Ward C23 and Male Short Stay Assessment Service: Ward C22

C23 provides a specialised service for patients referred who require urgent psychiatric evaluation and management. The in-patient unit can accommodate up to 16 individuals with a range of acute psychiatric disorders in adults and young people 13 and older. The ward is particularly geared to be able to provide longer-term care for certain categories of patient where hospitalisation in a tertiary facility is necessary e.g. complicated neuropsychiatric disorders and medical co-morbidity

• We provide a consultation service for patients referred from the Medical Emergency Unit as well as from other units and wards within Groote Schuur Hospital.
• We also offer a consultation service for patients referred from Regional hospitals, Community clinics and the network of mental health services as well as general health care practitioners within the drainage area of Groote Schuur Hospital.

The male short stay assessment unit at C22 provides for the needs of men suffering from acute psychiatric disorders in the Klipfontein area of Cape Town, as well as the GSH surrounds. Many of the individuals suffer from dual diagnosis in the form of psychosis and substance abuse.

GSH is a major tertiary and academic hospital, and as such caters for many specialist and sub-specialist services across all medical disciplines, The Liaison service supports the many individuals suffering from psychiatric and psychological co-morbidity.

The G22 ward has now evolved into a consultation liaison inpatient unit which provides a comprehensive assessment and treatment service, packaged around the needs of individuals with complex medical and psychiatric needs. The environment is strongly multi-disciplinary, with evidence-based psychotherapy a key component. The unit now offers three admission programmes:

1. In patient diagnostic assessment for complex patients, of variable duration.
2. 8 week therapeutic programme comprising individual case management, group therapy, life skills, family therapy and consultations from other medical specialties and allied health professionals.
3. 12 week eating disorder programme including specialist dietician input and access to the same therapies available in the 8 week programme.

Inclusion criteria: The unit accepts male and female patients from the ages of 15 years with a psychiatric diagnosis and co-morbid medical diagnosis. The unit also focuses on several patient groups: eating disorders, somatoform disorders, women’s mental health (pregnancy and gynaecological conditions), and chronic pain (including patients with analgesic dependence).

While the unit tries to accommodate as many patients as possible, individuals with active illicit substance abuse; current forensic investigation; and behavioural disturbance are generally not admitted.

Patients who meet the criteria can be booked for an assessment and tour of the ward which takes place on Wednesday mornings. Referral letters can be faxed to 021 404 6054. Patients will be contacted directly with an assessment date so please include their contact numbers. Urgent referrals can be discussed directly with the head of the unit Prof Jackie Hoare on 021 404 2134.

• The in-patient liaison referral service sees patients referred from all wards in Groote Schuur Hospital. Referral letters (“pinkies”) are dropped off at ward C23. Most patients will be seen within 24 hours of referral. Patients are initially seen by the liaison registrar and then discussed with a consultant. Consultant ward rounds and bed side teaching take place on Thursday mornings. HIV positive patients are seen by the neuropsychiatry registrar. Complex Liaison patients can be managed by the consultant or senior registrar in ‘non-psychiatric’ wards by daily review.
• As part of the in patient liaison service patients referred from Valkenberg Hospital for a medical evaluation and/or admission will now be followed up by the liaison team while at Groote Schuur Hospital. The referring doctor at Valkenberg needs to inform the liaison registrar that the patient is being transferred to GSH. The liaison registrar can be contacted on 021 404 2175. If a referral takes place after hours the on call doctor at Valkenberg can inform the on call doctor at C23. This will then be noted in the liaison communications book and taken over by the liaison registrar the following day. Referral information can be faxed to 021 404 2178.
• There are several liaison outpatient clinics being run at Groote Schuur Hospital.

Outreach services are provided in the form of telephonic support to Mowbray Maternity Hospital and St Lukes hospice. Complex patients are reviewed at the referring hospital by Prof Hoare, the appropriate liaison clinic or offered an in patient diagnostic assessment.

The Division of Neuropsychiatry offers a range of in- and out-patient services to individuals with HIV- and general neuropsychiatric disorders. The Division is a sub-specialist service, and as such is involved in the assessment and treatment of many complex cases, often referred on from services elsewhere.

