The author describes some problems of governing clinical mental health institutions as there are: responsability toward the regional population and patients, specificity of management in mental health, participation of personnel in management, democratie structure of the institutions, flexibility of the organisation, paying of the board of governors, some forms of government. He prefers a direction of two people: one out of the department of care and one of the managing department. It is necessary that these people have as most outstanding task only management. There is a parallelium between democratic structure of the institution and therapeutic climate. How can the clients/patients be represented (directly or better indirectly) in the management oft he institution? The author stipulates that a legal regulation of some aspects of the structure will be necessary in the future.