精神病患社區照顧之省思——社區化或機構化，選擇或困局？

Community Care for Persons with Chronic Mental Illness: A Choice or a Dilemma?

雖然自1960年代起，「去機構化」已成為一普遍之政策取向，然而並不意味其就適合各類精神病患之安排；再者，去機構化能否成功仍有賴完善的社區支持系統之建立。根據鄭泰安的研究結果指出，有86.3%回到社區的精神病患與家人同住；此種結果是家屬的選擇或是無法突破的困局？本文首先透過文獻分析，由服務之連續性與可近性兩方面分別檢視台灣在精神疾病治療層面與社區復健服務體系之現況；同時呈現照顧者所面臨的問題與需要，以及精神病患社區照顧的目標。再者，以實際的社區病患資料（N=244），就病患之社會功能狀況以叢集分析方法（cluster analysis）將病患加以分類。分析結果發現可將病患分為四種類型：全面高度功能（n=38, 15.6%）、高度獨立性與職能（n=62, 25.4%）、全面功能平均（n=88, 36.1%）、及全面低度功能（n=56, 22.9%），並進一步分析各組病患於病患人口變項、病患精神疾病相關變項、照顧者人口特徵與其它脈絡變項、與照顧結果幾方面之差異，以突顯出各類病患之輪廓。最後則由發現討論其對台灣精神病患照顧體系之意涵。

In Taiwan, due to limited resources, about 86.3% of the persons with chronic mental illness (CMI) stay in communities, mainly living with their family members. Did it reflect a choice or a dilemma faced by the caregivers of CMI patients? To understand the situation, this study has two major parts; first, the author addressed the service system, including hospital and long-tern care as well as community rehabilitation services, from the viewpoint of accessibility and continuity of care. Second, using an empirical data (N=244), this study examined the empirical typology of CMI patients based on their social functioning, and developed the profile for each group of CMI patients to reveal the situation of these patients and their caregivers. The analyses generated four distinct groups of persons with mental illness: 1) High SFS in All Aspects (15.6%), 2) High Independence & Occupation (25.4%), 3) Average SFS (36.1%), and 4) Low SFS (22.9%), Especially worthnoting is that the profile of the Low SFS group reveaied that they were high risk tor long-term care due the severity of their behavioral problems and the availability of caregivers' time and energy. The study demonstrated that community care may not be the most appropriate treatment modality for some of the CMI patients, however the caregivers did not have alternatives to choose from but keep the patients in the community. The potential treatment plans for each group of CMI patients based on their profiles and the implications for the community support system for CMI patients were discussed.