運用急性後期整合照護模式處遇多元監護處分之精神疾病病人

Post-Acute Care for Psychiatric Patients Under the Multiple Treatment Mode Provided Under Custodial Protection Sentence Conditions

將急性後期整合照護（post-acute care, PAC）的概念運用於精神科領域，具體的做法即為「全民健康保險思覺失調症醫療給付改善方案」中的「高風險病人出院後追蹤訪視」制度。雖然名稱不同，但其核心精神一致，均為協助病人功能復健、降低再入院風險，並延後機構化照護的時間。PAC概念已廣泛應用於各科別病人，對精神疾病病人亦具實質助益，特別是在我國現行監護處分中的「多元處遇」模式中，發揮了關鍵作用。透過PAC介入，使得受監護處分之精神疾病病人即使不住院，也能獲得延續性的精神醫療支持與社區追蹤服務，強化精神疾病的病情穩定度與社會功能，降低再犯與再入院率，進而使執行機關得以在不剝奪精神疾病病人自由的前提下，兼顧法律監督與精神醫療處遇之需求。故PAC不僅提升處遇成效，更使多元處遇模式得以真正落實於社區層面。本文介紹實務經驗，說明PAC如何運用於受監護處分之精神疾病病人的多元處遇，並建議未來於非住院處遇之監護處分模式中持續強化該制度之應用。

The concept of post-acute care (PAC) has been applied in Taiwan in the field of psychiatry through the“Post-Discharge Follow-Up Visits for High-Risk Patients”system, which is part of the“National Health Insurance Payment Improvement Program for Schizophrenia.”Despite the difference in name, the core principles of this system are the same as those of PAC, namely to support patients in functional rehabilitation, reduce the risk of rehospitalization, and delay the need for institutional care. The PAC model has been widely used across various medical specialties and has proven to be substantially beneficial for psychiatric patients. In particular, PAC plays a crucial role in Taiwan’s current“multiple treatment”model for forensic psychiatric patients sentenced to custodial protection. Through PAC interventions, patients under forensic disposition can receive continuous psychiatric care and community follow-up services even without hospitalization, thereby enhancing patient stability and social functioning, reducing recidivism and rehospitalization rates, and enabling the executing authorities to meet both legal supervision and psychiatric treatment needs without depriving patients of their freedom. Thus, PAC not only improves treatment outcomes but also allows the multiple treatment model to be effectively implemented at the community level. The practical experiences presented in this article illustrate how PAC is applied in the multiple treatment of forensic psychiatric patients sentenced to custodial protection. These experiences recommend increased implementation of PAC in non-hospital-based treatment models.