The forensic psychiatry unit at Valkenberg Hospital is dedicated to providing psychiatric assessments of defendants referred by the courts and rehabilitation of mentally diso rdered offenders. The Unit is responsible for educating students and colleagues. Research into current issues has a high priority. Within the greater context of mental health care in the community the Unit recognizes that it has to lobby for patients' rights and for needed reforms.

The Unit consists of the following:

• Maximum Security Ward (20) (including observation cases)
• Secure Wards (9/10)
• Closed/Controlled Ward (7)
• Open Ward (12)
• OPD

Each ward has a programme constructed within a behavioural/milieu system. Patients are placed into groups and given privileges accordingly.

THERAPEUTIC UNIT (WARD 1)

About the Unit

The Therapeutic Unit (Ward 1) forms part of the inpatient component of the Complex Emotional Needs Service. The unit provides specialised care for adults aged 18–60 years experiencing a range of psychiatric illnesses and psychological difficulties.

The service is available to individuals residing within the Valkenberg catchment area and offers a voluntary, time-limited, four-week programme. Patients attend the unit from Monday to Friday, returning home on weekends. This structure supports intensive therapeutic engagement while encouraging continuity with community and family supports.

How to refer:

Patients can be referred by any health care practitioner (psychiatrist, doctor, psychologist, nurse practitioner, social worker, counsellor, occupational therapist) on our referral form:

Link to online referral form: VBH-Therapeutic-Unit-Ward1-referral-2026.docx

E-mail for queries on: Referral.valkenbergward1@westerncape.gov.za

Client Group

The program caters for people with complex emotional needs who struggle with difficulties in emotional regulation. Patients often have a combination of more than one psychiatric condition, including mood disorders (particularly major depressive episodes and persistent, difficult to treat depression), personality disorders (i.e. borderline personality disorder), anxiety, trauma-related (PTSD), milder substance misuse (not actively using for at least 1 month), somatisation, ADHD, higher functioning autistic spectrum disorders (ASD), and other "problems in living" (e.g. bereavement, coping with trauma).

People referred should be willing and able to participate in both group therapy and individual case-management.

The aims of the Unit

The unit aims to assess the person's difficulties, formulate an understanding of these difficulties in terms of their life context, develop a treatment and management plan, provide containment and limited interventions, and refer the person for appropriate longer-term follow-up or treatment. This follow-up may be at the unit’s outpatient complex emotional needs follow-up clinic or outpatient psychotherapy service, a community clinic, or in the private sector.

Interventions offered

The unit offers a highly structured programme of individual case-management, medication management and group-based therapies that include psychoeducation, life-skills, problem-solving, self-awareness and dialectical behavioural therapy (DBT) skills training groups. The daily programme also includes other therapeutic activities (e.g. pottery, art, yoga).  The program consists of up to 4 groups daily with breaks for other activities and individual case management.

What the Unit does not offer

The unit is not geared towards helping people with primary substance use disorders (addiction), severe eating disorders (with low weight/BMI) or a primary diagnosis of a psychotic disorder. People with these disorders should only be referred to the unit if the disorder is secondary/ less severe and reasonably well controlled (i.e. able to remain abstinent from substances for a period).

Aggressive or violent individuals and those who are actively suicidal cannot be contained on this unit, and they should only be referred when they are no longer an active risk to others or themselves and if they are appropriate for the programme.

Homeless patients are not accepted unless they have stable accommodation in a longer-stay shelter to which they can return over weekends and after the programme. 

The unit is one component of a range of services for the assessment and care of people with serious mental illnesses. It is a short-stay inpatient unit for men suffering from a wide variety of psychiatric and neuropsychiatric illnesses which are too severe to be managed at a clinic, outpatient department or other hospital setting. It offers a high-care closed ward for very ill and /or behaviourally disturbed patients who do not need a closed environment; and an open pre-discharge ward for those patients who are not behaviourally disturbed and who may benefit from a ward programme.

The Women's Mental Health Unit is an acute in-patient unit for women suffering from a broad range of psychiatric disorders. the majority of the patients in the unit are psychotic and/or behaviourally disturbed at the time of admission.

About the service: 

Valkenberg Hospital is a specialist level psychiatric hospital serving patients who cannot be managed at a lower level of care and require more complex interventions.

Appointments at the outpatient department (OPD) are by referral only. We accept referrals for adult patients aged 18-60 years who are stable and able to attend an outpatient service. 

How to refer:

Patients can be referred by any health care practitioner (psychiatrist, doctor, psychologist, nurse practitioner, social worker, counsellor, occupational therapist), on our referral form:

Link to referral form: VBH-OPD-referral-form-2026.docx

Queries can be sent to: VBH.OPDREFERRALS@WESTERNCAPE.GOV.ZA

SERVICES OFFERED: 

COMPLEX EMOTIONAL NEEDS SERVICE:

This service is for adult patients (18-60 years) with complex emotional needs, emotional dysregulation and relationship difficulties. Patients often have more than one clinical diagnosis, with overlapping diagnostic boundaries, and this may include mood, anxiety, trauma-related (PTSD), substance use disorders, ADHD and higher functioning autistic disorders. Many patients have difficult to treat and persistent depressive disorders. A high number of patients have a personality disorder (i.e. borderline personality disorder). Patients often require longer treatment trajectories due to the slower change in symptoms. 

