精障者社區復健模式探討——以台灣地區的四個康復之友為例

精神疾病處遇除了以診斷、症狀控制取向的醫療外，對病情穩定可出院作定期門診者，長期後續的社區復健更是關鍵。一些民間團體嘗試開辦精障者社區復健方案，其中台北縣、市、高雄市及台南市康復之友協會，他們各有特色的主導模式，也發展出不同的社區復健方案營運策略。本研究透過檔案文件內容分析、方案運作參與觀察及知情人士深度訪談，探討：(1)此四個精神病友服務團體社區復健方案之內涵：(2)家屬主導程度不等的康復之友協會之社區復健營運模式，如何與其任務環境交換資源？(3)專業人員在不同的營運模式中扮演何種角色？與家屬權力互動如何？發現北市康的社區復健方案種類最多，地方勞政單位和社政單位的補助是主力；當地方政府財源有限時，中央補助的爭取是另一策略，例如南市康之於勞委會。聯合勸募的專業人事補助，近年也成為各康復之友協會的重要資源。協會創立時與醫療機構的聯結程度，及其後理事長及總幹事是否家屬、理監事中的家屬比例，也都有助於瞭解協會中家屬與專業權力的消長。

The ideal treatment for mental illness covers two parts: symptom-control medication, and follow-up community rehabilitation for out-patients. Among those few local groups which have tried to run community rehabilitation centers in recent years, the mental rehabilitation associations in Taipei City, County, Kaohsiung City and Tainan City are respectively in better development. Different leadership styles also result in various operation stategies. Data collection based on content analyses, participant observation, and in-depth interview accomplished the following research goals: (1) to examine the substances of those community rehabilitation programs operated by these four associations, (2) to uncover the resources exchange strategies of these associations, given different involvement levels of the family members of the mentally ill, (3) to analyze the roles played by the professionals in different operation modes. It is found that Taipei City case has developed various programs, and subsidies from both the labor unit and social unit of Taipei City constitute the major funding source. With limited local government subsidy, the Tainan City case applied for grants from the Labor Commission. Personnel subsidy from the United Way has become a necessary resource for all. Finally, the early linkage with hospital, whether the leader being a family member of the mentally ill, and percentage of family members on the board all make good indicators to predict the power struggle between the professions and the clientel.