從仙人掌咖啡屋歇業論推動慢性精病人復健的阻力

THE CLOSEDOWN OF CAFE' CACTUS: THE RESISTANCE IN THE WAY TO THE REHABILITATION OF CHRONIC PSYCHOTIC PATIENTS

作者等人在推動慢性精神病人復健工作時，曾提出「仙人掌計劃」，其中「仙人掌咖啡屋」由於多重困難，包括社會支持系統的缺乏、被動式的家族支持系統、醫療專業人員的角色過分膨脹以及社會心理上的偏見等，而於民國七十三年九月暫時歇業。為了進一步探討推動慢性精神病人復健的阻力，作者等人進行一份簡單的問卷調查，總共收集257份問卷加以分析整理及比較，結果發現：(1)社區組：教育程度較低，社會經濟地位中下階層多，接觸過精神病人的經驗少，主張「治安對策論」的比例高，認為精神病不能痊癒的多，參與及支持仙人掌咖啡屋的比例少。(2)高醫組（代表醫療系統）：教育程度高，專業人員多，優先考慮捐助精神病人推動復健者少，反對民間團體推動復健者多，對精神病的誤解少。(3)會員及客人組：社會經濟地位中上階層多，接觸精神病人經驗多，主張精神病依病情治療者多，對精神病預後較悲觀，優先贊助精神病人復健者多，以及參與支持仙人掌的比例高。以上三點也是推動慢性精神病人復健的各方阻力，針對以上的各方阻力加以探討，並提出這些阻力必須在政府承擔起主角的條件下，經由社會、家族及醫療專業支持系統的統合與努力，才可望漸漸消除，然後慢性病人復健的目標才可逐漸實現。

The authors had tried a rehabilitation program which led to the openning of a coffee shop ''Cafe' Cactus'' in Kaohsiung in December 1983. Unfortunately, it was closed down in September 1984. In order to elucidate the reasons behind the resistance encountered in carrying on such a program in the community, a questionnaire study was conducted. Among the 257 respondents who completed the questionnaires, there are four demographically different groups: (1) local community group (N=93); (2) medical college group (N=104); (3) members of Kaohsiung's Association of Friends for Mental Rehabilitation (KAFMR) (N=41); (4) guests of cafe' Cactus (N=19). There is a general trend for the respondents to assign a major role to the govermental institution or some other institutionizing organization to take care of the chronic patient despite of their preference of psychiatric-treatment to custodical-care orientation. Those who had some contact or experiences with the mental patients tend to be less pessimistic and more realistic with respect to the rehabilitation program. The fact that the chronic patients do not receive proper and adequate mental health care is acknowledged and analyzed in terms of the resistance and shortcomings in the underlying supporting systems. The cooperation, continuity, and interdependence among the family, social and mental health professional supporting systems are emphasized in order that the resistance might be alleviated.