

Current Status and Future Prospects of Campus Mental Health Care: Perspectives from School Nurs

近年來，兒童和青少年的心理健康指標（如自殺意念、自殺企圖及憂鬱症狀）的盛行率顯著增加，特別是在COVID-19疫情後，社交的隔離、家庭經濟壓力、家人離世的創傷等都導致了兒童及青少年心理健康問題的顯著增加（Racine et al., 2021）。校園心理健康問題因此受到更多關注，及早偵測、評估並給予專業治療或緊急處置變得尤為重要。學校被世界衛生組織認為是兒童和青少年心理健康維護的重要場所。然而，由於學生的認知能力和解決問題的能力較差，在心理健康問題的偵測、促進及自殺風險的緊急處理上，需要校園師長、同儕守門人或心理健康專業者提供心理支持及資源轉介協助。在台灣，主管機關如衛生福利部、教育部、國民健康署及國家衛生研究院等也陸續提出政策或計畫，儘管政策面有相當多的關注及資源導入，但實務面仍有許多需要協調及釐清的議題。學校衛生護理人員作為校園健康的第一線專業人員，經常需要處理校園兒童及青少年心理健康問題的症狀辨識、資源轉介及用藥評估或心理健康促進。然而在實務面和法律面上，學校衛生護理人員在處理校園兒童和青少年心理健康問題時仍面臨困難。因此，本文將從各國學校衛生護理人員聘任/任用制度及工作內涵、各國學校衛生護理在校園心理健康的介入方式及工作內容、台灣學校衛生護理人員面對校園兒童和青少年心理健康照護的現況與困境、以及台灣學校衛生護理人員角色及校園心理衛生工作建議等四個方面，提出文獻查證及實務觀察建議，以為日益嚴重的校園兒童及青少年心理健康問題提供實際解決方案。

In recent years, the prevalence of mental health indicators among children and adolescents（such as suicidal thoughts, suicide attempts, and depressive symptoms）has significantly increased, especially following the COVID-19 pandemic. Social isolation, financial stress, and traumatic family losses have exacerbated mental health issues in this population. Consequently, school mental health issues have gained more attention, and the early detection, assessment, and provision of professional treatment or emergency intervention have become particularly crucial. This is essential for saving high-risk children and adolescents from suicide. The World Health Organization（WHO）recognizes schools as important venues for maintaining the mental health of children and adolescents. However, due to students' limited cognitive abilities and problem-solving skills, the detection of mental health issues, promotion of mental well-being, and emergency handling of suicide risks require support from teachers, peer gatekeepers, or mental health professionals for psychological support and resource referral. In Taiwan, relevant authorities such as the Ministry of Health and Welfare, Ministry of Education, Health Promotion Administration, and National Health Research Institutes have introduced various policies and plans. Despite significant attention and resource allocation at the policy level, practical implementation still faces many coordination and clarification challenges. School nurses, as frontline professionals in school health, frequently handle the identification of mental health symptoms, resource referrals, medication assessment, and promotion of mental health. However, they encounter difficulties in practical and legal aspects when addressing school children's mental health issues. Therefore, this paper provides insights through literature reviews and practical observations from four aspects: the employment systems and job content of school nurses in various countries, the intervention methods and service content of school nurses in school mental health, the practices and challenges faced by school nurses in Taiwan regarding children's mental health care, and suggestions for the roles of school nurses and school mental health in Taiwan. These recommendations will help provide practical solutions to the increasingly severe mental health issues in schools.