司法精神醫療的治療模式與未來展望：聚焦在重症精神疾病之監護處分

Prospects and Current Models of Forensic Psychiatry: Focus on Custodial Protection among Patients with Severe Mental Illnesses

近年，精神疾病病人犯罪案件增加，使司法精神醫學議題受到關注，並促使社會安全網的建構。嚴重精神病人從醫院回歸社區，由於社區精神醫療不足，部分病人觸法進入司法系統。美國各州精神衛生法強調個人自主權，減少強制住院頻率，增加了精神疾病病人觸法的可能性。台灣精神衛生法在2022年12月修訂緊急安置和強制住院程序，並通過警察職權行使法和刑事訴訟法等法規，對精神疾病觸法者進行處遇。本文探討了風險-需求-反應模式、良善生活模式和復元模式在司法精神醫療中的應用，並分享嘉南療養院監護處分的執行方式。最後，提出減少不合宜媒體報導、加強專業司法鑑定、補足戒護人力等建議，以提升司法精神醫療效果，促進SMI病人回歸社區並減少再犯。

The rise in criminal cases involving individuals with mental disorders has highlighted forensic psychiatry and prompted the development of a social safety net. Literature indicates 20-40% of individuals with mental disorders enter the judicial system, with severe mental illness (SMI) patients constituting 9-20% of the prison population. Effective treatments and enhanced human rights have reintegrated SMI patients into the community, but inadequate community mental health services lead some to commit offenses. The U.S. Mental Health Acts emphasize individual autonomy, reducing involuntary hospitalizations and increasing offense likelihood. Taiwan's Mental Health Act revised for emergency placement and involuntary hospitalization procedures in Dec., 2022. The Police Power Exercise Act and Code of Criminal Procedure regulate handling offenders with mental illness. This paper explores the Risk-Need-Responsivity (RNR) model, Good Lives Model (GLM), and Recovery Model (RM) in forensic psychiatry, shares Jianan Psychiatric Center's guardianship practices, and offers recommendations to reduce inappropriate media coverage, enhance forensic evaluations, and supplement custodial manpower to improve forensic psychiatric care, facilitate SMI patient reintegration, and reduce recidivism.