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3 i ( )???? (1) (2) (1) (2) (3) 2003 / (2003 )

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7 1996 IOM(Institute of Medicine) Wayne County General Hospital Halfway House v

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15 2001 OECD Health Data GDP ( ) ( ) 1960 () Kennedy Joint Commission for Mental Illness 5

16 and Health NIMH(National Institute of Mental Health) 1963 Community Mental Health Act Aid to Disabled 85% 1963 Mental Retardation Facilities Community Mental Health Centers Construction Act (Community Mental Health Center) 1) 2) 3) 4) 5) () (1970) NIMH 1971 Community Mental Health Movement1973 New York Health Maintenance Organization Act Utilization Reviews 1975 Community Mental Health Centers Amendments 12 ( ) NIMH ECA () (1980) DRGs 1985 Salmon 1984 () (1990) 1990 (dually diagnosed) 6

17 1993 National Advisory Mental Health Council 1996 Mental Health Parity Act (carve-out) (Bennett1991Breakey1996 Domenici1993Frank1996Jensen1998Hales1996Santos, 1995Shern1995) () Psychiatric Rehabilitation Consultants (PRC)National Alliance for the Mentally Ill (NAMI) () Macmillan Royal Commission 1959 Mental Health Act 1963 National Plan for community care () Department of Health & Social Security (DHSS) 1975 White Paper Better Services for the Mentally Ill Audit Commission Better Services for the Mentally Ill () NHS Plan National Institute for Mental Health in England (NIMHE) 7

18 Mental Health National Service Framework (MHNSF) Care Programme Approach (CPA) 2000 Carers and Disabled Children Act 1966 Sabshin (Bennett1991)Breakey 1996 (modern community psychiatry) (cost-effective) (Breakey1996) 8

19 Needs for Care Assessment (NCA) Cardinal Needs Schedule (CNS)Camberwell Assessment of Needs (CAN) Perceived need for Care Questionnaire (PNCQ) ( )

20 1. Bennett, D.H., Freeman H.L.(Ed.). Community Psychiatry. Churchill Livingstone. 1991; Breakey W.R.(Ed.). Integrated Mental Health Services. Oxford University Press 1996; Domenici S P V, Mexico R N. Mental health care ploicy in the 1990s: Discrimination in health care coverage of the seriously mentally ill. J Clin Psychiary 1993;53(3): Frank, R G, Huskamp, H A, McGuire T G, Newhouse J P. Some econommics of mental health carve-outs. Arch Gen Psychiatry 1996;53: Hales, R.E., Yudofsky, S.C.(Ed.). Synopsis of Psychiatry. The American Psychiatric Press 1996; Jensen GA, Rost K, Burton RP. Mental health insurance in the 1990s: Are employers offering less to more. Health Affairs 1998;17(3): Johnson S, Prosser D, Bindman J, Szmukler G. Continuity of care for the severely mentally ill: concepts and measures. Soc Psychiatry Psychiatr Epidemiol 1997;32: Knapp M, Chisholm D, Leese M et.al. Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. Acta Psychiatr Scand 2002;105: Santos, A B, Henggeler, S W, Burns, B J, Arana, G W, Meisler, N. Research on field-based services: Models for reform in the delivery of mental health care to populations with complex clinical problems. Am J Psychiatry. 1995; 152(8): Shern DL, Donahue SA, Felton C, Joseph GR, Brier N. Partial capitation versus fee-for-service in mental health care. Health Affairs 1995; ; 22(3)

21 OECD Health DATA 2001 : 11

22 GDP OECD Health DATA 2001 % % % % % ( ) ( ) ( ) ( ) ( ) ( ) Knapp et.al. EPSILON study 2002,

23 . ---.( 2002/9/3 34 ) () ( ) 1. (Non-hospital care)2. (Care by the community) 3. (Care in the community)(rowland, Zeelan, & Waismann 1992; Ekdawi, Conning, & Campling, 1994) (full lives) (Ekdawi et al., 1994) / (5,305) (13,999) 19,304 (23,000 ) 84% % 0.76 ( ) 9.29 ( ) 13

24 0 ( ) ( ) 1997 Anthony (2002) (Anthony, Cohen, Farkas, & Gagne, 2002, p.2) (WHO, 1996) / (Anthony et al., 2002, p.102) Anthony Liberman (1994) Rutman(1994)

25 ( 1995) Anthony (2002) , (17 ) 4, ( 1992; 1995) (2002) ( ) ,304 ( 1997) 12 15

26 ( 1998) ( ) ( ) (2002) ( )

27 %81% Ellison & Russinova (1999) % 73% 62% 29% (2003 ) ( ) (0.97) DeSisto (1999) 35 Vermont Maine () (recovery) 1990 Anthony et al. (2002) 17

