| Abstract: | 本兩年期的研究計畫之主要目的在運用文獻蒐集、實證調查、焦點團體等方法，瞭解全國25縣市辦理心理衛生行政工作之現況與困境。並從社會資源的運用、組織結構與專業人力資源的建構、建立成效評量指標等角度，思考提供滿足民眾心理健康需求的不同心理衛生行政模式，以提供作為衛生署未來推動心理衛生行政工作之科學性依據及政策參考方向。第一年計畫重點在於調查全國25縣市政府近3年來所辦理之心理衛生業務及所提供之服務內容與服務量。同時比較各縣市政府與NPO民間組織等投入心理衛生工作之各種資源，並深入分析目前心理衛生工作所遇到的困境，以及提升服務品質之可行方向。研究方法包括次級資料分析、問卷調查、深入面談、地理編碼、焦點團體等。研究對象含蓋衛生局醫政主管、衛生所主任、業務承辦人員、社區心理衛生中心工作人員與離職人員，以及相關醫療與民間機構之負責人、業務主管或承辦人等。一般民眾心理衛生需求評估方面，採用社區論壇(關鍵訊息提供者)、網路與問卷調查等方法，深入瞭解不同縣市地區、群體與性別之社區民眾的心理衛生狀況與需要。心理衛生業務成效評量方面，則是先凝聚共識與徵詢意願之後，選擇試評幾項具有指標性之方案或願意配合之社區心理衛生中心。第二年計畫則是根據前一年各項調查的資源供給與服務現況等結果，以前瞻性思考未來民眾的需要及可能求助方式等相關資料，結合當地或聯結適當資源，提出心理衛生業務未來重點服務項目之建議。首先，持續尚未完成之縣市的民眾心理衛生需求之社區論壇與問卷調查。其次，協助資源不足的縣市召開示範性資源連繫會議，建立起多元之社區心理健康資源整合或跨區支援模式。最後，透過社會指標分析與專家焦點座談方式，建立一個國內首度之社區心理衛生需求指標體系，並整合各項社區民眾心理衛生需求調查之主觀結果，以有效監測全國25縣市社區心理衛生問題之發生率、盛行率、高危險群與其可能發展之途徑，並長期追蹤民眾相關主觀感受的變化趨勢。統計方法在量化方面，除描述統計外，亦進行集群分析、皮爾森積差相關分析、主成份分析、因素分析、多元線性迴歸分析等，質化方法則採歸納與排序方式。
The goal of the two-year research project is to plan and design government’s mental health administration models for the 25 counties and cities all over Taiwan. A multi-method approach, including literature review, social indicators and resources analysis, survey of the organizational structure and professional human resources, community forum, focus group, field survey and the performance assessment, will be adopted in the research. Hope the collected data will shed some lights on the mental health needs of community residents. Based on these important findings, some useful recommendations for research-based planning, evidence-based practice, and mental health policies will be provided for the Department of Health. The arranged works of the first-year research are: (1) To investigate the current status of mental health services of Taiwan’s all 25 counties and cities, including administrative planning, fiscal resources, program evaluation, budget allocations, local resources networks and human resources. (2) To survey government’s mental-health related workers’ opinions on mental health practices and occupational stress and self-efficiency. (3) To use forum, internet and questionnaire to survey community residents in order to understand their perceptions of mental health problems, CMHCs and service needs in some counties/cities. (4) To hold a conference for government’s administrators and planners in order to arrive a consensus of trying the pilot evaluation of community mental health services. (5) To implement a pilot evaluation of community mental health services in some counties/cities. The arranged works of the second-year research are: (1) To use key informants forum, internet and questionnaire to survey community residents in order to understand their perceptions of mental health problems, CMHCs and service needs in some counties/cities. (2) To hold a co-ordination conference to assist some insufficient resources areas to network various human-service agencies and mental health personnel. (3) To analyze the social indicators and to hold a focus group in order to set up useful indicators for planning and an appropriate priority system based on mental health needs in Taiwan.
