A Study of the Operational Situation and Difficulties of Comminity Mental Health Centers in Taiwan －Front-line Workers Viewpoint

• Main Authors: Ching-Teng Yao, 姚卿騰
• Other Authors: Yue-Chune Lee
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/87073947394758534795

碩士 === 國立陽明大學 === 衛生福利研究所 === 95 === Psychological disorder has become more prevalent in the presence of modernization and societal change. Mental health is important in the realm of public health. Taiwan has passed the Mental Health Act in 1990 and since then cities and provinces have established several community mental health centers. It is important to investigate the performance of these centers. This study uses community psychology viewpoint to investigate the operational status as well as difficulties faced and coping strategies used, and aims to provide recommendations and directions for future operation. This study uses the organizational analysis structure developed by Wong & Millette (2002) as the base and modifies it to suit the current situation. Factors that affect the operation of organizations are separated into two major groups, namely internal and external environment. Internal environment include organizational objective, resources, services and delivery and leadership; external environment include political factors, delivery recipients, local resources and organizational cooperation. The main research methods of this study are in-depth interviews with purposive sampling and secondary data analysis. Workers at the centers were selected as subjects, including 14 workers from 9 health departments, 3 workers from 2 hospitals. Secondary data were also used to ensure the completeness of the results. Interviews were tape recorded and organized into texts. Two-tires coding method were used and meaningful concepts were organized into groups and analyzed using the structure mentioned above. The results were compared with those found by secondary analysis and precision of the findings are ensured. Important findings of this study include: Community mental health centers are facing operational difficulties because (1) organizational objectives: unclear objectives and imprecise definition of roles; (2) organizational resources: inadequate personnel, no monitoring system, inadequate central budget and no local budgets; (3) organizational services and delivery: incomplete service provided, overly defined area and ineffectiveness, high burden for suicide preventive works, and unable to perform case management; (4) leadership: misrecognition of local government officials, local chief officials paying inadequate attention, rigid organizational culture that does not allow upward communication,; (5) policy-wise: the central government lacks clear objective and operational strategies, not the primary objective and no continuous policies; (6) delivery and recipients: the public is unaware of mental diseases, and do not know the operation of the centers; (7) local resources: lack of local resources for mental and social welfare, unaware of the operation of the centers; (8) organizational cooperation: departmental selfishness inhibits cooperation. Strategies that the community mental health centers used to deal with these difficulties include (1) local awareness and resources provision; (2) intense publicize to increase recognitions; (3) cooperation among different departments; (4) effective linkage for medical and public resources; (5) provide direct services; (6) to go deeply into community preventive works. This study recommends that in order to provide better community mental health services, the government should immediately form clear policies for community mental health and clarify the structure and models for these centers and to increase resources for the centers and provide direct services. The monitoring system should also be developed and local government should prioritize the works of the centers. Keyword：the community mental health center、front-line worker、community psychology、organizational analysis、operational status、operational difficulty