[Experiences with the North Rhine-Westphalia PsyKG (mental health regulation) exemplified by the city of Münster].Gesundheitswesen. 1999 Nov; 61(11):553-9.G
The law on assistance and precautionary measures in cases of mental illnesses (PsychKG) for North Rhine Westphalia came into force on 1.1.1970. It replaced the "law on committal" of 1956. Thus the PsychKG of North Rhine Westphalia has been in force for more than twice as long as its predecessor which had been, as in other Federal states of Germany, a special part of the police regulations. The new North Rhine Westphalian provision of 1970 was the first to take the step towards a genuine law for mental patients (Saage/Göppinger 1994). It laid the foundations for a right of mental patients to assistance from their local authority--as a duty (section 3, section 5)--and already spelled out the principle of an assistance planned individually and focussed on the person. This principle is still in use today. While the sections about committal have been replaced by a Federal law ("Law on voluntary jurisdiction", (FGG), section 70), the other parts on precautionary assistance, on care during committal and on after-care for mental patients are still in force. A legal review planned already ten years back was abandoned after two years of discussion, for two reasons: firstly, because the setting of standards of quality and equipment for the ambulant care, which had been called for by the providers of social-psychiatric services seemed impossible to finance. Secondly, it was decided to wait until other new laws would be enforced, such as the "Law on care" (1992) and the new North Rhine-Westphalian law on Public Health care services (1997). In his article, the author examines the practical experience in applying the PsychKG NW from the viewpoint of a socio-psychiatric service provided by the local authority, and of the co-ordination of psychiatric activities between such services. These perspectives survey the remarkable variety of possible courses of action for different local authorities on the basis of a unitary legal norm. The article also presents the basic ideas developed over the last ten years in the Association of Social-Psychiatric Services of North Rhine-Westphalia (of whose executive committee the author is a member) with regard to the reform and implementation of the PsychKG: the legal duty to ensure care for all mental patients according to their needs, to provide for their medical, mental (psychic) and social requirements in the sense of the WHO guidelines, the duty of all parties concerned to co-ordinate and co-operate, and the inclusion of modern principles (which had, however, been developed already 30 years ago) such as the priority of out-patient treatment over inpatient treatment in the further development of care-service structures.