臺灣社區精神復健機構發展近況及興革建議

Recent Developments and Suggestions for the Psychiatric Community Rehabilitation Centers of Taiwan

研究目的：回顧台灣近四十多年來精神復健機構的發展歷史，探討目前設置及服務近況，並審視近年來最重要精神復健的核心概念「復元」，分析目前於精神復健機構實務面與政策面的問題，並提出建議供未來實務照顧和政策擬定的參考。研究方法：經由關鍵字「精神復健」、「康復之家」及「社區復健」搜尋。1980至2019年10月華藝（Airiti Library）、中文電子期刊服務（CEPS）與學位論文服務（CETD）資料庫、政府公開資訊發表文獻（共27篇）及臨床經驗，來描述目前精神復健機構近況、可能問題，並提出興革建議。研究結果：目前台灣精神復健機構的發展規模較四十年前已有大幅的進步，住宿型精神復健機構之設置數量已超過預估需求數量，但仍有少數縣市區域目前尚未開設；日間型精神復健機構的發展可能受到健保給付未合理調增的影響，目前整體的數量未達預估需求量且成長停滯。研究結論：在邁向復元成功時，精神病人的社區精神復健需求是多元的，需要投注更多的資源並加以整合，特別是在各縣市心理衛生中心或進行個案管理，提供病人更積極有效的協助。

Purpose: The objectives of this review are to examine the history of the development of psychiatric rehabilitation institutions in Taiwan over the past 40 years, to explore the current settings and services, and to assess the core concept of the most critical aspect of psychiatric rehabilitation: recovery. We analyzed the practical and political aspects of current psychiatric rehabilitation institutions to propose recommendations for reasonable care and policy development. Methods: We used openly published government information, 27 related publications, and practical experience in the clinical care of patients to describe the current state of psychiatric rehabilitation institutions and to analyze possible problems. Results: The analysis indicated that Taiwan’s psychiatric rehabilitation institutions have made significant progress compared with 40 years ago. The number of residential psychiatric rehabilitation institutions exceeds the estimated demand, although there are still a few counties that have not yet opened institutions. The development of day-care psychiatric rehabilitation institutions may be affected by an unreasonable increase in health care payments. In fact, currently, the number of day-care institutions does not meet estimated demand; growth has stagnated. Conclusions: The needs of patients with psychotic disorders are diverse in terms of mental health rehabilitation services. They require integrated resources, especially the case management system, to provide them with more active and practical assistance.