以社區復健中心建構在地支持生活的行動

The Movements of the Daily Support Life Construction in the Community Psychiatric Rehabilitation Center

精神衛生法定義「社區精神復健」是指為協助病人逐步適應社會生活，於社區中提供病人有關工作能力、工作態度、心理重建、社交技巧、日常生活處理能力等之復健治療。這裡指涉的是社區精神復健所提供的服務內容，目的是協助精神障礙者逐步適應社會生活，但服務內容對於社區精神復健中心的定位仍受限在醫療體制的框架之中；從國際健康功能與身心障礙分類系統（ICF）的精神出發，真正落實促進精神障礙者在社區生活應該思考幾個面向，要如何促進服務對象能夠與社會建立連結？要如何促進在社區生活的能力？要如何協助建構與維持社區生活的網絡？在這個行動過程中，需要不斷反思如何逐漸降低服務使用者對專業體系與工作者的依賴，以恢復個人主體在社區生活的各種獨特樣貌與能力。透過這樣的行動過程，社區精神復健中心可以在既定的精神醫療體制之外，扎根社區生活扮演更積極促進的角色；在狀態呈現疏離隔絕之處，建立主動式的外展訪視連結與生活重建服務；在扎根日常生活之處，透過共同生活，逐步建立與拓展有覺知的經驗與行動；在社區生活中，促進非正式網絡的構聯支持，降低對體系的依賴，促進自立生活發展的可能性。因此，社區精神復健不能僅在復健上著眼，更要促進個人在社區自立自主的生活適應與發展，能夠持續長遠、深層且廣泛的思索與挑戰，建構出真正屬於在地生活的社區支持系統。

Mental Health Act-the definition of the community psychiatric rehabilitation service is help patients adapt community life gradually, and provide rehabilitation therapy, such as work abilities, work attitudes, psychological rebuilding, social skills, self-care abilities etc. for patients. It means what the community psychiatric rehabilitation service provides is to help people with mental disability adapt community life gradually, however, the orientation of community psychiatric rehabilitation center is still limited to the frame of medical system; start from the spirit of International Classification of Functioning, Disability, and Health Professional System (ICF), we should think some aspects to implement people with mental disability in the community, and how to promote service recipients to connect with the community ? How to promote the abilities in the community ? How to help them to build and maintain the connection of community life ? In the process of movements, we need to keep thinking how to decrease the service users' relies on the professional system to recover the uniqueness and abilities of the individuals' subjectivity in the community life. Through the process of movements, the community psychiatric rehabilitation center can be apart from the established medical system, playing an active and promotive role in the community life. We can build active outreach visit connections and life re-construction services in the statement of isolation. Through live together, we can build and extend aware experience and movements in daily life. In the community life, we can promote the support of informal organization to decrease the relies on the system and promote the possibilities of independent living capabilities. Thus, we focus the community psychiatric rehabilitation on not only the rehabilitation but also promoting the individuals' living adaptions and developments in the community, and it can last long-term, deep and widespread thinking and challenges and construct the true community support system of daily life.