重度精神障害者の地域生活支援システムについて—ACT-J，ACT-Kの試みからみる課題

Community life support systems for people with severe mental illness : An analysis of ACT-J and ACT-K trials

要旨：脱施設化の推進には，精神科病床削減だけでは不十分であり，地域における生活支援体制の構築が不可欠である．重度精神障害者に対する地域生活支援システムとして米国各州を始め諸外国にも広まっているACT（assertive community treatment）は，入院期間を短縮し，地域生活を安定させ，利用者の満足度も高いなどの効果が実証されており，日本においても試行が始まっている．米国におけるACT普及の歴史と日本における導入の試みの分析より，日本においてACTを有効な形で普及させるためには，財源の確保，地域システムの構築，スタッフの教育・研修，当事者の参画プログラムの適合度評価などの課題があることが分かった．

　Simply reducing the number of psychiatric wards to promote deinstitutionalization is insufficient:as such, the establishment of community life support systems is indispensable. Assertive community treatment (ACT) has spread not only throughout the U. S. but also other countries as a community life support system for people with severe mental illness. ACT has resulted in both reducing the hospitalization period, and stabilizing users' community life, culminating in their marked satisfaction. Analysis of the history of ACT in the U. S. and attempts to introduce it to Japan identified various problems such as securing financial resources, establishing a community system, educating/training staff members, encouraging participation of people with severe mental illness and assessing the fidelity of programs to spread ACT as an effective form.