28 / (p.31) recovery (Spaniol et al., 1994)Deegan (1988) (p.57)deegan(1988) % (improved) / (recovered) (DeSisto et a., 1999) () ( ) (ACT) () 18

29 35 25 () 1. 1) (flexibility) / 2) 3) Deegan (1988) (paraprofessional) 4) - 19

30 5) (connection) 6) ( ) 2. 1) / 2) 3) 4) (Russinova, 1999) 1. (1995) 2. (1992) 3. (1997) 4. (2002) 15(2) (1998) 11(4)

31 6. Anthony, W., Cohen, M., Farkas, M., & Gagne, C. (2002). Psychiatric rehabilitation. Boston, US: Center for Psychiatric Rehabilitation, Boston University. 7. Anthony, W. & Liberman, R. P. (1994). The practice of psychiatric rehabilitation: Historical, conceptual, and research base. In Spaniol, L. et al. (Ed). An introduction to psychiatric rehabilitation (pp ). Columbia, MD: International Association of Psychosocial Rehabilitation Services. 8. DeSisto, M., Harding, C. M., McCormick, R. V., Ashikaga, T., & Brooks, G. W. (1999). The Maine and Vermont three-decade of serious mental illness: Longitudinal course comparisons. In Patricia Cohen et al. (ed.), Historical and geographical influences on psychopathology. (pp ). Mahwah, NJ: Lawrence Erlbaum Associates, Publishers. 9. Ekdawi, M. Y., Conning, A. M., & Campling, J. (1994). Psychiatric Rehabilitation: A Practice Guide. New York, NY: Chapman & Hall. 10. Ellison, M. L., & Russinova, Z. (1999). A national survey of professionals and managers with psychiatric conditions: A portrait of achievement and challenges. Boston, US: Center for Psychiatric Rehabilitation, Boston University. 11. Russinova, Z. (1999). Providers hope-inspiring competence as a factor optimizing psychiatric rehabilitation outcomes. Journal of Rehabilitation, 65(4), Spaniol, L, Koehler, M., & Hutchinson, D. (1994). The recovery workbook. Boston, US: Center for Psychiatric Rehabilitation, Boston University. 21

32 22

33 23 (rehabilitation) /

34 24

35 68,763 / 25

36 need () () () 26

37 () () ( ) () () () () () () () () () ( ) ( ) 27

38 28

40 ,713 1,826 30

41 , ,

42 32

43 33 Clark(1984) 1960 Phenothiazine medication (Anon,1984)Hagedorn(1992)

44 () Caplan(1964) () () () () ( ) (1) (2) (3) (4) 34

45 (5) (6) () () --- () (1) (2) 35

46 (3) DIY (4) (5) / / () () () () (sheltered employment) () (supported employment) () (open employment) () 36

47 37 () () (TCL) 1. ( ) a. ( ) b. c. 1. a. b.24 c. d a. ( ) b. c. ( ) 3. a. b a. b a. b. c.

48 ()THERAPEVTIC EXERCISE (1) (2) (3) (4) () (1) (2) (3) SUBLUXATION (4) (5) PHENTHIAZINE ()ELEMENTS OF THERAPEUTIC EXERCISE (1) (2) () (1) (2) () (1) MATS (2) 38

49 () (1) (2) () (1) (2) (3) () ()RECOMMENDG ACTIVITIES () KEABLE(1985) ( ) (KEEP FIT) KEEP FIT SESSION ( ) ( ) (1) (2) (3) ( ) MINAS(1978) (1) (2) 39

50 (3) (4) (5) (6) (7) ( ) (1) (2) ( ) (1) ANDERTON WINTERBANE (2) GELLHARN TWANCE (3) A GYM CLUB FOR PEOPLE WITH MENTAL HANDICAPS (4) BILL ( ) (1) (2) (3) ( ) SESSION KEEP-FIT EXERCISES MAT ROM WARMED UP STRETCHED 5 STAFF WALL BARS ( ) STAFF 40

51 (Empowerment) (Life Style Redesign) 3. ( ) (family to family education) 4. () (1) (2) (3) 7. 41

52 42

53 台灣精神障礙者之社區照護發展理想與實務研討會會議時間九十二年十月二十五日(星期六) 會議地點台北榮總致德樓第一會議室記錄整理蔡淑娟 43

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87 B1 (02) #643 (02) (02) (02) (02) (02) (02) B1 (04) (04) (04) (04) (07) (07) GPN: ISBN:

心理障碍防治（下）.doc

心理障碍防治（下）.doc ( 20 010010) 787 1092 1/32 498.50 4 980 2004 9 1 2004 9 1 1 1 000 ISBN 7-204-05940-9/R 019 1880.00 ( 20.00 ) ...1...2...2...3...4...5...6...7...8...9...10... 11...12...13...15...16...17...19...21 I ...23...24...26...27...28...30...32...34...37...39...40...42...42...44...47...50...52...56...58...60...64...68