97年度(第一年)計畫之研究目的為(1)瞭解25縣市政府投入心理衛生業務的資源、新增業務內容及其服務量、資源整合、執行信心、工作壓力、委外方案等現況。(2)瞭解縣市政府心理衛生相關現職、離調職人員與公衛護士在工作上的困難瓶頸、壓力狀況、執行信心與角色功能，及對工作環境、待遇條件與政策方向等之期待或意見。(3)辦理社區心理衛生中心相關人員焦點支持團體。(4)進行民眾心理健康與服務需求之調查。(5)舉辦縣市心理衛生業務試評說明會。(6)進行3縣市心理衛生業務試評計畫之前置工作。研究方法以問卷調查、網路調查(25縣市6090位)、深入訪談與綜合座談為主。研究主要發現與結果如下：(1)各縣市心理衛生工作規劃與執行在行政層級上的歸屬有不少差異。(2)多數縣市無獨立辦公與會議場所，1/2以上有個別諮商室，電話晤談室使用率最高。(3)各縣市實際參與心理衛生工作總人數逐年皆有成長。(4)縣市政府心理衛生業務經費亦呈逐年增加趨勢，但1/2縣市完全依賴中央經費。(5)每位縣市民眾平均所得心理衛生相關經費(94年3.2元，95年3.7元，96年4.7元)，呈逐年成長。(6)各縣市每位工作人員平均管理年度總經費額度也有不同，96年最高與最低相差19倍。(7) 95年各縣市每位精神病患平均獲得衛生署補助經費為每位一般民眾平均獲得經費的221倍，96年更加大為234倍。(8) 94~96年縣市心理衛生經費編列最高的項目皆是「民眾心理衛生宣導與教育」，但逐年下降；「心理衛生專業諮詢(諮商)」經費則呈逐年上升。(9)各縣市各工作項目執行之成長率以「心理衛生研究」最高，「物質濫用防治」與「團體輔導」居次，「危機處置」再次之。(10)各縣市委外項目以「心理衛生研究」最多，「心理衛生專業諮詢(諮商)」次之，以醫療院所與生命線協會為主。(11)各縣市自殺防治重點工作僅在個案通報與訪視，但地方政府是否成立自殺防治中心對提升訪視率沒有太大助益。(12)各縣市處理危機或災難事件繁多，服務方式具多樣性。(13)各縣市物質濫用防治工作有大量成長，但以電訪為主。(14)各縣市專線電話服務量皆有成長。(15)各縣市社區宣導平均場次逐年增加，但平均時數呈逐年縮短，平均參加人次為150人左右。(16)各縣市教育訓練平均場次逐年增加，平均3.6~4.1小時，平均參加人次為60人左右。(17)各縣市資源聯繫會議，94年平均13場19人，95年平均11場19人，96年平均16場15人。資源機構數以台北市最多，台中縣次之。(18)多數縣市已開辦「定點諮商」服務，臨床心理師駐診最多，使用率35%以上，每位平均使用次數1~5次；服務對象以「一般社區民眾」、「精神衛生個案」與「自殺通報個案」為主。(19)各縣市方案評估以過程階段最多。(20)工作人員離(調)職原因，以「工作耗竭」最多。(21)「災難心理衛生」被工作人員評為專業能力與執行信心最低、壓力程度最高的項目。(22)心衛中心現職人員對「待遇與福利」與「工作環境」滿意度均低於離調職人員。心衛中心人員對「心理衛生政策環境」滿意度低於公衛護士。七成以上心衛中心人員對政策環境不太滿意。(23)公衛護士訪視自殺民眾所面臨的困境及問題，以「拒訪」最多。1/7公衛護士「很難走出民眾再度自殺身亡的陰影」。(24) 19縣市衛生局25人參加焦點支持團體，8項議題有22人次發言，辦理成效良好。(25)辦理兩次高雄縣衛生局「定點諮商服務」焦點支持團體，心衛中心及衛生所均有8人參加，辦理成效良好。(26)受試民眾最近生活狀況的整體感受稍高於「有點快樂」，男性顯著低於女性。(27)「經濟」與「工作」是影響受試民眾目前生活整體感受之最重要因素。(28)受試民眾抒壓方式以「找人聊天」與「睡覺」為主，最常求助對象除「朋友家人」外，就是職場同事和同學；「村里長」或「大樓或社區警衛」則是民眾最不可能求助的對象之一。(29)1/2以上受試民眾願意自費求助心理師，其中近九成可接受的費用每小時500元或以下。(30)受試民眾對「心理諮商或心理治療」服務的看法傾向較正面，絕大多數認為這項服務是縣市政府應重視的。(31)只有三成受試民眾聽聞過社區心理衛生中心，得知來源以「衛生所或健康服務中心」最多。不到一成曾參加相關活動或接受過服務。(32)六成受試民眾期待心衛中心能提供「定點諮商或心理治療」服務。七成願意花費單程「30分鐘以內」交通時間。(33)受試民眾覺得「衛生所或健康服務中心」為設置心衛中心最適當地點。(34)受試民眾若使用定點諮商服務之最優先考慮因素為「交通便利性」。(35)舉辦1場次縣市心理衛生業務試評說明會，成效良好。(36)分別完成「職場心理衛生」(台中市衛生局)、「資源聯繫整合」(屏東縣衛生局)與「定點諮商」(高雄縣衛生局)三項試評計畫之第一階段各項工作，總計編製2份需求或滿意度調查問卷，4份定點諮商服務評估表單。基於以上主要發現與結論，本研究亦對委託單位(衛生署)未來推動心理衛生行政工作相關政策，提出諸項建議。
The goals of this research project in 2008 were to (1) understand the administration of mental health services of 25 counties and cities in Taiwan, (2) understand work condition and roles/functions of mental health personnel in local governments, (3) conduct focus groups for CMHC personnel, (4) investigate mental health status and service needs of residents, (5) conduct mental health service pilot evaluation conferences, and (6) implement preparatory work for pilot evaluation in three cities/counties. Questionnaires, internet surveys (25 cities/counties, 6090 participants), interviews, and discussion forums were used. Major findings were: (1) mental health service planning and implementation were done by different administration levels among cities/counties. (2) Independent office areas remained scarce in most cities/counties. About 1/2 had counseling rooms; phone-consulting rooms were most used. (3) Annual growth in mental health personnel number was found in every city/county. (4) Mental health funds increased annually. However, 1/2 of the cities/counties depended fully on federal funds. (5) Mental health service expenditure per person increased annually ($3.2NT in 2005; $3.7NT 2006; $4.7NT 2007). (6) There was variation in the amount of annual funds managed by city/county personnel with difference as great as 16 times in 2007. (7) In 2006, Department of Health subsidized each mental patient 221 times more than an average civilian; the difference grew to 234 times in 2007. (8) In 2005-2007, “public mental health promotion” composed the greatest portion of mental health funds, but with a steady decrease yearly. “Mental health counseling” showed annual increase on funds. (9) “Mental health research” had the highest growth rate among city/county work items, “substance abuse prevention” and “group counseling” the second, and “crisis intervention” the third. (10) “Mental health research” was the most outsourcing programs, “mental health counseling” the second, with hospitals and lifelines as major outsourcing agencies. (11) City/county