当事者が措置入院制度において入院不要と判断された家族の体験のプロセス

Family Experiences in Cases When an Individual Does Not Require Hospitalization Under the Involuntary Admission System of the Mental Health Act

要旨

　目的：措置入院制度において当事者が入院不要と判断された際の家族の体験を明らかにする．

　方法：2005年以降に措置入院が検討され入院不要とされた家族8名に半構造化面接を行い修正版グラウンデッドセオリーアプローチで分析した．

　結果：家族は自傷他害の恐れを伴う当事者と関わる中で【巻き込まれの日常化】の循環的プロセスを経験していた．これは『不安と巻き込まれの日常』から『支援要請にともなう葛藤』を経て『全関係者への対応』に進み，入院不要の判断後『怒りと絶望』を抱え，『支援の欠落への直面』に至った．その後『医療的支援確保への調整』や〈分離による環境調整〉を試みながらも『改善の実感なき日常回帰』を経て困難な日常に戻っていた．

　結論：家族は入院不要の判断後も危機的状況が続き，制度的な支援不足により孤立しやすい．制度上の訪問支援，一時的な分離環境の整備など継続的な家族支援体制の構築が求められる．

　Objective: This study aimed to clarify the experiences of families when an assessment is done on their family member confirming that involuntary admission under Japan's involuntary hospitalization system is not required.

　Methods: We conducted semi-structured interviews with eight family members whose cases were assessed as not requiring involuntary hospitalization after 2005. The data were analyzed using the Modified Grounded Theory Approach.

　Results: The families experienced a cyclic process of daily crises, referred to as the "Normalization of Involvement." This process began with "Anxiety and Everyday Involvement," moved through "Conflict over Requests for Support," and then to "Responses to All Stakeholders." Following the decision that hospitalization was not required, the families faced "Anger and Despair" and subsequently "Confrontation with the Lack of Support." Later, they attempted "Coordination to Secure Medical Support" and "Environmental Adjustment through Separation" but ultimately returned to a "Daily Life without a Sense of Improvement" and persistent difficulties.

　Conclusions: Even after the determination of non-admission, families continued to experience crises and faced isolation due to the lack of systemic support. Ongoing support systems, including psychiatric emergency outreach and the provision of temporary separation environments, are needed to assist these families.