探索台北My House機制與網絡 --兼論會員的康復

Abstract

慢性精神病患社區化是台灣從民國60年代起的思維。在30多年的發展下，政府建構了精神醫療網，以及擬定推行相關的政策法令以發展社區精神復健，民間機構也有對應的努力。但近幾年在社區復健的發展中，出現了個別化和多元性不夠的反思。在這樣的反思和需求下，台灣在民國90年後，陸續成立了會所模式，讓精神障礙者有自主選擇的空間。這樣創新的模式在剛起步的情況下，究竟提供了什麼樣的機制和網絡，對當中的會員康復又有什麼樣的助益，是本研究所關心的問題。 本研究以質性研究以回應研究主題，選取台北My House當作研究對象，隨機抽取七位會員和三位工作人員作為訪談對象，輔以參與觀察蒐集資料。研究發現從台北My House的內部交流，談到與社區的交流，而再切回台北My House在會員的康復上所扮演的媒介。 研究結果發現在台北My House內部機制上，會所工作日受限於「維繫會所運作」的責任，而在「提高自我價值」、「促進人際互動」與「培養就業能力」上的發揮都有所限制，也就是「任務取向」與「過程取向」的差異和衝突。在台北My House外部網絡上，目前以發展就業網絡為主，而提供會員其他資源和資訊的連結，與社區採取「和平相處」的態度。台北My House在會員康復上，提供了康復導向的環境、自主選擇的起步，以及支持性網絡發展的空間，但如何幫助會員邁向自立，仍是需要長期努力的部份。 根據研究結果，在會所內部機制、會所外部網絡，以及精神醫療復健體制三方面做出建議，以及提出未來研究建議。

The community-based service for people with chronic mental disability is the thinking traced back to 1970’s. Over the next three decades, the psychiatric medical network was established. Related policy was set up to develop community psychiatric rehabilitations as well. Led by the government, the non-profit organizations also contribute a lot of effort. However, the reflection of the unsatisfied demand on individualization and variety emerged during the recent development. Clubhouse model was established in response to the reflection and demand after 2000’s to provide personal space to choose for people with mental disability. The research is dedicated to look into the mode and network of this new model and the benefits it provides to its members in terms of their recovery. The research applied qualitative research method in response to the theme. Seven members and three staffs of My House, Taipei were randomly selected as the interviewees. Participant observation was also used to collect data. The research finding focused on the interaction within My House, the interaction between My House and community, and the role My House play on the recovery of its members. First, the research indicated that in terms of its inner mode, the work-ordered day of My House is occupied with the responsibility of daily clubhouse operation. As a result, its major tasks such as enhancing self-value, promoting interpersonal interaction and cultivating work ability are limited. It’s referred to the conflict between task-oriented work and process-oriented work. Second, in its outer network, My House has developed the employment network and provides connections with other resources and information to its members. My House holds a “peaceful interaction” attitude toward its community. Finally, My House dedicated itself to the establishment of a recovery-oriented environment, self-choice, and the development of supportive network for the recovery of its members. However, it remains its major concern that how to help its members to achieve independency. Based on the findings, the researcher will provide suggestions on the improvements of the inner mode of the clubhouse, the outer network of the clubhouse, and the psychiatric rehabilitation system. Furthermore, the researcher will make recommendation on future research.