我想回家：長期住院精神疾病患者出院回歸家庭與社區之經驗探討

Abstract

本研究為瞭解曾經長期住院後重返家庭生活的精神病患，其出院返家及家庭支持歷程，從中討論病患能夠出院的契機、穩定留在家中生活的因素、還有家屬對於病患的未來照顧安排與規劃。期望透過本研究更清楚看見長期住院精神病人回家之路，以及在家中的生活樣貌，作為相關研究、政策制定與工作單位的參考與建議。本質性研究以深度訪談法，和兩個家庭照顧者、病人進行資料蒐集，分析結果後有針對受訪者與家庭進行後訪，並進一步瞭解醫院社工師的服務觀點以增加多元資料來源。以主題分析法進行資料整理、歸納與分析後，得出以下為研究結果。一、 長期住院病患出院返家契機與條件：主觀條件，需病人與家屬皆有意願達成病人出院返家生活的目標；客觀條件在病人方面，主動出院需病情穩定、功能良好，被動出院則可能因年齡漸長、身體狀況不佳所致；客觀條件在家庭方面，需滿足病人返家後的經濟資源與照顧資源。隨著客觀條件達成越多，家庭的主觀意願也可能會提升。二、 在家中穩定生活之家庭支持樣貌：家庭會在能力範圍內做出些微資源調整，以應對病人返家後可能的挑戰。而病人在家中穩定生活的關鍵，有服藥遵從穩定、家庭經濟狀況穩定、主要照顧者堅定的信念與照顧意願；正式社區資源缺席病患在社區的生活。三、 病人未來的生活與照顧規劃：家庭生命週期不同，對於未來病人照顧規劃會有所不同。相同的是家庭聚焦在照顧所需的經濟安排，以及根據病人的健康狀況評估未來所需資源。後依據研究結果，提出政策與實務建議如下：一、 社區精神復健機構方面：社區精神機構去標籤化，提升病人與家屬使用意願；並且從出院準備服務轉銜至社區復健機構，主動瞭解病人與家庭需求提供相對應的資源。工作者可嘗試以非正式、廣義社區支持，連結病人資源，加強病人的社區及社會支持。二、 擴大支持社區慢性精神病患家庭：政府福利政策增加涵蓋在社區的慢性精神病患及其家庭，並考慮納入慢性精神病患在社區的長期照顧需求，以減輕家庭的照顧壓力；另對於有意願接病人返家，卻受限於經濟限制的家庭，政府應在財務上給予更多補助支持，協助病人在家中可穩定生活。This study aims to understand the process of reintegration into family life for psychiatric patients who have been hospitalized for extended periods, focusing on their discharge and the subsequent support from their families. It discusses the opportunities that enable patients to be discharged, the factors that help them maintain a stable life at home, and the future care arrangements and plans made by their families. The goal is to provide a clearer view of the journey of long-term hospitalized psychiatric patients returning home and their life at home, serving as a reference for related research, policy making, and work units.This qualitative research utilized in-depth interviews with two family caregivers and patients for data collection. Post-interview follow-ups were conducted with the respondents and their families to gain further insights, including the perspectives of hospital social workers to increase the diversity of data sources. Thematic analysis was used to organize, summarize, and analyze the data, leading to the following research results.1. Opportunities and Conditions for Long-term Hospitalized Patients to Return Home:Subjective Conditions: Both patients and their families must be willing to achieve the goal of the patient returning home.Objective Conditions on the Patient's Side: For active discharge, the patient’s condition must be stable and functional. Passive discharge might result from aging or poor physical health.Objective Conditions on the Family's Side: The family must have the financial and caregiving resources necessary to support the patient after their return home. As more objective conditions are met, the family's subjective willingness may also increase. 2. Family Support for Stable Life at Home: Families will make minor adjustments within their capacity to address potential challenges after the patient's return. The key factors for the patient’s stable life at home include adherence to medication, stable family economic conditions, the caregiver’s strong belief and willingness to provide care, and the absence of formal community resources for the patient's life in the community. 3. Future Life and Care Plans for Patients: Family life cycles affect future care plans differently. However, families commonly focus on the economic arrangements necessary for care and assess the required resources based on the patient’s health condition.Based on the research results, the following policy and practical recommendations are proposed:1. Community Mental Rehabilitation Institutions: De-stigmatize community mental institutions to increase the willingness of patients and families to use these services. Transition from discharge preparation services to community rehabilitation institutions, proactively understanding the needs of patients and families and providing corresponding resources. Workers can try using informal and broad community support to connect patients with resources and enhance community and social support.2. Expand Support for Families of Chronically Mentally Ill Patients in the Community: Government welfare policies should cover chronic mentally ill patients and their families in the community, considering the long-term care needs of these patients to reduce family caregiving pressure. For families willing to take patients home but constrained by financial limitations, the government should provide more financial support to help patients live stably at home.