• Our in-patient service offers 5 tertiary in-patient beds at Ward G22. We admit women with HIV-associated neuropsychiatric disorders, older women with neuropsychiatric disorders; and a range of complex conditions including neuro-inflammatory, neoplastic, cerbro-vascualr and epileptic disorders. The Unit has a full multi-disciplinary team, and has excellent working relationships with key related fields, including neurology and infectious diseases. Patients are referred from other GSH wards, psychiatric hospitals and out-patient clinics. We are not able to admit patients with life-threatening medical co-morbidity, although we can manage some complex conditions, and we cannot generally manage very behaviourally disturbed individuals. Most of our patients stay 2-6 weeks, before being discharged or referred on to other units. Referrals are discussed with the ward registrar on 021 4045456.
• The Division of Neuropsychiatry provides outpatient services for several “clusters” of disorder. The Division takes referrals from:

1. GSH services, GSH district catchment (patients seen in local CHCs), and the GSH tertiary hospital (patients seen at district/secondary hospitals in metro west). We generally do not take directly from primary level. We provide mainly an assessment and refer down service.
2. Patients <18 should be referred to Child and Adolescent Psychiatry.
3. Those needing psychometric testing should be referred to the Neuropsychology service (021-404 9111).

• Addictions is a growing area in psychiatry and mental health at GSH. The addictions service supports individuals admitted to GSH in the psychiatry and other medical/surgical wards. Patients with substance use disorders related to opiate addiction, methamphetamine and other substances are seen. A number of out-patient services are also available.
• The addictions clinic runs on a Thursday morning, and includes an opioid substitution clinic. Psychiatrists include: Drs Dannatt and Karjiker. Appointments can be made at 021 404 9111. The aim of this clinic is to assist with the assessment, management and providing advice on complicated addictions cases as well as those with other co-morbid psychiatric disorders (dual diagnosis). It is expected that these patients have been initially assessed and some appropriate interventions have been provided prior to any decision to refer. We do not do acute detoxes in this unit and patients needing this service should continue to be managed in the primary care setting or district/regional hospitals. Where possible we do refer back to primary referral agencies or to addiction agencies in the community.
• Criteria for referral: Patients must live within Metro West; not currently hospitalised; adults between 18 to 65 years; and have an addiction disorder (alcohol or illicit substance dependence, over the counter dependence, gambling addiction, overeating) that has been partially or non-responsive to primary care treatment or because of co-morbidities is not manageable in the primary care or regional hospital setting.

• In addition to the OPD services listed under the sub-specialist areas above, the GSH OPD supports the GSH district and hospital at secondary level. We receive many referrals from other medical services within GSH, often for more routine associated psychiatric disorders, such as depression and anxiety.
• General specialist psychiatry clinics are led by the head of OPD- Dr Ian Lewis- and supported by sessional specialists and medical officers.
• We also offer a comprehensive psychology OPD service, led by Ms Nuruneesa Lalkhen. Referrals to this service typically come from neurology, genetics, women’s health and the psychiatric service. Groups for anxiety management, depression and post-head injury are also offered.

• History of Immunomolecular Psychiatric Outpatient Clinic At J2 Groote Schuur Hospital
• Following the 92% completion of the HUMAN GENOME PROJECT in 2003, Dr Elizabeth Peter-Ross (B.Th., M.D., D.O.H., L.M.C.C., FFPsych (SA)) started the Neurogenetic Psychiatric Outpatient Clinic at J2 Groote Schuur Hospital in June 2005. The clinic assesses patients who have a known genetic disorder and a mental health need or when two or more persons in the same family have similar mental health needs. The overall aim was to find suitable persons to help further our understanding of the shared cellular and molecular pathways in neurogenetic psychiatric disorders. In 2012, Dr Elizabeth Peter-Ross and three other prominent psychiatrists started the Special Interest Group (SIG) for Cellular and Molecular Psychiatry within the South African Society of Psychiatry (SASOP). In 2018, Dr Elizabeth Peter-Ross had a paper published on Catatonia which included three families with similar genetic histories. In January 2022 as our knowledge of the link of psychiatric disorders to the metabolic and abnormalities in the immune system expanded, the name of the outpatient clinical was changed to Immunomolecular psychiatric outpatient clinic so as to include persons with a known Immunological condition and a mental health need. 
• REFERRALS process
• The Immunomolecular Psychiatric Outpatient Clinic accepts referrals of all ages and does not discriminate on the basis of intellectual ability. A GP or another health professional can refer a client directly to this clinic by completing the [referral form] and sending it to: peterem@mweb.co.za

