精神障礙者與人性尊嚴：社會工作人員觀點

The Social Workers’Perspective on People with Mental Disabilities and the Human Dignity

目的：本研究旨在了解與精神障礙者一起工作的社會工作人員（包括醫療場域的精神社工、社區心理衛生中心的心理衛生社工及自殺防治關懷訪視員）對人性尊嚴概念的理解以及在工作實務上，哪些行為可以促進並維護服務對象尊嚴。方法：本研究採用質性訪談方式，進行資料蒐集，透過立意取樣及滾雪球方式，共有13位與精神障礙者一起工作的社會工作人員參與研究。結果：研究結果顯示，人權概念裡的普世價值、文化相對論以及社會工作基本原則的自主、平等、不歧視、尊重皆是社會工作人員對人性尊嚴概念的多元詮釋。無論是在門診、急性病房、慢性病房等醫療場域或者是社區裡，社會工作人員維護精神障礙者尊嚴的具體作為，可透過傾聽病患需求、尊重病患對藥物的選擇與決策權、根據病患功能退化程度，看見病患需求，確保其意見被理解與自主性、關注兒少病患發展階段，強調意見表達與賦權等形式，來展現社會工作人員對服務對象尊嚴的重視與維護。結論：本研究突顯了社會工作專業是維護精神障礙者尊嚴的重要角色之一，不僅社會工作人員需要覺察與意識到社會工作實務是一項具有道德意義的尊嚴工作，尊嚴維護的專業關係互動也是對精神障礙者因疾病所引發的脆弱性的一種回應。如此一來，才可以在精神衛生服務裡讓精神障礙者感受到自己的價值意義，促進精神障礙者尊嚴的維護與恢復。

Objective: This study aims to understand the perspectives of social workers working with people with mental disabilities (including mental health social workers in medical settings, community mental health center social workers, and suicide prevention care managers.) regarding the concept of human dignity and behaviors that can promote and maintain the dignity of service users in practice. Method: This study used qualitative interviews for data collection. Using purposive and snowball sampling, 13 social workers working with people with mental disabilities participated in the study. Results: The research findings indicate that universal values within the concepts of human rights; cultural relativism; and the principles of autonomy, equality, non-discrimination, and respect within social work principles are diverse interpretations of the meaning of human dignity by interviewees. However, regardless of whether they are in outpatient clinics, acute wards, chronic wards, or in the community, upholding the dignity of people with mental disabilities can be achieved by listening to their needs, respecting their viewpoints and decision-making rights regarding medication based on the degree of functional decline in patients, recognizing their needs, and ensuring that their opinions are understood. Focusing on their developmental stages, social workers seriously consider the opinions of pediatric patients and empower them to reflect on their emphasis on maintaining the dignity of their service users. Conclusion: This study highlights that social work is an important role in maintaining the dignity of people with mental disabilities. Social workers must be aware that social work practice is a work of dignity having moral significance. Moreover, professional interactions that protect the dignity of people with mental disabilities are a response to the vulnerabilities of people with mental disabilities owing to their mental illness. Thus, only mental health services allow people with mental disabilities to feel their own value and significance, thereby promoting and restoring their dignity.