論精神疾病之強制性醫療處遇 —以精神醫療實務工作者視角切入

Abstract

近年由精神障礙犯罪之社會案件帶動針對精神疾病患者強制性醫療處遇之修法，包含刑法之監護處分及精神衛生法之強制住院及強制社區治療，一方面被視為立法機關對社會矚目犯罪所引發社會議題的積極應對，另一方面實則為國家對於緩和大眾對於特定族群之恐慌與焦慮所進行之國家治理手段。而為討論現行的修法方向及精神醫療實務工作間存在的問題與差距，及實際上面對的阻礙及困境，是否能夠妥善回應涉及精神疾病議題的個人乃至於社會的需求，以及對於降低再犯率的期待等，並考量到處遇策略的形成與場域運作係複雜的現象，且會因個人、社會、文化、媒體等情境脈絡而有不同的影響，處遇信念亦可能因專業養成及個人價值觀有所不同，因此本論文採取現象學分析之研究方法，以深度訪談精神醫療實務工作者之訪談文本檢視我國目前的精神障礙犯罪者處遇制度及處遇措施運作之困難之處，並探討不同專業人士（司法、精神醫療、助人工作者）對於處遇的不同視角與觀察，及在處遇方案上跨領域合作及溝通產生之問題。制度層面而言，以風險評估及再犯預防為核心之再犯危險性要件，與醫療處遇之執行與目標有核心的矛盾與差異，回歸到強制性醫療處遇之本質，監護處分及期間之評估應以可行之治療方案作為依歸。於實踐上，即便在強制框架下，仍應以實踐自主性之醫療處遇為目標，精神醫療之替代性決策相關規範亦須進一步完善。

The amendment of the law on compulsory medical treatment for people with mental illnesses, including the custodial punishment in the Criminal Law and the compulsory hospitalization and community treatment in the Mental Health Law, which is regarded as the legislature's proactive response to the social problems caused by the attention of the society on crimes on the one hand, and on the other hand, it is the means of the state's governance to alleviate the public's panic and anxiety towards the specific ethnic groups. In order to discuss the problems and gaps between the current direction of law revision and mental healthcare practice, the obstacles and dilemmas faced in practice, and whether it is able to appropriately respond to the needs of individuals and even the society involved in mental illness. This thesis adopts the research method of phenomenological analysis to examine the current treatment system of mentally disabled offenders and the difficulties in the operation of treatment measures with the text of in-depth interviews with psychiatric healthcare practitioners. At the institutional level, the recidivism risk element, which is centered on risk assessment and recidivism prevention, has core contradictions and differences with the implementation and goals of medical treatment. Returning to the nature of mandatory medical treatment, the assessment of custodial punishment and duration should be based on feasible treatment plans. In practice, even under a mandatory framework, the goal should still be to realize autonomous medical treatment, and the norms related to alternative decision-making in mental health care should be further improved.