強制精神疾病照護之專家意見：質性探索研究

Abstract

自從聯合國2006年通過《身心障礙者權利公約》以來，國際上關於強制精神疾病治療對人權影響的討論越來越多。儘管如此，強制精神醫學治療仍然深深植根於世界各地的精神衛生法規之中。在台灣，強制精神疾病治療採取強制住院和強制社區治療等兩種形式 ，兩者均屬於 2007 年《精神衛生法》的管轄範圍。本研究透過與11 位專家（包括精神科醫生、臨床社會工作者、臨床心理學家）進行了半結構化的定性訪談，瞭解並闡明 2007 年《精神衛生法》之實踐與專家的相關經驗。研究結果揭示了專家對法律標準的解釋與法律本身之間的脫節，精神衛生立法之目的與施行上的落差，以及專家對強制精神疾病治療之人權議題的看法與人權文件中規定的國家義務之間的差異。 最終，本論文認為，國家未能履行其在台灣的人權義務，廢除強制精神醫學治療並為心理衛生服務提供充分支持，讓精神衛生專業人員在實踐心理健康的前線平衡醫療與人權的需求。 雖然廢除強制治療是終極目標，但在實現之前，至少應有相關立法及程序改革，以確保患者權利受到完善的保障，並減輕精神衛生專業人員所承受的壓力。

Since the United Nations adopted the Convention on the Rights of Persons with Disabilities in 2006, recent years have witnessed increasing dialogue around the human rights implications of mandatory psychiatric care. Nonetheless, mandatory psychiatric care remains deeply ensconced in mental health laws across the globe. In Taiwan, mandatory psychiatric care takes the form of mandatory psychiatric admission and mandatory community treatment, both of which fall under the 2007 Mental Health Act. This study aims to elucidate experiences with and perspectives towards the 2007 Mental Health Act in practice, through utilizing semi-structured qualitative interviews with 11 experts (psychiatrists, clinical social workers, and clinical psychologists) working with the system of mandatory psychiatric care in Taiwan. Findings reveal disconnects in expert interpretations of legal criteria, tensions between the intentions and applications of mental health legislation, and disparities in expert perceptions of human rights in mandatory psychiatric care and the state obligations put forth in human rights documents. Ultimately, the state has not fully complied with its human rights obligation to abolish mandatory psychiatric care in Taiwan and provide adequate support for mental health services, leaving mental health professionals struggling to balance medical care and human rights on the frontlines of psychiatric practice. While abolishing compulsory treatment should be the goal, several suggestions for legislative and procedural changes are extrapolated which can help protect patient rights and reduce pressure on mental health professionals before abolishment of mandatory psychiatric care is achieved.