家族療法としての地域精神保健ネットワークミーティング—養育担当者すべてが保護能力を失い孤立した兄妹への援助

Network Meeting as Family Therapy for Mental Health in a Regional Community: Social support for isolated siblings whose caregivers had lost their ability to perform parental roles

【抄録】　筆者らは，保健婦，PSW，民生委員，教師，医師などで構成される地域ネットワークミーティング（NWM）が果たす機能について，家族療法の視点から考察した。事例は，養育担当者がすべて保護能力を失い，孤立した兄妹への援助が求められたケースである。祖父（痴呆），母（精神分裂病）は入院となり，妹は養護施設へ入所となった。この介入過程で，16歳の兄は孤独感や関係者への不信感を強く発展させた。NWMで精神科医に求められる役割は，社会が分担して担っている親役割に関する具体的助言であり，事態の推移に関する力動的理解の枠組みであった。NWMに参加する精神科医は，会議全体のまとめ役を期待されていることにも自覚的である必要がある。

　A case of a 16-year old boy and his younger sister is presented. No caregiver was able to serve as a guardian, but continuous supporting activities for the isolated children were required. Interventions for the family were made for two months. The children's natural caregivers, their grandfather and mother, had been admitted to psychiatric units due to dementia and schizophrenia, respectively. The girl needed to enter a protective institution and, consequently, the boy was obliged to live alone. He developed a sense of deep helplessness, persecutory anxiety and distrust of supporting staff members. From the view-point of family therapy, functions of the community network meeting (NWM) are discussed. It consists of public health nurses, psychiatric social workers, district welfare commissioners, school teachers, psychiatrists, etc. Roles of psychiatrists who work for NWMs are ; 1) to make comprehensive suggestions concerning the carrying out of the parenting task entrusted to social resources, and 2) to present-psychodynamic frameworks useful for understanding possible future situations and for caseworking. Psychia-trists in NWMs should be aware that the other participants may expect them to steer the meet-ing.