Situational Analyses of the Legislative Process on Community Psychiatric Rehabilitation in the Mental Health Act of Taiwan R. O. C

Background and Purpose: A sound mental health system requires a combination of pharmaceutical intervention and community psychiatric rehabilitation. In Taiwan, the Mental Health Act defines the systemic design and implementation. Despite several amendments in the past 30 years, the resulting mental health system continued to be dominated by medical authorities. Taiwanese with mental illness have encountered serious issues such as insufficient community psychiatric rehabilitation programs and service discontinuity, which had a profound impact on patients’ well-being and mental health recovery.

The latest amendment and promulgation of the Act happened in 2022, and community psychiatric rehabilitation was once again among the focal amended areas. However, during the legislative discussions on the draft by the Executive Yuan, there had been significant disputes between the administrative representatives and policy advocates over the scope and content of community psychiatric rehabilitation.

This study aims to investigate how the concept of “community psychiatric rehabilitation” was constructed in this complex policymaking process, and to present the influencing factors in the discursive context that ultimately helped to shape the foundation of the community psychiatric rehabilitation system.

Methods: We collected the transcripts of the legislative sessions on community psychiatric rehabilitation and the archival documents. We also conducted expert consultation to better understand the background and dynamics of the legislative process.

This study applied Situational Analysis approach. Situational Analysis was developed by Dr. Adele E. Clarke, a second-generation grounded theorist. Influenced by postmodernism, Dr. Clark focused on the situation in which issues occur, and analyzed the complexity of "situatedness." The analytical process involves phases of constructing situational maps, social worlds/arenas maps, and positional maps, through which the researcher specifies and maps the important elements of a situation, theorizes their relationships, constructs critical actors’ perspectives and their social worlds, and identifies crucial discursive positions.

Results: In creating the situational map, we identified various relevant elements, such as individuals (administrators, legislatives, and grassroots advocates, etc.), collective human elements (professional associations, service organizations, etc.), political elements (existing regulations, political party affiliations, etc.), legislative elements (the Convention on the Rights of Persons with Disabilities, the People with Disabilities Rights Protection Act, etc.), and cognitive/ideological elements (etiological models of mental illness, familism, etc.).

Next in constructing social worlds/arenas maps, we identified the bureaucratic realm and the rights-focused realm, between which there were distinct discourses regarding community psychiatric rehabilitation. Finally, we established a positional map by using “the level of recognizing person-centeredness” as one axis and “the perceived scope of Mental Health Act” as the other, and revealed the dissonance behind the legislative discourse and likely the distance between the supportive statement of community mental rehabilitation in legal texts and the actual commitment to it in action.

Conclusions and Implications: The findings shed light on the complexities of legislative process regarding community psychiatric rehabilitation, the exercise of power in discourse, and contextually important influencing factors. The results may encourage further dialogues on the root causes of the scarcity of community psychiatric rehabilitation in Taiwan, so as to facilitate future development of the mental health system.