は じ め に地域医療の基本方針となる医療計画に盛り込むべき疾病として指定してきたがん、脳卒中、急性心筋梗塞、糖尿病の4大疾病に、新たに精神疾患を加えて「5大疾病」とする厚生労働省の方針から、本県でも「第1期信州保健医療総合計画～「健康長寿」世界一を目指して～」が保健、医療分野の一体的な計画として策定され、その後平成30年度からは「第2期信州保健医療総合計画」として、「健康長寿」という一つの目標に向って推進しています。
また現在、厚生労働省が提起した「精神障害にも対応した地域包括ケアシステムの構築」が進められており、地域包括ケアシステムの構築強化として、保健・医療・福祉関係者が情報共有や連携を行う協議の場の構築、障害保健福祉圏域及び市町村ごとの協議の場を通じて、精神科医療機関、その他の医療機関、地域援助事業者、市町村等との重層的な連携による支援体制の構築の推進、障害福祉計画、医療計画で示された目標の達成に向けた取組の強化等が挙げられています。
長野県は広く、それぞれの圏域ごとに地域医療の環境が異なっていることもあり、県全体から生じる精神保健福祉のニーズにどのように応えていくかが常に課題となっています。一つの方策として、「精神保健福祉ハンドブック」を定期的に発行し、これを基にして市町村を含めた県下全体の精神保健相談や福祉的な対応を支援させていただいております。また、精神保健福祉においては必要とされる情報が急速に変化することもあるため、本書でまとめられた最新の社会資源を知る必要性は益々高まっています。
この「精神保健福祉ハンドブック」では、精神障がいの理解や福祉制度の解説に加え、精神科医療資源や相談窓口へのアクセスの向上などを意識し、必要な情報やサービスにより早く確実につながることを目指しております。お寄せいただいたご意見を基に改善をはかっておりますが、使いにくい点などございましたら、ぜひ当センターまでご意見をお寄せください。精神障がい者のための福祉サービスはまだ十分とは言えない面がありますが、本冊子を熟読し、ご活用いただけるよう、お願い申し上げます｡

令和５年３月長野県精神保健福祉センター所長 矢﨑 健 彦

目Ⅰ 精神障がい者の理解のために

次······································································· 1

Ⅱ 精神障害者保健福祉手帳・障害年金・各種手当
１ 精神障害者保健福祉手帳とは？······················································································ ３⑴

精神障害者保健福祉手帳の概要 ························································································· ３⑵

手帳を持っていると受けられるサービス ·················································································· ５

２ 障害年金を受けるには？········································································································ ９⑴

障害年金の概要 ················································································································ ９⑵請求手続き ····················································································································· 1１⑶

請求後・決定後の手続き ··································································································· 1２⑷留意点 ··························································································································· 1２⑸

特別障害給付金 ·············································································································· 1３⑹

県内年金事務所一覧········································································································ 1３３ 各種手当を受けるには？······································································································ １４⑴

特別障害者手当 ·············································································································· １４⑵

障害児福祉手当 ·············································································································· １４⑶特別児童扶養手当 ··········································································································· １５⑷

児童扶養手当 ················································································································· １５⑸

心身障害者扶養共済制度 ································································································· １６Ⅲ 生活費及び医療費に困ったときの支援制度
１ 生活費に困ったときは？ ······································································································· １７⑴

生活保護 ························································································································ １７⑵

生活福祉資金 ················································································································· １７⑶

無料低額診療所 ·············································································································· 1８⑷住居確保給付金 ·············································································································· 1８⑸

新たな住宅セーフティネット制度における相談支援 ·························································· 1９

２ 医療費の負担で困ったときは？ ···························································································· 20⑴

自立支援医療（精神通院医療） ·························································································· 20⑵

福祉医療費給付事業········································································································ 21⑶

高額療養費制度 ·············································································································· 23⑷

国民健康保険料の軽減と減免 ·························································································· ２４⑸

後期高齢者医療制度········································································································ 24⑹

医療費の所得税控除 ········································································································ 24

Ⅳ 障害者総合福祉法・介護保険法・県独自（委託）事業
地域の生活で使えるサービスは？ ······················································································ ２５⑴

障害者総合支援法 ··········································································································· ２５⑵介護保険法····················································································································· ２６⑶

県独自（委託）事業 ·········································································································· ２７Ⅴ 就労を支援する相談機関・働いている人のための保障制度
１ 就労を支援する機関は？ ····································································································· ２８⑴

公共職業安定所（ハローワーク） ···················································································· ２８⑵長野障害者職業センター ································································································· ３０⑶障害者就業・生活支援センター ······················································································· ３１⑷若年者就業サポートセンター（ジョブカフェ信州） ··································································· ３２⑸地域若者サポートステーション ······················································································· ３２⑹

生活就労支援センター（まいさぽ）················································································· ３３⑺その他の労働に関する相談先····························································································· ３５２ 働いている人が受けられる保障制度は？ ·············································································· ３７⑴

健康保険の傷病手当金 ···································································································· ３７⑵

