康復之家前住民回歸社區之生活經驗探究

Abstract

本研究的目的在於瞭解康復之家服務使用主體—康家前住民的經驗，透過探究前住民目前於社區中的生活狀況檢視康復之家經驗於病友生命歷程中之意義，希望可以做為利於病友復原之支持性住所工作模式的參考。因而提出三個研究問題：1. 前住民離開康復之家回歸社區，目前（各面向的）生活狀況為何？2. 前住民離開康復之家至今的生活變化歷程為何？3. 前住民對於過去康家生活的看法與感受為何？又康家經驗對前住民來說意義為何？本研究採深度訪談法，訪談四位康家前住民，並且同時納入精神復健領域專業人員與康家資深實務工作者之經驗及意見，形成與康家住民經驗、研究者詮釋三者間的相互對話。在分析方法上，以類屬分析彙整前住民之經驗故事，包括於社區生活之現況及對過去康家生活的感受與評價，而後統合出康家場域內的復原內涵；並以情境分析為輔建構出故事的脈絡情境，以利讀者閱讀與自我詮釋。研究結果發現：康家住民現今於居住型態、社交網絡、工作與生活安排、家人關係、對自我的了解與壓力因應上均有正向改善，此改善對照住民於康家生活的經驗可以說部分來自康家的正向影響。而前住民對康家生活的觀感則表現於對康家環境的評價、對與人相處的回憶、以及與康家工作人員的互動等。從前住民現在於社區中的生活狀況以及過去於康家的經驗與感受，可以歸納出康復之家於精神復健服務體系中的位置，它們的存在意義為為病友帶來：陪伴、社區融合與社區資源、激發獨立自主與自我決定、回歸社區的促成。透過住民對於康家經驗的描繪，發現對於康家服務住民本身關注的為：工作者的態度、專業人力配置的適足性、康家規範的彈性化以及對住民自主性的尊重，此為現今針對康復之家的評鑑制度中較為不足者。透過此研究，研究者希望可以啟發多元化、更尊重病友自主選擇的支持性住所服務模式之概念，並且期待「回歸社區」之概念能更為彈性與寬廣，不受限於制度規範。

The research goal of this thesis is to provide a reference to those who intend to restructure the current psychiatric rehabilitation service system, especially to establish a more diverse supportive residential model beneficial for the recovery of the mentally ill. Through collecting the experiences of psychiatric halfway house service users, referred as the ex-residents in this thesis, the thesis explores the lives of the ex-residents after they return to the community. The thesis also endeavors to find out what the experiences of staying in halfway houses mean to these psychiatric patients. Next, three research questions are brought forward: 1. The lives of ex-residents after they returned to the community. 2. What are the changes after residents left the halfway houses? 3. When looking back, what do ex-residents look at their lives staying in halfway houses? To discover the answers, Depth Interview is employed in this research, with four ex-residents being interviewed. Moreover, the opinions and experiences gathered from a number of professionals and practitioners are also included, creating an in-depth dialogue between the ex-residents’ experiences, the researcher's interpretation as well as professional views. The Generic Analysis, on the other hand, is conducted, basing on the stories told by the ex-residents, to reexamine the concept of recovery in the context of halfway houses. In addition, the Situational Analysis is at the same time used to organize and weave the story contexts. The analysis presents the following results. There are improvements in ex-residents’ living arrangement, social networking, working status, family relationship, self-understanding and stress coping capacity. The improvements might be the results of the positive influences by the halfway houses the four ex-residents used to stay in. By analyzing stories of ex-residents, a number of aspects are found concerning their life condition in halfway houses, including the environment and atmosphere of the facilities, the memory of mingling with other residents, and the experiences of interacting with the staff. These aspects provide a way for the researcher to evaluate the services at these facilities. From the past experiences as well as their lives in the community at present, the position of halfway houses within the rehabilitation system can be found. For these residents, halfway houses provide them with companions and social resources and serve to initiate their self-motivation and self-determination, eventually leading them to return to the community. Still, there are rooms for improvements, including the attitudes of workers, the sufficiency of manpower, particularly professionals, the flexibility of the disciplines and the respect for residents’ autonomy. Through this thesis, the researcher aims to inspire the establishment of supportive residential service programs that are more diverse and show respect to the autonomy of patients. Furthermore, the researcher expects the concept of ‘recovery’ and ‘returning to the community’ be broadened and in the near future, receive wider understanding, leading eventually to the loosening of the current rigid and limited rules.