協助精神病人跨越社區生活障礙：康復導向個案管理

Abstract

個案管理是社區精神病人精神照護服務的核心工作，而社區心理衛生中心在新版的精神衛生法中被賦予此項職責。已有明確的個案管理實證研究指出，資源連結模式有其侷限，而有效的元素包含穩固的治療性結盟、外展服務與為其需求提供連續性與整合性的服務。呼應衛生福利政策白皮書「以人為中心，社區為導向，康復為目標」的宣示，本文建議在精神病人個案管理服務中，康復導向應與問題導向並重，採用實證與促進康復的工作方法，並重視社區心理衛生中心對於服務使用者的心理與社會的可近性。方法包括：在分級納入康復的指標、彈性調整外展服務的焦點、將同儕納入個案管理服務中，以及架構社區心理衛生中心各類員工的康復導向在職教育訓練。  Case management is a core service in community mental health care for people with major mental illness and a responsibility granted to community mental health centers by the new Mental Health Act of 2022. Empirical case management studies have reported that limitations exist in broker model. Studies also reveal that effective elements include strong therapeutic alliance, outreach services, and needs-based continual and integrated services in case management process. In response to the White Paper of the National Health and Welfare Policy 2025 in which person-centered, community-oriented, and recovery-targeted care is emphasized, we suggest that case management services targeting people with psychosis be both recovery-oriented and problem-oriented. Evidence-based and recovery-promoting care approaches should be adopted, and emphasis must be placed on the psychological and social accessibility of the community mental health centers to service users. This involves introducing recovery indicators into the client grading system, flexibly adjusting the focus of outreach services, involving peer support and workers in case management services, and establishing recovery-oriented on-the-job education for all employees in community mental health centers.