厚生年金の障害手当金（一時金） ···················································································· ３７⑶雇用保険の失業給付金（求職者給付の基本手当） ····························································· ３８⑷労働者災害補償保険（労災保険） ···················································································· ３８Ⅵ お金の管理や契約に関する支援制度
お金の管理や契約などで困ったときは？ ············································································· ３９⑴

日常生活自立支援事業 ···································································································· ３９⑵

成年後見制度 ················································································································· ３９Ⅶ 市町村単独事業の実施状況及びデイケアの状況
１ 市町村単独事業実施状況 ·································································································· ４２⑴

市町村単独実施事業の概要······························································································ ４２⑵市町村単独実施事業の詳細······························································································ ４５⑶市町村が実施するデイケア ································································································ ４５

２ 福祉医療費給付事業 市町村別助成 ·················································································· ４６

Ⅷ 身近な相談機関⑴

市町村 ··························································································································· ４７⑵保健福祉事務所 ·············································································································· ５３⑶

市福祉事務所·················································································································· ５４Ⅸ 専門的かつ広域的な相談機関⑴

障害者総合支援センター ··································································································· ５５⑵

精神保健福祉センター ······································································································ ５７

Ⅹ 様々な悩みに対応した相談機関⑴

社会福祉協議会 ·············································································································· ５９⑵

児童相談所····················································································································· ６０⑶総合教育センター・教育事務所··························································································· ６０⑷女性相談センター（配偶者暴力相談支援センター） ································································ ６１⑸

男女共同参画センター（あいとぴあ） ··················································································· ６１⑹いのちの電話 ·················································································································· ６１⑺

自死遺族に関すること ······································································································· ６２⑻よりそいホットライン ··········································································································· ６２⑼LINEによる相談 ·············································································································· ６３⑽にんしんSOSながの ········································································································· ６４⑾若年性認知症コールセンター ····························································································· ６４⑿

犯罪被害・暴力等に関すること ··························································································· ６５⒀

障がい者虐待防止センター ································································································ ６５⒁法律に関すること ············································································································· ６６⒂

人権相談に関すること ······································································································· ６７⒃児童・青少年に関すること ·································································································· ６７⒄

消費生活に関すること ······································································································· ６８⒅

地域生活定着支援センター ······························································································· ６９⒆

性的マイノリティに関すること ······························································································ ６９

Ⅺ その他の活用できる施設⑴ 長野県障がい者福祉センター（サンアップル）・サテライト施設 ··················································· ７０⑵

救護施設 ························································································································ ７１⑶長野ダルク ······················································································································ ７１

Ⅻ 医療機関等
１ 医療関係相談機関 ············································································································· ７２⑴

長野県精神障がい者在宅アセスメントセンター「りんどう」 ······················································· ７２⑵認知症疾患医療センター ··································································································· ７２⑶高次脳機能障害支援拠点病院··························································································· ７２

２ 県内の医療機関（指定自立支援医療機関（精神通院医療）） ··············································· ７３

XIII 精神保健福祉関係自助グループ・団体
１ 自助グループ ····················································································································· ８7⑴

精神障がい当事者会 ········································································································ ８7⑵

精神障がい者家族会 ········································································································ ８9⑶

アルコール依存症に関する自助グループ ·············································································· ９1⑷

薬物依存症に関する自助グループ ······················································································ ９5⑸ ギャンブル依存症に関する自助グループ··············································································· ９6⑹

てんかんに関する自助グループ ··························································································· ９7⑺

家族を自死で亡くされた方のグループ ················································································· ９7⑻

認知症に関するグループ ··································································································· ９8⑼ 発達障がい児者家族の会 ································································································· ９8⑽

ひきこもり関連の支援機関・家族会 ····················································································· ９9⑾

摂食障がいに関する自助グループ····················································································· 100⑿

性的マイノリティに関する自助グループ ··············································································· 100

２ 精神保健福祉ボランティアグループ ··················································································· １０1
３ 精神保健福祉関係団体 ···································································································· １０3⑴

長野県精神保健福祉協議会 ···························································································· １０3⑵

長野県精神障がい者スポーツ推進協議会·········································································· １０3⑶

きょうされん長野支部 ······································································································ １０3⑷

信州ＳＳＴネットワーク ······································································································ １０3⑸

医療団体・職能団体 ······································································································· １０4

このハンドブックの使い方
長野県内の精神保健福祉に関する支援の充実を図るため、地域で支援にあたっている方々に、支援の参考にしていただけるよう作成いたしました。今後の支援のステップアップに役立てていただけたら幸いです。

手帳について年金について…P3～

手当について…P9～

生活費の支援について…P14～

医療費について
…P20～

…P17～

地域生活のサービスについて一番身近な市町村の支援について

…P25～
…P42～

就労の支援、制度について

・通所や通院の支援・精神保健相談…P28～

・公営施設・公営住宅

お金の管理や契約について

・市町村デイケア…P39～など

県内の精神保健福祉について知りたい！

身近な相談先について病院について

…P47～

…P73～

専門的かつ広域的な相談先について
・自分の住む場所から通える病院、…P55～

様々な悩みに対応した相談先について

診療内容、予約の有無など

仲間や団体について…P59～

活用できる施設について・支え合っていける、当事者や…P70～

家族等のグループや団体など…P87～