• Background:
• Transgender and Gender Diverse (TGD) people are a minority group facing significant prejudice, stigma, and discrimination. The human rights and dignity of TGD persons are often undermined in interactions with institutions, including the healthcare system.
• With this in mind, the Groote Schuur Hospital (GSH) Transgender Multi-Disciplinary Team was formed in 2009 with the overarching goal of respecting TGD people's dignity and right to identity and expression. The group comprises of multi-disciplinary members committed to providing clinically sound and competent gender-affirming healthcare services to the TGD community. Access to gender-affirming healthcare can significantly impact the well-being and quality of life of those who seek it.
• The team follows best practice standards of care such as the WPATHStandards of Care for the Health of Transgender and Gender Diverse People (Version 8), and has contributed to developing the national ‘Gender-Affirming Healthcare Guidelines’ published by the Southern African HIV Clinician’s Society (SAHCS).
• The GSH Transgender team has input from a range of disciplines such as Clinical Psychology, Psychiatry (Adult and Adolescent), Endocrine (Adult and Adolescent), Plastic Surgery, Gynaecology, Speech Therapy, Family Medicine, Sexology, Clinical Social Work, and includes representatives from both private and public sectors, as well as NGOs and advocacy groups.
• Referrals to the GSH Transgender Clinic
• GSH offers various gender-affirming services across clinical disciplines, including Psychiatry and Mental Health, Endocrinology, Speech Therapy, Gynaecology and Plastic Surgery. These Outpatient Department (OPD) clinical services are offered on separate days in the respective clinics.
• Our clinics accept referrals of people who experience a marked incongruence between their experienced /expressed gender and the gender assigned at birth who are 18 years and older. A GP or another health professional can refer a client directly to the GSH Transgender Clinic by completing the referral formand sending it to:GSH.PsychOPD@westerncape.gov.za.
• Most clients are first seen at the J2 Psychiatry OPD where we assist with an assessment of both Gender Incongruence, and also mental health. Clients will then be referred to gender-affirming services available at GSH and in the community, and will also be referred for mental health care follow-up if necessary.
• Referrals can be sent directly to the Endocrine and Plastic Surgery clinics at GSH if clients have already had a comprehensive assessment (including a mental health assessment) and are ready to begin gender-affirming hormone therapy and/or be reviewed for gender-affirming surgery. Please get in touch with these services directly via:
• Endocrine OPD: GSHendocrinology@gmail.com
• Surgery OPD: Clients must take their detailed referral letter to F-floor (Room 14) to secure a booking in person or by phone (021) 404-5566.
• Services and appointments
• Psychiatry and Mental Health:
• Clients who have not had a comprehensive assessment (including a mental health review) by a referring doctor will be seen at the Psychiatry Outpatient Department for their first appointment at the GSH Transgender Clinic. Here, a member of the Transgender Clinic team will see clients for an assessment of both Gender Incongruence, as well as a mental health assessment.
• Based on a client's gender-affirming and mental healthcare needs, they will be referred to other outpatient clinical services at GSH (which includes Endocrine, Speech Therapy, Gynaecology, Plastic Surgery and Psychiatry).
• Because GSH has limited resources for psychotherapy and counselling services, we will provide clients with information on community resources for psychosocial counselling and support (e.g. Triangle Project).
• Once a referral has been received, clients will be contacted with an appointment date. Please note that this clinic usually has a 2-3 month waiting list.
• Please send referrals to GSH.PsychOPD@westerncape.gov.za
• Endocrinology:
• The Endocrine clinic seeks to provide gender-affirming hormone therapy to align a client’s body and their experienced gender identity. This requires ongoing lifelong monitoring for side-effects. The lowest effective dose is administered to limit side-effects, where possible. The rate of progression differs from person to person and treatment is always individualised. Although this form of treatment is relatively safe, there are potentially serious side-effects. The Endocrine service will take into consideration a client’s general health, risk factors for certain side effects, and current medications, as these will influence the type and dosage of therapy available to a client.
• Clients are initially evaluated at 3 monthly intervals, but these appointments are usually reduced to every 6 months at a doctor’s discretion. Blood tests are usually required prior to each appointment. These should preferably be performed at a client’s nearest clinic to ensure that results are available at the time of their clinic appointment. Clients referred from the Psychiatry OPD Transgender Clinic will be referred for their blood tests on the same day as their Psychiatry appointment.
