台灣精神病人社區化照護仍有一段漫漫長路！精神病人的治療除需要急性期的藥物治療，也需要持續期與穩定期的心理社會復健。這十多年來，為了精神病人社區化照護，國內增設了上百家康復之家、社區復健中心，也開辦許多職業重建訓練、就業輔導、支持性與庇護性就業，但是即使社區復健資源及人力的量能增加，許多精神病人仍停滯在社區精神復健機構，加上近幾年來精神病人社區傷人事件層出不窮，顯示社區精神醫療網仍有許多需要補救的破洞。
台灣精神病人社區照護六大困境
台灣精神醫學會賴德仁理事長表示，目前台灣精神病人社區化照護因醫院到社區之間的照護沒有連續性，缺乏個案管理平台，導致衛政、勞政、社政各種資源整合不足；社區復健機構照護品質需加強，健保給付、評鑑條文需重新修訂，避免社區復健機構的再機構化；現行社區化照護仍非以病人與家庭需求為中心，在賦權增能、鼓勵自主及家庭支持上仍是不足；污名化誤解仍然存在，使得精神病人抗拒與不敢就醫，而穩定者仍無法被社區或雇主友善接納；家屬仍承受長期照顧精神病患責任與負擔，無法得到完整社會支持與資源協助；身心障礙鑑定與需求評估並未完整落實，無法與後續需求與福利資源銜接等六大困境。
賴德仁理事長說，台灣精神病人社區化照護，除要投資增設足夠機動的社區照護團隊，另一方面也要營造友善接納的社區環境；法令、資源要到位，衛政、社政、勞政、警政等跨團隊的合作，精神病人才能更有效的就醫與自立，家屬的負擔才能減輕，引發社會治安的問題才能減少。
康復者說自己的故事、做自己的主人
康復之友聯盟李麗娟理事長說明，過去對精神病人的刻板印象就是他們沒有能力為自己做決定，而多由醫療人員或家人幫他們做決定，這是錯誤的，因為只有他們自己才了解自己想要什麼不要什麼；現在國際的趨勢，也都是鼓勵精神病人周遭的人支持他們自己的決定，而非替他們做決定。
汙名化加重身心狀況 完善社區化照護是關鍵
當精神病人自我汙名化程度越高，其身心症狀越嚴重、失能程度越高、生活品質越差。台灣精神醫學會張家銘秘書長強調，目前的主要精神醫療照護團隊皆在醫院，離開醫院缺乏追蹤關懷訪視與連結，因此要打破目前停滯在社區機構而無法真正回歸社會的困境，社區個案管理團隊的連續性、持續性與與分級機動管理，是一定要建置的，才能重新恢復他們在社區的生活能力。
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There is still a long way to go for community care in Taiwan mental patients! In addition to the need for acute phase medication, the treatment of psychiatric patients requires psychosocial rehabilitation in duration and stabilization. For more than a decade, for the community-based care of mental patients, there have been hundreds of rehabilitation homes and community rehabilitation centers in China, as well as many vocational reconstruction training, employment counseling, supportive and sheltered employment, but even community rehabilitation. The amount of resources and manpower can be increased. Many mental patients are still stuck in community mental rehabilitation institutions. In addition, there have been many incidents of mental wounding in the mentally ill community in recent years. It shows that there are still many holes in the community mental health network that need to be remedied.
Taiwan's mental patient community care six major dilemmas
The Chairman of the Taiwan Psychiatric Association, Mr. Lai Deren, said that the current community-based care for mental patients in Taiwan is not continuous due to hospital-to-community care, and lacks a case management platform, resulting in insufficient integration of resources for health, labor, and social affairs; The quality of institutional care needs to be strengthened. The health care payment and evaluation provisions need to be revised to avoid the re-institutionalization of community rehabilitation institutions. The current community-based care is still centered on the needs of patients and families, empowering and empowering families and families. Support is still insufficient; stigma misunderstandings still exist, making mental patients resistant and afraid to seek medical treatment, while stable people still can not be accepted by the community or employers; family members still bear long-term care for mental patients' responsibilities and burdens, unable to get a complete society Support and resource assistance; physical and mental impairment assessment and needs assessment have not been fully implemented, and can not be connected with the follow-up needs and welfare resources and other six dilemmas.
Chairman Lai Deren said that the community-based care of mental patients in Taiwan, in addition to investing in the establishment of a sufficiently mobile community care team, on the other hand, should also create a friendly community environment; laws and resources should be in place, health, social, labor, With the cooperation of police and other cross-teams, mental patients can seek medical treatment and self-reliance more effectively, and the burden on family members can be alleviated, and the problem of social security can be reduced.
Rehabilitated people say their own stories, be their own masters
Chairman Li Lijuan of the Friends of Rehabilitation Alliance stated that the stereotype of mental patients in the past is that they are incapable of making decisions for themselves, and it is wrong for medical staff or family members to make decisions for them. It is only because they understand themselves. What do you want to do; now the international trend is to encourage people around mental patients to support their own decisions, rather than making decisions for them.
Stigma increases the physical and mental condition. Perfecting community care is the key
When the mental patient is self-poor, the more serious the physical and mental symptoms, the higher the degree of disability and the worse the quality of life. Secretary-General Zhang Jiaming of the Taiwan Psychiatric Association stressed that the current main mental health care team is in the hospital, leaving the hospital lacking follow-up care visits and links, so to break the current predicament in community institutions and can not really return to society, community case management team Continuity, continuity and hierarchical mobility management must be built to regain their ability to live in the community.
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