【發言稿-中英對照】CRPD國際審查會人約盟十七個團體共同聲明代表：酷兒盟

台灣酷兒權益推動聯盟代表 秘書長 胡勝翔 發言稿：

我是台灣酷兒權益推動聯盟Taiwan Gender Queer Rights Advocacy Alliance Taiwan Gender Queer Rights Advocacy Alliance,TGQRAA ) 秘書長胡勝翔（Nelson Hu），今代表17個團體之平行報告提出幾點回應。

第一點：我國對於身心障礙者的定義與認識僅限領有身心障礙手冊（證明）者，以至於國家報告統計僅限於此。

首先，政府對於身心障礙者係指身心障礙者權益保障法下，經鑑定與評估後持有身心障礙證明方為法定身心障礙者，持有該手冊（證明）後續才能依據其需求申請各項補助、支持服務。目前身心障礙鑑定與評估系統（ICF）過於僵化，需經六個月穩定在政府指定的區域醫院等級以上穩定就診、回診方能申請身心障礙鑑定。但實務上卻忽略疾病造成的障礙、社會對於障礙者之汙名化等，舉例來說：對於極特殊罕病患者，在此鑑定系統下該疾病已確診並經醫師評估將導致肢體、認知功能快速下降，依然仍需經過六個月觀察方能申請身心障礙鑑定；對於精神疾病患者（社會心理障礙者）而言，在社會極具汙名化情況下，若要穩定回診勢必造成工作上的影響，往往需向職場請假，更甚者身份一旦曝光工作除不保外，政府亦無任何對於此行為採取任何保障，導致精神疾病患者（社會心理障礙者）不願意取得身心障礙手冊；對於多重身份者而言（係指同時擁有性別身份與障礙者身份或同時擁有原住民族身份與障礙者身份的多重身份者），以性少數社會心理障礙者為例，本因性別身份易與原生家庭關係破裂而需在外就業自立，工作本需穩定無法經常請假。若然每個月都請假回診，易導致身份曝光與工作不保，且對於多重身份者而言，並非每一個人都有這麼多時間、財力等成本去取得該手冊（證明）。

第二點：無障礙

政府現行無障礙觀念、設施仍侷限物理環境，其法規也僅包含特含部分特定建築，且僅針對特定障別之障礙者。如精神疾病患者（社會心理障礙者）在政府認知下，其肢體功能「正常」而毋須無障礙，但精神疾病患者（社會心理障礙者）之特殊性在於人與人（社會）之互動產生的障礙，但政府全然僅以外觀作為判斷依據。

第三點：支持服務需求評估

政府所提供各項支持服務採取被動式、專家學者本位主義所設計，導致諸多服務未能以障礙者為中心，除了欠缺障礙者之參與外，諸多支持服務未能因應個別化、差異化所調整。以精神疾病患者（社會心理障礙者）為例，現行僅提供專線、社區健康復建中心等被動式、專家式支持服務，且諸多服務並未考量精神疾病患者（社會心理障礙者）的需求，更多服務全然都以常人之邏輯思考，並且去脈絡化地提供服務。如：當精神疾病患者（社會心理障礙者）情緒低落或高漲時，往往被認定是「發病」，卻忽略情緒的原由。政府現行的服務也欠缺更多以障礙者為中心所發展之服務，如同儕支持等。又，現行諸多支持服務需取得法定身心障礙者身份資格，即便精神疾病患者（社會心理障礙者）另有精神衛生法規範政府須提供支持服務，但仍以專家學者為主要設計者，並未考量到精神疾病患者（社會心理障礙者）實際需求。

第四點：身心障礙者權益保障推動小組

現行各級政府（如行政院、衛福部、各級縣市政府）雖依據身心障礙者權益保障法皆設置身心障礙者權益保障推動小組，但該小組除了無法處理跨部會（局處）之事務外，其小組定位亦不明，又組成委員皆由該政府所指派（台北市除外）。同時，各部會（局處）首長亦為小組委員，部會（縣市）首長亦為小組召集人，導致部會（縣市）首長不召開會議或僅在不違反身心障礙者權益保障法情況下，無法有效確保該小組發揮保障身心障礙者之功能，且小組委員在政府指派下，全然無障礙者自主參與之精神。另外，專責審議強制住院與強制社區治療審查會之委員亦由政府指派，雖精神衛生法規定需有病人團體代表，但政府仍以指派方式為之。

Nelson Hu, Secretary General, Taiwan Gender Queer Rights Advocacy Alliance (TGQRAA )

PWD has to be assessed regularly (every 6 months) to qualify for the “disability card”, which entitle them for particular subsidies and services. To persons with invisible disabilities such as those with mental disorders, the cost of undergoing various types of assessments is too huge. They would have to go to assigned local hospitals or medical centers for assessments, pay fees for regular return visits, and request their supervisors in the workplace to approve their sick leave for each return visit, and so on. In addition, the disability card or certificates they succeed in obtaining not only fail to offer them sufficient protection of rights, but may also become an obvious target to be discriminated against by the society as well as the owner’s employers and colleagues. The fact that the safeguarding certificates eventually become a stigma-carrying label leads many persons with invisible disabilities to give up possessing these documents. For persons encountering multiple discrimination (such as PWD who are also LGBTQI or indigenous), it is even more complicated. For LGBTQI persons, there already existed tensions between the individuals and family members, the requirement of regular clinical visits often make situations worse, both at home and at work.

The government’s understanding on accessibility is limited to the physical environment. For persons with psychosocial disabilities and other invisible disabilities, the government often fails to detect their special needs in communication and during the interaction with others. The government should learn to appreciate the unique nature of accessibility in information and services for psychosocial disabilities.

Even though our “People with Disabilities Rights and Protection Act” clearly states that PWDs should receive various support services to promote independent living, However, there are no mechanism to involve and consult PWDs as to their specific needs. The services are developed by experts and scholars who often fail to respond to adjust to the differences and uniqueness in needs of persons with psychosocial disabilities. This results in service options being unsuited to practical subsistence needs or overly stringent criteria for qualification that cause difficulties for PWDs to access needed resources and underutilize services. For example, mood changes were often regarded as “episodes”, without looking into background and emotional factors causing mood variations. The State Reports pointed out that Article 8 of the Mental Health Act required the government to set up cross agency community care, support, and rehabilitation framework, but there has been a general reluctance by the Ministry of Health and Welfare and other government departments to invest sufficient personnel and financial resources to develop alternative and multidisciplinary treatment and rehabilitation support options for people with mental disabilities.

The central and local governments are required by law to set up a “Committee for the Promotion of the Rights of Persons with Disabilities”, which are chaired by local government, composed of directors of various departments, and appointed experts or representatives. These committees gather only infrequently, and the appointed members often do not enjoy autonomy.

The “Mental Illness Mandatory Assessment and Community Treatment Review Committee” (“The Review Committee”) is made up of medical professionals, family members, and legal professionals. However, the appointment of the Review Committee members lacks openness and transparency, although there should be representatives of patient groups, in practice they are also appointed by the government.

備註：感謝人權公約施行監督聯盟召集人黃嵩立翻譯。