精神科作業療法の治療構造からみた再入院予防に作用する要因—統合失調症者への支援を通じた探索的検討

Factors contributing to the prevention of rehospitalization from the perspective of therapeutic structure in psychiatric occupational therapy: An exploratory study through supporting a client with schizophrenia

要旨：本論の目的は，事例に提供した作業療法実践を後方視的に報告し，治療構造の観点から再入院予防に有効に作用した要因を検討することであった．方法は，再入院を繰り返していた統合失調症を有した事例に対し，認知行動療法や元気回復行動プランにポジティブ作業に根ざした実践を併用した介入アプローチによる作業療法で支援した．その結果，事例のWell-Beingをはじめ，再入院までの期間延長に寄与した．本実践の知見は，精神障害者の再入院予防のために，クライエントの状態やニーズに応じた柔軟な介入アプローチの併用と治療環境の整備，作業活動を介した対象関係の拡大といった要因が治療構造に含まれることの重要性が示唆された．

　This study aimed to retrospectively report on the psychiatric occupational therapy provided a case of schizophrenia and to examine the factors that were effective in preventing rehospitalization from the perspective of the treatment structure. The method was to support the client who was frequently hospitalized with occupational therapy that combined cognitive behavioral therapy, the Wellness Recovery Action Plan, and the Positive Occupation-Based Practice approach to intervention. As a result, the occupational therapy contributed to the client's well-being and extended the time between rehospitalizations. Findings from this practice suggest the importance of incorporating factors such as the combination of flexible intervention approaches according to the client's condition and needs, the development of the therapeutic environment, and the expansion of the objective relationship through occupation into the treatment structure to prevent the rehospitalization of individuals with mental illness.