suicide prevention focused mostly on case reporting and visiting. However, whether local governments established suicide prevention centers had no significant facilitation on visiting rate. (12) Cities/counties handled various crisis events, showing diversity in services. (13) Cities/counties demonstrated large increase in substance abuse prevention work, but mainly on telephone interviews. (14) Hotline services increased in every city/county. (15) Community mental health promotion activities increased annually in number with average of two hours and 150 attendants. (16) City/county educational trainings increased annually in number with average of 4-5 hours and 60 attendants. (17) City/county resource-coordination conferences amounted to 12 meetings with 22 attendants in 2005, 11 meetings with 25 attendants in 2006, and 16 meetings with 20 attendants in 2007. Taipei had the most resources, Taichung the second. (18) Most cities/counties had provided “individual counseling” care with clinical psychologists and with usage rate above 35% and 1-5 visits/client. (19) Program evaluation in cities/counties focused solely on process evaluation. (20) “Burnout” was the greatest reason of mental health personnel for leaving or transferring from the job post. (21) Mental health personnel considered having the lowest professional ability/confidence and the highest stress level on “crisis intervention.” (22) CMHC personnel were less satisfied on “remuneration and welfare” than were those no longer on the job. They also had lower satisfaction level on “mental health policy” than did public health nurses. 70% of CMHC personnel displeased with mental health policy. (23) “Refusal of interview” was the main response of people committed suicide visiting by public health nurses. 1/7 of public health nurses “had difficulties escaping the guilty of death of recurrent suicide clients.” (24) 25 workers from 19 city/county health bureaus joined focus groups speaking 22 times over 8 topics, demonstrating great effectiveness. (25) 8 people from CMHC and health clinics joined focus groups held twice in Kaohsiung County for individual counseling services, showing excellent effectiveness. (26) Research participants rated slightly above “a little happy” on overall life condition, with men significantly lower than women. (27) “Finance” and “work” most influenced the overall feeling of living among participants. (28) Most employed stress-relieving methods were “chatting with others” and “sleep.” Besides “family and friends,” most participants sought help from co-workers and classmates. “District chiefs” and “community securities” were the least possible avenues for seeking help. (29) Over 1/2 of participants were willing to pay for psychologists, with nearly 90% of those willing to pay $500 NT/hour. (30) Participants held positive opinion on “psychological counseling” and agreed greater emphasis on this service by the government. (31) Only 30% of participants heard of CMHC and acquired the information mainly from “health clinics or service centers.” Less than 10% of participants participated in activities or received services from CMHC. (32) About 60% of participants anticipated “individual counseling.” services provided by government. 70% of participants were willing to spend “30 minutes or less” one-way commuting to the site. (33) Most participants agreed the most appropriate location for CMHC was in “health clinics or services centers.” (34) “Traffic convenience” was the first consideration of participants when employing counseling services. (35) One city/county pilot evaluation conference was organized with great success. (36) Researchers completed first-phase preparatory work on three pilot evaluation projects: “workplace mental health” (Taichung City Health Bureau), “resources coordination” (Pingtung County Health Bureau), and “individual counseling care” (Kaohsiung County Health Bureau). Two needs-and-satisfaction questionnaires and four individual-counseling evaluation forms were established. Suggestions to the Department of Health on mental health work and policies are discussed. |
