- 研究生：劉緹潔
- 論文名稱：從生態觀點檢視慢性精神障礙者的社區融合
- 指導教授：張恒豪
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關鍵字：CRPD、慢性精神障礙者、支持性決策、嚴重特殊傳染性肺炎、社會排除
- 論文中文摘要
研究發現，在微視系統中，慢性精神障礙者會因病識感不佳、功能受損發展受阻；而家屬採取替代性決策的照顧模式，讓慢性精神障礙者面臨無法自我決策的困境◦而居間系統中，家屬會面臨缺乏心理衛生知識、雙老家庭、缺乏照顧者輪替、經濟不足等困境◦在外部系統中，則面臨缺乏無障礙設施、福利制度不符使用、嚴重特殊傳染性肺炎等環境因素，導致慢性精神障礙陷入社會排除◦最後，鉅視系統中，病態觀點和汙名歧視，讓慢性精神障礙者生活受到言行疾病化、問題醫療化、排擠疏離等歧視對待◦研究分析發現，醫療模式的病態觀點和新自由主義的福利制度，會導致社福補助、無障礙環境及支持系統等多方面不足◦專業人員、家屬、民眾習慣關注於疾病失能，並以醫療解決慢性精神障礙者的生活困境◦長久下來，慢性精神障礙者會因認同汙名標籤轉化為自我汙名◦
研究結論指出，醫療模式的邏輯下，精神障礙者的主體性未被尊重、制度未採納障礙者與家屬需求、服務非依障礙者實際困境設計、習以疾病觀點看待問題◦現有的相關制度缺乏多元發展的精神醫療模式、未能全面規劃的心理衛生服務、未完善的無障礙環境以及服務、僅流於法規制定的反歧視政策等障礙◦導致社區慢性精神障礙者的生活面臨多重限制、家屬因支持不足能量耗竭、精障者面臨多面向社會排除、社區環境未達到實質性平等◦
本研究採用 CRPD 以權利為基礎的人權模式建議，目前慢性精神障礙者與家屬面臨的社會制度障礙◦（一）在尚未廢除強制治療制度前，需確實維護精神障礙者的法律保障，促進發展社區危機處理服務系統◦（二）建立融合教育學習環境及提供精障家屬心理衛生服務◦（三）健全無障礙環境及人力，完善精障家庭照顧支持◦（四）將心理衛生課程納入學校課綱及合作倡議促進完善人權制度◦
- 論文英文摘要
This study was conducted with patients with chronic mental disorder in community rehabilitation centers as the research subjects.The ecological perspective was adopted as the research framework,and the semi structured in-depth interview and participant-as-observer methods were used to collect and analyze data. The study aims to examine the difficulties encountered by people with chronic mental disorders in social inclusion and the limitations imposed by the medical model social system on people with chronic mental disorders.
In the microsystem,people with chronic mental illness have a poor sense of awareness and impaired functioning, and families adopt a substitute decision-making model of care,leaving people with chronic mental illness in a difficult position of being incapable of self-determination. However, in the mesosystem, family members face difficulties, such as lack of mental health knowledge and caregiver rotation,dual elderly families,and inadequate financial resources. Further, environmental factors,such as lack of accessible environment, incompatible welfare system, and the COVID-19 pandemic,lead to social exclusion of those with chronic mental illness.Finally,the pathological perspective and stigma in the macrosystem have led to the discriminatory treatment of people with chronic mental illness in terms of illness and behavior,medicalization of problems, exclusion, and alienation. The pathological view of the medical model and neoliberal welfare system results in deficits in social welfare benefits, accessibility, and support networks. Professionals,families, and the public are accustomed to relying on medical treatment for chronic mental illness; overtime, this results in people with chronic mental illnesses being stigmatized,and they develop self-stigma.
The medical model does not respect the subjectivity of people with mental disabilities or incorporate the needs of people with disabilities and their families.Services are not designed according to the needs of people with disabilities,and the problem is viewed from a disease perspective.The existing system lacks a multidimensional mental health model,comprehensively planned and developed services, an accessible environment, and effective anti-discrimination policies,resulting in multiple restrictions on the lives of people with chronic mental disabilities,depletion of family members owing to inadequate support, social exclusion of people with mental disabilities, and a community environment that is not substantially equal.
This study is based on the Convention on the Rights of Persons with Disorders,which lists the social barriers that people with chronic mental disabilities and their families face today. (1) Before the compulsory treatment system is abolished, it is essential to ensure the legal protection of people with mental disabilities and promote the development of a community-based crisis management service system. (2) An integrated education learning environment should be established, and mental health services should be provided to families with mental disabilities. (3) Accessibility and care support available for families with mental disabilities should be improved. (4)Mental health curriculum should be included in school syllabus, and collaborative initiatives to promote the improvement of the human rights system should be incorporated.
