心衛社工處理精神疾病合併成人保護事件結案決策模式之探討

A Discussion of the Closure Decision-Making Model in the Handling of Mental Illness by Mental Health Social Workers in the Context of Adult Protection Cases

為回應社會期待並強化弱勢群體保護，政府積極規劃社會安全網絡機制，並關注涉及精神疾病的複雜社會問題，進而推動心理衛生社會工作；然而，社會工作服務流程從接案、評估、處遇以至於結案，其結案決策顯得格外重要且困難，本文即透過質性深度訪談，釐清社工評估結案時的核心考量與實務挑戰，分析影響決策的關鍵脈絡因素，探尋提升決策品質所需的支持，並嘗試歸納其決策模式，研究發現心衛社工的結案決策誠如受訪談者的經驗反映，常是在「責任與解脫」之間拉扯的歷程，鑲嵌於高度複雜、充滿壓力與倫理張力的實務脈絡中，其決策評估主要環繞於安全風險的動態管理、個案身心功能的穩定性與復原潛力評估及對家庭與社會支持系統承接韌性的檢視；因此，具體建議政府應檢討與優化結案指標與流程設計、積極拓展與整合在地社區資源網絡、研修全國性結案指導原則與評估工具、強化跨部會協調機制與資訊系統整合效能並充實社區心理衛生體系資源與專業人力。

In response to societal expectations and to strengthen the protection of vulnerable groups, the government actively plans social safety net mechanisms and focuses on complex social issues involving mental illness, thereby promoting mental health social work. However, the social work service process, from case reception, assessment, treatment to case closure, makes case closure decisions particularly important and challenging. This article uses in-depth qualitative interviews to clarify the core considerations and practical challenges social workers face when assessing case closure. We also analyze the key factors influencing decision-making, the support needed to improve decision quality, and attempt to summarize decision-making patterns. Research has found that, as reflected in the experiences of interviewees, the decision-making process for closing cases by mental health social workers is typically a tug-of-war between ''responsibility and relief.'' It is embedded in a highly complex, stressful, and ethically charged practical context. The decision-making assessment primarily revolves around the dynamic management of safety risks, the assessment of the stability and recovery potential of the individual's physical and mental well-being, and the examination of the resilience of family and social support systems. Therefore, this paper recommends that the government review and optimize closing indicators and process design, and actively expand and integrate local community resource networks. The government should also study national closing guidelines and assessment tools, strengthen cross-regional coordination mechanisms and information system integration effectiveness, and enrich the resources and professional personnel of the community mental health system.