• Initial Endocrinology appointments will be requested by the referring practitioner – most often from the Psychiatry OPD practitioner who first saw the client. Clients who are being referred by another mental health practitioner after a comprehensive review, can be referred directly to the Endocrine clinic, and do not need to first be seen by the Psychiatry Transgender clinic.  Referrals can be sent to: GSHendocrinology@gmail.com
• Upon acceptance of a referral, clients will be contacted by the Endocrine admin clerk with an appointment date. Should there be a need to verify the dates of the appointment or concern relating to excessive delays, clients can contact Kuhle on 021 404-5007. The hospital will also send clients a SMS two weeks prior to their appointment with confirmation of the date. Follow-up appointments will be made internally through the administrative clerk.
• Surgery Appointments:
• After the initial appointment at Psychiatry J2 OPD, clients will be referred on the same day to the Plastic Surgery booking office, on F-floor (Room 14) to obtain a date for a future appointment with the plastic surgeon.
• Clients who are being referred by another mental health practitioner (after a comprehensive assessment of Gender Incongruence and mental health), can be referred directly to the Plastic Surgery clinic, and do not need to first be seen by Psychiatry OPD. Clients must take their detailed referral letter to F-floor to secure a booking in person, or phone (021) 404-5566.
• Unfortunately, GSH has very limited resources for gender-affirming surgeries. This has resulted in a substantial waiting list, and most procedures can only be undertaken many years after a client is initially referred.
• Surgery will refer the client to Psychiatry OPD for a mental health review prior to any scheduled surgical interventions.
• How to find and contact us
• Please note that each clinic (Psychiatry, Endocrine, Plastic Surgery) manages their bookings separately. To cancel or reschedule an appointment, please liaise directly with the relevant clinic.
• Psychiatry OPD: Psychiatry Out-Patient Department (J2 OPD), D-floor, UCT Neuroscience Institute. Please contact the admin clerk, Faghrie, and ask to speak to the Psychiatry OPD Nurse who manages the Transgender Clinic’s referrals and bookings.
• Contact no: 021 404-2151. GSH.PsychOPD@westerncape.gov.za.
• Endocrine OPD: G-floor – GSH Out-patient building. Clients should contact Kuhle on 021 404-5007 for more information on their appointment dates.
• Referrals can be sent to:GSHendocrinology@gmail.com
• Plastic Surgery OPD: F-floor, Out-patient building. Patients must either phone 021 404-5566 to make an OPD booking or go in person to room 14, F floor in the OPD building.
• Information and support
• For general queries and information on local resources, please contact GenderdynamiX:
  021 447-4797 https://www.genderdynamix.org.za/
• Unit 21, Collingwood Building, 10 Anson Street, Observatory, Cape Town
• For General Practitioners: please have a look at the following resource regarding gender-affirming hormone therapy: https://www.genderdynamix.org.za/general-practitioners
• For professional queries and consultation related to hormone therapy – please contact A/Prof Elma De Vries: devrieselma@gmail.com
• Triangle Project
• Triangle Project has a clinical services programme with volunteer healthcare practitioners and LGBTQIA positive therapists offering specialized expertise in LGBTQIA+ care. Trans and gender diverse persons can access group support, individual counselling, relationship counselling, family counselling, and/or support with negotiating social transition at school, college, University or the workplace. Services can be free or on a sliding scale – depending on the client’s financial circumstances.
• Contact:
• http://triangle.org.za/
• info@triangle.org.za
• 2, 4 Seymour Street, Observatory
• Helpline: 021 712 6699
• Counselling appointment bookings: health2@triangle.org.za
• Triangle Project offers a monthly trans and gender diverse support group. Visit the website or call Heather Adonis at Triangle Project for more information - 021 422 0255.
• Legal Issues
• The practitioners on the GSH Transgender team can assist GSH clients with the application for changing their gender marker on their ID. The application at Home Affairs requires letters from two practitioners.
• Legal Resources Centre (LRC) is a law clinic that uses law as an instrument of justice for vulnerable and marginalised persons in South Africa. In promoting/advancing the rights of transgender persons, the LRC provides legal assistance with Act 49 related cases, difficulties in accessing care through medical aids as well as legal assistance related to various cases where transgender persons are discriminated against.
• To make an appointment, call 021 481 3000; www.lrc.org.za