打破精神疾病污名，我們任重道遠

Cheng-I Yang

doi:10.6847/TJPMHN.202412_19(3).01

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医药卫生 > 预防保健与卫生学
医药卫生 > 社会医学
社会科学 > 心理学

DOI： 10.6847/TJPMHN

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打破精神疾病污名，我们任重道远

Breaking the Stigma of Mental Illness: A Long Road Ahead

杨政议(Cheng-I Yang)

精神卫生护理杂志； 19 卷 3 期 (2024 / 12 / 01) ， P2 - 4

繁体中文;英文 DOI： 10.6847/TJPMHN.202412_19(3).01

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摘要 │ 参考文献 (11)

摘要〈TOP〉

认知（cognition）是影响人们对精神病人的基础理解， 可能正确也可能错误。刻板印象（Stereotype）则是在错误或片面的认知基础上，对精神病人产生的简化与归纳性看法，而污名化（stigma）是刻板印象进一步深化，形成负面情感与歧视行为，造成实际的不公平对待和排斥，三者彼此相关但有层次差异（Jacobs & Quinn, 2022）。这些现象，特别是污名化在社会上造成人们对精神病患的误解与歧视，造成精神病人可能因社会大众的污名化态度而面临各种负面後果，包括遭受各种歧视、失去工作以及被社会孤立，进一步影响他们的自我认同、社会融入，甚至医疗求助（Dubreucq et al., 2021）。照理说，随着社会进步，多年来政府机关制定相关政策与法律、医疗机构卫生教育与宣传、甚至大众传媒正向报导的推动，社会大众对於精神疾病应该有更正确的认识，对於精神疾病污名化的态度也应该改善才是，但两个分别在美国及德国的相关研究都显示，过去数十年，民众对於精神疾病的污名化改善状况，仅在忧郁症有些许进步，对於思觉失调症的污名化则停滞不前，甚至更糟（Pescosolido et al., 2021；Schomerus et al., 2022）。台湾目前欠缺长时间的纵贯性观察，无法得知确切状况，但我们从时而有名人在媒体公开现身说法，坦承自己罹患忧郁症，却仍未曾听闻有人公开袒露有思觉失调症的现象看来，或可窥伺一二。再照理说，受过医护教育，医护人员应对精神疾病患者采取积极、同理且支持的态度，然而，部分医护人员仍可能对於精神疾病存有偏颇的看法，而对精神疾病患者成功康复的可能性持消极及负面态度（Carrara, et al., 2019）。甚者，许多研究指出患有精神疾病的人经常受到医护人员和学生的污名化，从而影响了他们所接受的照护品质，学者认为这是医护人员和学生欠缺相关知识和培训所造成（Riffel & Chen, 2020）。笔者有感而发，将本期主题订为「打破精神疾病污名，我们任重道远」，期许你我做更多的努力，让社会大众及专业人员全面改变对精神病人的污名化态度及对待方式。本期总共收录了一篇专栏稿、两篇研究稿、一篇行政专案以及一篇的个案报告。首先，在我们本期专栏「论投资护理人力创造照护之经济实力」一文中，李选教授与张婷副教授呼应2024年国际护理协会推动主题：有护理师才有未来-护理创造经济实力，呼吁政府及相关单位与团体，肯定护理人员的价值，持续挹注资源，改善护理教育与职场环境，以保护宝贵的护理人力资产。本期的研究稿收录了两篇文章，都与本主题有关，其中，叶和廖（2024）在其「不同社区复元课程设计对护生精神疾病刻板印象之影响」的研究中，发现透过课程教学活动的介入，可以有效降低护生对於精神疾病的刻板印象。而陈等人（2024）在其「电影教学法提升长照学生精神照护同理心之成效：以实体面授、同步远距教学为例」的研究中，也证实了采用实体面授方式的电影教学法能丰富学生学习体验，促进长照学生对精神病患者的同理心。此外，本期所收录的行政专案「提升精神科病房护理师第二代抗精神病长效针剂注射护理技术之正确率」中，作者（潘等，2024）分享了如何运用建立标准作业流程、举办教育训练、制作影片及其QR code，建立稽核制度以及开发练习辅助器，成功提升了护理师注射技术正确率。而在「运用认知行为治疗辅以人际社会节奏治疗於一位反覆自伤的双相情绪障碍症青少女之护理经验」的个案报告中，作者（李和李，2024）则分享其经验，描述如何运用多元介入方式，照护个案复杂的健康问题，协助其恢复健康。

