康復之家精障者的復元內涵探討

Abstract

「精神」是一個看不到、摸不著的抽象詞語，對此有著各式的論述與可能性，但當醫生診斷為「精神疾病」的當刻起，對個體的認識則常透由醫療專業所標籤的診斷來理解，於是疾病成了主要的關注焦點，由於醫療模式多視精神疾病為慢性化且預後不佳的疾病，因而令人感到無望。復元的觀點認為疾病只是生命的一部份，即便是「帶病生活」依然能開展屬於「人」的生活與新的可能性。國內雖然深受醫療模式的影響，但仍不時可見令人讚歎的復元者，他們是如何邁向復元？其中蘊涵了那些內涵？尤其近年來康復之家發展蓬勃，諸多精障者在無須長期住院但有返家困難的情況下入住康家，研究者帶著在實務工作中對於這群精障者的牽掛，於是便以康復之家的精障復元者做為本研究所探討的主體，期待藉此達到以下目的： 一、瞭解一些精障復元者的故事與經歷。 二、探討精障者復元的相關影響面向。 三、發掘康復之家對精障者復元的意義。 四、提供「復元觀點」服務處遇之建議。 在研究方法與設計上是採質性研究方法，以深度訪談為主、焦點團體為輔，並搭配訪談大綱及個人基本資料問卷來收集資料，本研究於2006年11月至2007年3月，以滾雪球方式來邀請符合資格的研究參與者，針對其中七位精障復元者的生命故事與經驗，參考Jacobson（2001）的多面向分析為本研究之分析架構。 本研究有以下三個主要發現： 一、復元是多面向的經驗 在自我層面上，復元者的自我狀態並非是靜態的結果，此乃是由被動到主動的轉化過程；系統的面貌多是以疾病照護為主，個體與系統的協調上多是順應以求生存，此外，研究發現藥物與工作對於精障者的復元有其重要性；在他人關係方面，復元為個體向外與他人連結的行動展現，此有賴自然關係下所形成的支持架構；在問題解釋方面，復元者對疾病問題有不同的解釋架構，此是來自於疾病經驗中的反思與體認。 二、康復之家對精障者復元的意義 康復之家提供精障者再生的「家」；此外，康復之家亦扮演精障者邁向復元的中介角色，催化復元的發生。 三、台灣現有之環境仍有諸多不利於復元的因素 台灣的復元概念尚待啟蒙，政策及實務的運用亦有限；再者，國內康復之家深受醫療模式的影響；此外，社會文化仍深受精神疾病的烙印與歧視的影響。 依據研究發現並參考相關文獻與實務經驗，提出以下建議： 一、對實務工作者的建議 與精障者建立伙伴關係，而非只是服務對象；傳遞復元的希望與權能感；非正式支持網絡的架構與整合；加強對轉介康復之家前的入住準備。 二、對政策及方案的建議 建構長期性、個別性且整合性的個案服務系統；提供「復元觀點」的服務處遇方案，如正式雇用精障復元者、提供最小限制性的環境、尊重精障者的認知與選擇權；發展多元化的居住方案；社區復健政策與社會教育的推展倡導；修正福利法規中對於障礙者收入的限制。 三、對未來研究者的建議 對於復元定義與內涵的深入探討；瞭解康復之家以外的精障者之復元經驗；從事歷時性的研究；針對康復之家能否成為一個「家」的後續探討。

Mental illness is regarded to become chronic with poor prognosis. When a person is diagnosed with mental illness, the illness become the main concern of one’s life. According to the recovery perspective, the illness is only one negative part of one’s life, person with psychiatric disorder can still have new possibilities and develop other positive parts of their lives. In the last decade, halfway houses for mental illness people had substantial growth in Taiwan. Many people with psychiatric disorder who had no need to stay in hospital but can’t live with their families, moved to stay in the halfway houses. The author is interested in their way of recovery of people stay in halfway houses. Aims: The aims of this study are: 1. To understand the recovery process of mental illness people. 2. To explore the recovery dimensions of the people with mental illness. 3. To understand the meaning of the halfway house in their recovery process. 4. To provide suggestions for future service and intervention. Research Design: This study began from November, 2006 to March, 2007. The study used qualitative research approach, with in-depth interviews with 7 participants and conducted 2 sessions of focus group. Snowball sampling was used to invite qualified participants. The study used the dimensional analysis of Jacobson（2001）as an analysis framework. Result: The major results of this study are summarized in three parts: 1. Recovery is a multi-dimensional experience. Self, others, the system, and the problem are four dimensions in recovery. The “self” is not a static state, it is a transforming process from passive to active. The “others” is how the individual demonstrated his action to reach out to other people, and now he get his support in these informal relationship. The “system” is to see how the individuals survive in the mental health system with obedience gesture and the study revealed the importance of medication and occupation about their recovery. The “problem” is interpreted differently by participants through their dept self-reflection into their own illness experiences. 2. The halfway house can serve as a substituted “home” for residents, and it plays the role of media for their residents to facilitate their recovery process. 3. As our society and culture are still influenced by stigma and discrimination of mental illness. This study also found out there are many disadvantages for people with psychiatric disorder live in Taiwan’s society. The halfway house program is deeply influenced by medical model. Suggestion: For mental health workers: 1. Establish partner relationship with mental illness people. 2. Empower and instill the hope of recovery to mental illness people.3. Help mental illness people to develop and integrate their informal support network. 4. Enhance their preparation before moving to halfway house program. For policy and service design: 1. Construct a long-term integrated and individualized mental health services. 2. Provide a recovery perspective oriented service programs. 3. Develop a multiple residential program for different needs. 4. Promote community rehabilitation and social education with more active programs. 5. Modify the income limitation of welfare regulations to the people with mental illness. For future research: 1. Explore the definition and contents of recovery from different mental illness people and mental health workers. 2. Understand the recovery experience of non-halfway house residents. 3. Engage in longitudinal research of their recovery experience. 4. Explore the possibility of halfway house to become a recovery 'home'.