把生活找回來—演慈康復之家的生活取向服務模式

Abstract

台灣社區復健實踐場域強調「醫療取向」的主流照顧模式，並聚焦在醫療品質管理（機構式照顧）上，此模式阻礙了社區復健應以促進「個體復元」為目的的進步潮流。演慈康復之家從賦權理念出發，賦予個體（住民）支配自己在康復之家中應如何生活的自主權，工作者則積極在背後發揮支撐與促進「個體復元」的力量，並陪伴個體在社區中生活、工作與學習，推動個體去發展自身的生活知識與技能，最終達到「復健治療」目的。\n然而主流醫療規訓知識卻越箍越緊，「我們不專業」成為演慈康復之家揮之不去的夢魘。我陷在主流論述邏輯裡糾纒、辯解而倍感艱辛，卻無法說清楚在地詮釋與發展。本文目的即在整理演慈康復之家的價值理念與工作模式，將我們協助「被精神疾病困住個體」在地生活的想法與作法，進行更完整的論述，期能長出在地的工作知識，以強化在地正當性及抵抗能力。\n本文在方法學上引用詮釋現象學中「生活經驗」的概念，來探究演慈康復之家的生活世界，透過對「偶發事件」與「主題」的掌握，藉此捕捉「行動經驗」的本質與意義，並進一步形構出演慈康復之家工作模式。\n在精神醫學的邏輯裡，個體面臨環境壓力源溢出自身能夠承受的生理脆弱點而致「狂」，其保護因子除了在必要時打針吃藥之外，其實還有很多可為的實踐空間。據此，本文即提問演慈康復之家還可以做什麼？可以怎麼做？為了回應這個提問，本文總結出「支撐個體健康生活」工作架構及服務理念、邏輯與內涵，取名為「生活取向服務模式」並闡明其核心精神與工作原則、生活取向基本假設與取向作為的內涵，以及如何操作生活取向服務模式協助個體回到生命主體找回尊嚴。這個服務模式從個體的改變、發展與成長著手，首先釐清個體的生活目標、偏好及個體「想要怎樣生活／可以怎樣生活」的抉擇，接續的服務則聚焦在提供支撐與協作，以便讓個體學習「可以怎樣自主生活，而不是怎樣被照顧」。\n從實踐行動的過程中，我們看到生活取向服務模式與促進個體復元的世界潮流相呼應，本文也透過在地運作與實踐成果，突顯其與醫療取向復健模式在理念與實際運作上的衝突，最後針對二個取向的基本假設及取向作為，進行比較論述、辯證與總結。

Medical-oriented care models are the mainstream care models for rehabilitation in Taiwan. These models mainly focus on medical quality management (institutionalized care) and lack incentive for promoting “personal recovery.” Yeantsy Supported Group Housing empowers individuals (residents) to take control of their own livelihood in the community and staff members actively provide support and promote “personal recovery.” Staff members accompany individuals as they live, work, and learn within the community and help them acquire useful life knowledge and skills, ultimately achieving the therapeutic goal of rehabilitation. \nAmid the increasing stringency of mainstream medical disciplinary knowledge, “lack of professionalism” has become a lingering nightmare for Yeantsy Supported Group Housing. The institution struggles to grasp and debate about the logic of mainstream discourses, failing to clarify local hermeneutics and development. This study organized the values and work patterns of Yeantsy Supported Group Housing and provided a complete discourse of the institution’s views and efforts in helping “individuals suffering from psychiatric disorders” in order to develop local working knowledge and reinforce local legitimacy and resilience.\nThe lived experience concept in hermeneutic phenomenology was adopted to explore the community of Yeantsy Supported Group Housing. “Incidents” and “themes” were observed to elucidate the nature and meaning of “experiences of action” and develop a suitable working model for Yeantsy Supported Group Housing.\nIn psychiatry, individuals may enter a state of “craze” when environmental stressors overwhelm their tolerance and trigger biological vulnerability. Injection and medication are common forms of treatment (protective factors). However, other viable means are also available. To determine what Yeantsy Supported Group Housing can do for these individuals, we first consolidated the service logic and content of Yeantsy Supported Group Housing to develop the Life-Oriented Service Model. We then expounded the core ideologies, work principles, and the basic assumptions and actions of the proposed service model and how to employ the model to help individuals re-discover themselves and restore their dignity. The proposed service model focuses on the changes, development, and growth of individuals. Staff members should first elucidate the life goals, preferences, and life choices of the individuals, and then focus on providing support and assistance, thereby enabling them to learn to live for themselves rather than being cared for by others.\nThrough practice, we validated that the Life-Oriented Service Model conformed to the world trends of promoting personal recovery. Local operation and implementation outcomes highlighted the differences in the theoretical and practical applications between the proposed model and those of conventional medical-oriented rehabilitation models. Finally, we compared discourses, debates, and summaries based on the basic assumptions and actions of the two orientations.\nKeywords: Supportive housing, Personal recovery, Life orientation, Medical discourses, Hermeneutic phenomenology