并列摘要〈TOP〉

Cognition serves as the foundation for people's basic understanding of individuals with mental illness, which can be either accurate or flawed. Stereotypes are simplified and generalized views about individuals with mental illness, based on incorrect or biased cognition. Stigma, on the other hand, is a further intensification of stereotypes, leading to negative emotions and discriminatory behaviors, ultimately resulting in actual unfair treatment and social exclusion. These three concepts are interrelated but differ in their levels and nuances (Jacobs & Quinn, 2022). These phenomena, particularly stigma, contribute to misunderstandings and discrimination against individuals with mental illness in society. As a result, individuals with mental illness may face various negative consequences due to the stigmatizing attitudes of the public, including discrimination, job loss, and social isolation. These outcomes further impact their self-identity, social integration, and even their willingness to seek medical help (Dubreucq, et al., 2021). Logically, with societal progress over the years, including the implementation of relevant policies and laws by government agencies, health education and awareness campaigns by medical institutions, and the promotion of positive reporting by mass media, the general public should have developed a more accurate understanding of mental illness, and attitudes toward the stigma surrounding mental illness should have improved accordingly. However, two related studies conducted in the United States and Germany indicate that over the past few decades, improvements in public stigma toward mental illness have been minimal, with only slight progress observed in attitudes toward depression, while stigma surrounding schizophrenia has remained stagnant or even worsened (Pescosolido et al., 2021; Schomerus et al., 2022). In Taiwan, there is currently a lack of long-term longitudinal studies, making it difficult to determine the exact situation. However, from the occasional cases of public figures openly discussing their experiences with depression in the media, contrasted with the absence of individuals publicly disclosing a diagnosis of schizophrenia, one might infer a similar pattern. Additionally, healthcare professionals, having received medical and nursing education, should adopt a proactive, empathetic, and supportive attitude toward individuals with mental illnesses. However, some healthcare professionals may still hold biased views about mental illness and maintain a pessimistic and negative attitude toward the likelihood of recovery for patients with mental disorders (Carrara et al., 2019). Furthermore, numerous studies have pointed out that individuals with mental illnesses frequently experience stigmatization by healthcare professionals and students, which adversely affects the quality of care they receive. It had been attributed this to the lack of adequate knowledge and training among healthcare professionals and students (Riffel & Chen, 2020). Moved by this concern, I have chosen the theme of this issue as "Breaking the Stigma of Mental Illness: A Long Road Ahead." It is my hope that we can collectively make greater efforts to bring about a comprehensive change in the public and professional attitudes and treatment of individuals with mental illnesses. This issue includes a total of one editorial article, two research articles, one administrative project, and one case report. First, in our featured editorial, " Investing in the Nursing Workforce to Build the Economic Power of Health Care" Professor Lee and Associate Professor Chang echo the 2024 theme of the International Council of Nurses: Our Nurses. Our Future. The economic power of care. They call on the government, relevant organizations, and groups to recognize the value of nurses, continue allocating resources, and improve nursing education and workplace environments to protect this vital nursing workforce asset. The two research articles in this issue focus on topics closely related to this theme. Notably, in their study titled " Effect of Different Community Recovery Course Designs on Nursing Students' Stereotypes Toward Mental Illness," Yeh & Liao (2024) found that the integration of course teaching activities effectively reduced nursing students' stereotypes toward mental illness. In their study "Enhancing Empathy in Long-Term Care Students Through Film-Based Teaching: A Comparative Study of In-Person and Synchronous Remote Instruction," Chen, et al. (2024) demonstrated that using film-based teaching methods in an in-person setting enriched students' learning experiences and significantly enhanced the empathy of long-term care students toward individuals with mental illness. Additionally, this issue includes an administrative project titled " Improving the Accuracy of Nursing Techniques for Administering Second-Generation Long-Acting Antipsychotic Injections in Psychiatric Ward Nurses." In this project, the authors (Pan, et al., 2024) share their strategies for improving accuracy through the establishment of standard operating procedures, conducting educational training, producing instructional videos with QR codes, implementing an audit system, and developing practice aids. These efforts successfully enhanced the accuracy of nurses' injection techniques. Lastly, the case report " Nursing Experience in Applying Cognitive Behavioral Therapy Combined with Interpersonal and Social Rhythm Therapy to Care for an Adolescent Girl with Bipolar Disorder and Recurrent Self-Harming Behavior " by Lee and Lee (2024) offers insights into their experience of using a multidisciplinary approach to address the complex health issues of the patient, ultimately supporting her recovery.

参考文献 ( 11 ) 〈TOP〉

李婕瑀, C. Y.,李佳錡, C. C.(2024)。运用认知行为治疗辅以人际社会节奏治疗於一位反覆自伤的双相情绪障碍症青少女之护理经验。精神卫生护理杂志，19(3)，42-48。
连结：
李选, S.,张婷, T.(2024)。论投资护理人力创造照护之经济实力。精神卫生护理杂志，19(3)，7-13。
连结：
陈美玲, M. L.,王孝慈, H. T.,阙可欣, K. H.,王志嘉, C. C.,刘宜钊, I. C.,陈凯伦, C. R.,陈志弘, C. H.(2024)。电影教学法提升长照学生精神照护同理心之成效：以实体面授、同步远距教学为例。精神卫生护理杂志，19(3)，22-32。
连结：
叶美玉, M. Y.,廖佩君, P. C.(2024)。不同社区复元课程设计对护生精神疾病刻板印象之影响。精神卫生护理杂志，19(3)，14-21。
连结：
潘怡旻, Y. M.,余春娣, C. T.,欧李芝容, C. J.(2024)。提升精神科病房护理师第二代抗精神病长效针剂注射护理技术之正确率。精神卫生护理杂志，19(3)，33-41。
连结：

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