臺灣地區精神疾病醫療與心理衛生保健工作網之建立

ESTABLISHMENT OF MENTAI HEALTH CARE NETWORK IN TAIWAN: A PROPOSAL

本篇是著者應行政院衛生署的要求所提出的精神疾病醫療與心理衛生保健工作網的構想。把臺灣地區分為北部、中部、南部、東部、臺北市、高雄市等六個地區，指定各地區內的公立、財團法人醫療機構及社區心理衛生中心等主要醫療機構，再加該地區內公立綜合醫院及社會福利特約私人醫院為配合醫療機構，在各醫療機構中或各機構之間建立各種治療服務模式以利病患的流程並給予整體性的醫療服務。各醫療機構應積極與各地區內的公共衛生、心理輔導、社會福利、教育、危機調適等機構之間建立個案的評估、轉介、督導、追踪等工作網以給病患及其家屬在社區內的醫療服務，以預防病情的再發外，進而應督導各機構的工作以利個案的早期發現，早期治療，並協助心理衛生教育的推行。著者並介紹臺北市立療養院與其他醫療機構在臺北市所建立的工作模式及幾年來的業績作為各地區的參考。著者強調精神疾病醫療為整個國家醫療工作網的重要一環，雖然目前精神科療設施及療人員人力相當不足，然醫療網的建立可彌補其不足，發揮羣體力量而提高醫療效果。著者最後建議在衛生署專責行政單位，並在各地方政府成立心理衛生保健諮詢委員會，配合中央政策而全國性推展精神疾病醫療與心理衛生保健工作。

This paper reports a proposal for the establishment of the mental health care network as an integral part of the nationwide medical care delivery system. The total of 14 administrative prefectures and 2 special cities are divided into 6 catchment areas; namely northern, middle, southern and eastern Taiwan plus Taipei city and Kaoshiung city in which all of 16 public mental hospitals, psychiatric units of teaching general hospitals and 4 provincial community mental health centers are assigned as main area treatment centers and having all of 35 government general hospitals and some private mental hospitals under social welfare funds as affiliating treatment centers respectively according to their geographical locations. In each of the catchment areas, various treatment programs are proposed within and/or between each of the main and affiliating treatment centers in order to procide the patients and their families with comprehensive and continuous care. Main treatment centers in each catchment area are required to extend their treatment and care to the community by establishing various service program between each of agencies in community related with mental health such as schools, social welfare agencies, guidance and crisis intervention agencies,. public health stations and general practioners etc. The service programs include in-service training of primary health care workers, general practioners, consultation and supervision of case work and establishment of systems for case referral and follow-up care of the discharged patients in community etc. The programs and care delivery systems developed by the Taipei City psychiatric Center in Taipei city was illustrated as a model for this proposal. In order to develop nationwide mental health care network as reported in this paper, it is recommended that a relevant institute and/or administrative unit be established within the Department of Health of the Executive Yuan, to be responsible for overall planning, evaluation and supervision of the program and also a special committee within the governments of Taiwan province Taipei city and Kaoshiung city respectively as a consultant and guiding body for local governments in carrying out the projects within each of the catchment areas.