去或留？機構化運動的挑戰：以台灣慢性精神障礙者住宿型機構為例

Remove or save? The challenge of the deinstitutional movement: Taking Taiwan's residential institutions for people with chronic mental disorders as an example

我國於2017年將CRPD國內法化，繼之邀請國際專家審查我國實施情況並提出建言，國際專家依據CRPD第十九條針對我國身心障礙福利機構提出逐步使住宿機構及其他規模之特定居住安排予以退場之建議。有鑑於此，本文以精障者為例，從西方國家去機構化運動之發展進程進行回顧，探討北美、歐陸與斯堪地維娜亞半島等不同國家在針對精神醫療實施去機構化之成效。其後回溯台灣機構式照護、精神醫療發展及精障者長期安置三者在歷史脈絡之發展與關聯，再就台灣機構式照護現況與精障者特性，進行深入討論以釐清精障者之需求，探究去機構化之意義及其衍生之個人助理與社區自立生活實施於精障者所面臨之挑戰。
研究發現精神病人縱使病程處於慢性化，依然呈現多樣性之需求，或有病人可回歸社區或家庭，然而實際上國內外之研究已確定縱使經過相當之治療後仍有部分重症精障者仍無法回歸社區需要長期安置照顧服務。職是之故去機構化運動對於精障者宜參考去機構教養化之精神而非全面關閉機構，否則借鏡西方國家經驗只是去機構化變成轉機構化或再機構化而已。因此，去機構化及其衍生之個人助理與社區自立生活，則應視需求審慎評估後實施而非一體適用所有障礙者。

Taiwan legalized the CRPD in 2017, and then invited international experts to review my country’s implementation and put forward suggestions. According to Article 19 of the CRPD, international experts have proposed to gradually withdraw accommodation institutions and other specific residential arrangements for disability welfare institutions in my country. In view of this, this article takes chronic mental patients as an example, reviews the development process of the deinstitutionalization movement in Western countries, and explores the implementation of deinstitutionalization of psychiatric care in different countries such as North America, Europe, and Scandinavia effectiveness. Later, I reviewed the historical development and connection of institutional care in Taiwan, the development of psychiatric care, and the long-term placement of people with mental disorders, and then conducted in-depth discussions on the status of institutional care in Taiwan and the characteristics of the mentally disabled to clarify the relationship between chronic mental illnesses. Demand, explore the meaning of de-institutionalization and the challenges faced by the implementation of personal assistants and community self-reliance in the implementation of chronic mental illness in Taiwan.
Studies have found that even if the course of the disease is chronic, there is still a need for diversity, or patients can return to the community or family. Therefore, the de-institutionalization movement should refer to the spirit of de-institutionalization for patients with chronic mental illness rather than completely shutting down the institution. Otherwise, based on the experience of Western countries, it will only become tran-institutionalization or re-institutionalization. Therefore, de-institutionalization and its derivative personal assistants and self-reliance in the community should be implemented after careful assessment based on their needs rather than being applied to all barriers.