(*For the inpatient component of the complex emotional needs service see-Therapeutic Unit/ “Ward 1” program and referral.)

1.  Complex Emotional Needs: Outpatient Assessment and case-management clinic:

This service offers outpatient assessment, treatment planning (pharmaco-and psychotherapy) case management and follow up for patients with:

• Mood, anxiety, personality and trauma-related disorders; autistic spectrum (higher functioning), ADHD, co-occurring substance use disorders
• Complex presentations overlapping diagnostic boundaries
• Where primary care management has not been sufficient or where clinicians anticipate a more complex treatment trajectory
• Patients who may not yet be ready for individual or group psychotherapy, but may reach readiness at later stage
• Patient discharged from the ward 1 inpatient therapeutic program where more complex treatment is anticipated.

This service does not accept referrals for:

• Primary psychotic disorder (Schizophrenia, schizoaffective/schizo-bipolar) disorder (See outpatient psychosis clinic)
• Primary diagnosis of severe substance use (addiction) (refer to addiction services)
• Severe eating disorder (low BMI)

2. Complex emotional needs: Outpatient: Group therapy (DBT/MBT/Dynamic):

This service offers a once weekly outpatient-based group therapy service. It is advised that patients have an individual case manager or individual psychotherapist. The service runs on a Friday morning and offers Dialectical Behaviour Therapy and Mentalization Based Treatment for patients with complex emotional needs.

 

• Dialectical Behaviour Therapy: DBT is an evidence based dialectical and cognitive behavioural treatment for patients with emotional dysregulation and personality disorders. Groups offer didactic skills training including mindfulness training, distress tolerance, emotional regulation and interpersonal effectiveness skills training.
• Mentalization Based Treatment: MBT Is an evidence-based treatment for patients with emotional dysregulation and personality disorders. It is a psychodynamic treatment that focuses on fostering a culture of mentalization within groups. Mentalization is the ability to interpret self and other's behaviour in terms of intentional mental states, thoughts, feelings and desires- to see the self from the other’s point of view and to understand the emotions behind your own and other’s behaviour. Group work is focused on difficulties in relationships and fosters the maintenance of mentalization in the context of insecure attachment styles. 
  
   

PSYCHOTHERAPY AND PSYCHOLOGY SERVICES:

1. Individual psychotherapy:

Short term: 6-8 sessions- and up to-24 sessions. Limited availability for longer, medium term treatments. Treatment may be psychodynamic or cognitive behavioural depending on clinical patient-related factors. Treatments may be short term and supportive or medium term and supportive-explorative.

2. Psychometric/neuropsychological assessment:

This service is for adult patients (<60 years) where there is suspected cognitive impairment on bed-side screening. This may be due to head trauma or medical conditions.

 OUTPATIENT PSYCHOSIS SERVICE:

1. EISH-Early Intervention Support and Help

This service offers a day-hospital service for outpatients with early phase psychosis and their families. Patients are required to attend with a family member or treatment partner on a weekly basis for a minimum of 4 months. Two parallel groups are held, one for patients and one for family members, starting 10h00 in the morning. This is followed by a Yoga session. Following this, patients will see their individual case managers and may also see the medical doctor if this is required. The group sessions provide a source of support to patients and families. Each family will have the opportunity for family meetings with all members of the family. Group sessions also involve psychoeducation and cover topics such as signs and symptoms of illness and relapse, coping with relapse, medication, stigma, goal setting and recovery, substance misuse, physical health and relationships. 

This service accepts patients:

• With early phase or first episode of psychosis (Psychosis NOS, schizophreniform, schizophrenia, bipolar I with psychosis, schizoaffective disorder)
• Age <35 years
• Able to attend the service with a family member or close treatment partner
• Motivated to attend weekly for 4 months.

This service cannot accept referrals for:

• Patients who are not motivated/refusing to attend
• Patients who are violent disruptive and aggressive
• Patients who are multi-episode patients not in the early phases of their treatment
• Patients who cannot be accompanied by a family member or treatment partner

2. Psychosis Outpatient Clinic:

This service accepts adult patients (18-60 years) for a consultation which may last 1-3 sessions followed by a management plan and feedback to the referring clinicians. Depending on clinical complexity , some patients may need longer follow-up.

 This service accepts:

• Patients with treatment-resistant psychotic disorders (bipolar I with psychosis and schizophrenia spectrum disorders).
• Patients with complex comorbidities such as schizophrenia or bipolar type I disorder with psychosis with co-occurring anxiety, obsessive and trauma-related disorders, ADHD, higher functioning autistic spectrum disorder or substance use disorders.
• Patients with medication side-effects and complex medication regimens.

This service cannot accept referrals for:

• Patients with uncomplicated clinical profile that can be manged at a community clinic.
• Patients who need urgent or emergency care for psychosis (Local emergency room/ district hospital).
• Patients with severe major neurocognitive disorders.
• Patients who are at risk to themselves or others and are not suitable to be assessed in an ambulatory setting.