Unpaid care-work and paid work：The dilemma for caregivers who have family member with chronic mental illnesses

本研究是針對十二個慢性精神病患家庭照顧者的就業狀況進行觀察與分析，為了更深入瞭解無酬照顧慢性精神病患的家庭照顧者對工作者角色的影響，本研究採用質性研究法中的深度訪談方式進行資料收集。而地域方面，為了呈現慢性精神病患的家庭照顧者在不同地域中使用支持資源的差異，本研究分別在大台北地區與彰化進行選樣訪談，分析並了解不同地區之資源差異對照顧者在就業上的挑戰。 訪談收集之資料經編碼歸類為「照顧工作困境」、「職業過程」、「職業關係」等三大類分析訪談資料，經研究發現如下： （1）照顧工作困境： 主要分成五點： 一、照顧者在支持資源的使用上相當貧乏 二、照顧者對於取得支持資源的資訊不足 三、照顧者對於醫療資源的熟悉度不高或使用能力有限 四、照顧者覺得支持資源並非切合病患與照顧者雙方的需求 五、病患服藥的穩定度低，將使日後病情控制上增加難度 不論是在疾病急性期或慢性期，病患所出現的正面症狀或負面症狀產生的影響，都會影響家庭成員的互動模式。常出現親人互斥、慢性精神病患及家屬互相傷害的情形，讓照顧者無所適從，無法界定照顧的界限。 照顧者會因為照顧工作影響生理與心理狀態，因為在社會的支持上無法從熟悉的社會網絡中獲得支持，照顧者常感受到孤立無援。也因為照顧工作的原因，照顧者對有酬工作的需求通常是強烈的。 （2）職業過程： 照顧者的職業生活是備受干擾，照顧的過程中會使勞動力耗損或不能恢復。選擇職業的時間與地點也受到照顧工作的限制，時間方面有的需要固定的時間，有的需要部分工時以便完全配合病患目前的狀態。工作的地點則不得離開家庭太遠，以因應許多臨時得突發狀況。工作類型也是以彈性高的工作為主。 （3）職業關係： 慢性精神病患家屬有時也同時是擁有慢性精神障礙者的身分，找工作時也相當不容易。同時在背負汙名化的情況下，不願告知雇主家中有生病的患者需要照顧，怕雇主質疑照顧者的工作能力。照顧者也會因為照顧工作壓力過大，在勞動力上給付不完全，有時需要常常請假或是遲到早退，造成與雇主之間關係較為緊張；同事之間也會因為不定時要分擔工作致使同事無法諒解，總之，照顧者不穩定的狀況讓照顧者不僅與雇主關係緊張，與同事之間也產生隔閡。 照顧者的就業困境主要來自照顧工作，因此若照顧工作的負擔減輕，照顧者的職業生活自然可以順利發展。減輕照顧負擔的方式可以藉由政府的支持資源或同儕團體取得。另外也可以從教育方面著手，給予社會大眾正確的觀念，去除對於精神障礙者的汙名化，讓照顧者同時從汙名化的壓力中被釋放出來。本研究希望從「政府支持資源」、「同儕家屬團體」、「去除汙名化」著手。本研究歸納出以下三個政策建議： （一）提昇精神病患社區精神及社會資源的整合 （1）勞工政策部分：職業重建與庇護工場之間在資源上的分配必須依照精 障者的特性來分配資源。 （2）社會福利部分：加強提供慢性精神病患照顧者的社區化支持 （二）鼓勵同儕家屬團體建立，給予照顧者更多社會支持，推動相關照顧者支持法案。 （三）加強精神疾病知識，從正規教育、社會教育著手去除汙名化。The study focuses on the work challenges of those caregivers who care for family member with chronic mental illnesses. Depth interviews were performed on twelve families who have family members with chronic mental illnesses .In order to present the geographic difference of medical resources for family caregivers, we target samples at north Taiwan (Taipei City and New Taipei City) and middle Taiwan (Changhua county and Chiayi county). Due to the unpaid care work , caregivers’ career are often affected. As the caregivers spend on care work, they decrease their labor force participation. The employment type, working hours and workplace are also limited. They tend to choose flexible working hours in order to meet the patients’ illness needs. In case of the emergent accident, they also choose working places that are not far away from home. This study also finds that some caregivers have chronic mental disorder, which makes them difficult to find job too. In addition, due to the stigma in our society, they are unwilling to disclose to their employers the fact that they are from a family with chronic mental disorder patient. They also fear that the employer will question their working ability. Some employer even thinks that the caregivers may also become patients. Because of the heavy pressure for the caregivers, they are unable to pay attention and concentrate on their jobs. Some of them often arrive at working place late and leave early, which makes workplace relationship tense and difficult. The career difficulties for caregivers result from the care work. If the care work burden decreases, the career of caregivers will also become much smooth and even unaffected. The resources provided by governments and peer family groups are the ways to decrease care work. Besides, we can educate the public to diminish the negative attitude toward the people with mental disorder.. This study concludes by proposing three policy recommendations as follows: (A) Strengthen the integration of chronic mental patients in the community and social resources (1) Labor policy: the allocation of resources between vocational rehabilitation and sheltered workshops must be reconsidered according to the characteristics of chronic mental disorder patients. (2) Social Welfare: strengthen the support of chronic mental patients in community-based system for caregivers. (B) Encourage the establishment of peer groups, provide caregivers with more social support and promote related act and policy. (C) Promote and learn the knowledge of mental illness, remove the stigma by formal education and social education