広島県精神障害者退院促進事業参加実践の報告

A report on the government project to promote hospital discharge for patients with mental disorders in Hiroshima prefecture

要旨：精神障害者退院促進支援事業は，入院患者のうち症状が安定しており受け入れ条件が整えば退院可能である者に対して，社会的自立の促進を図るものである．2004年度広島県の本事業に参加する機会を得たので，作業療法士の立場から初年度の実践について報告をした．対象者の目標数は20名で，対象者数も20名であった．そのうち5名が事業を終了し，4名が退院した．退院を阻害する要因が家族や身寄りの無いことである場合には，本事業は有用であった．作業療法士の本事業への参画及び活躍が期待されるが，そのためには作業療法に対する理解が社会の中に浸透することや，個別治療を行える体制の整備等が課題である．

　A Government project called "Seishin-shougaisha Taiin Sokushin Jigyou", promoting hospital discharge for patients with mental disorders, was started in Japan from the year 2003, intended to encourage social independence. The subjects are patients with mental disorders who have stable symptoms and can be discharged from hospitals under a suitable environment. From the viewpoint of an occupational therapist, the author reports on the first-year results of this project, which has been in operation in Hiroshima Prefecture from May of 2004. The target number of subjects was 20, and 20 patients were indeed considered to be suitable for this project. 5 of the 20 subjects completed the project, and 4 of them were discharged. An individual support plan was designed for 8 subjects. When the patients had not been discharged from the hospitals because of their families, or had no families or relatives and such circumstances stood in the way of their hospital discharge, this project appeared to be useful.

　Of all the subjects, 8 were receiving occupational therapy. Occupational therapy is very useful for solving their problems of activities of daily living and improving their social skills, which helps them to live in their community. However, because the purpose of the therapy was not written in the project documents, proof of the effectiveness of occupational therapy in this project has not been presented. It is desirable that occupational therapists participate actively in this project; therefore, better understanding of occupational therapy, development of a medical system for individualized occupational therapy and learning the theory and practice of care-management are required.