There are currently two units within the mental handicap programme of the Associated Psychiatric Hospitals (APH), the Alexandra Hospital Unit and the Lentegeur Care and Rehab. Unit. The two units are moving closer together and in the future will have one medical superintendent. They could therefore be considered together. Nature of the service - It provides in- and outpatient services for people with mental handicap in the Western Cape Province. Each unit should have 500 beds to give a total of 1000 beds. At present there are 1200 beds. There has been a move away from custodial care, but the legacy of the past will take time to work through. Deinstitutionalisation has resulted in over 200 patients being placed in group homes or with their families i.e. discharged from hospital. Together with natural attrition, the number of inpatients has declined from 1600 in 1992 to 1200 in 1999. No new long-term patients are admitted. Some people coming in via the short term programme may ultimately stay for prolonged periods. No person is "institutionalised". Patients are only admitted for medical reasons. Both hospitals run short term programmes. Alexandra Hospital has a six bedded ward where adults and older adolescents with dual diagnosis are managed. Admissions come via the outpatient clinic. The expected duration of stay is from one to three months. Lentegeur Hospital has an eight bedded ward for children. The focus is on behaviour management or developmental skills training. The expected length of stay is from one to three months. An inpatient ward for adolescents with dual diagnosis is being planned. Outpatient services are held at both hospitals. There are no drainage areas. Alexandra Hospital tends to focus on adults and Lentegeur on children. However, if people live closer to a particular hospital, they can be seen at that hospital. The Alexandra Hospital outpatient service is held weekly. Patients are divided into two categories - those with dual diagnosis and the other mentally handicapped patients. Although the distinction is not absolute, those with a dual diagnosis are seen by the psychiatrist or psychiatric registrar and the others by the multidisciplinary team. All new patients are discussed by the clinical team on receipt of an application form and an allocation for the appropriate consultation is made. The Lentegeur Hospital outpatient service is held weekly. On one week new patients are seen by a multidisciplinary team and the next week individual follow-up visit are held. NB - a joint psychopharmacology meeting is held twice a month with the pharmacology department. Complicated cases (in- or outpatients from either hospital) are discussed. Indications and exclusion criteria for admission - All admissions are considered by the admissions teams. Indications are people with mental handicap (IQ < 70) and mental health problems. Acutely psychotic mentally handicapped patients from the community are best admitted to an acute unit (Groote Schuur Hospital, Tygerberg Hospital or one of the APH Psychiatric Hospitals) until the acute problem is treated. Transfer to one of the mental handicap units can be arranged with a member of the admission teams. Exclusions are mentally handicapped people with social problems and forensic patients. Indications for transfer of patients to other services - forensic patients with mental handicap. Arrangements for follow-up after discharge - There are a number of options; outpatient clinic, community mental health team, day hospital, general practitioner or private psychiatrist. Rates/fees - According to PAWC rates. Channels of communication -inquiries about admission or in patients and past patients; * Alexandra Hospital phone ext 224 and ask for a member of the admissions team * Lentegeur Hospital phone ext 1283 or 1285.