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Clinical Services

Groote Schuur Hospital

Groote Schuur Hospital provides a comprehensive in- and out-patient psychiatry service across several disciplines and levels of care. A brief description of services is given below:

  • Emergency Psychiatry Services

    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.

  • Consultation Liaison Psychiatry Services

    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.

    Outpatient clinics

    Clinic

    Day

    Venue

    Consultant

    Psychologist

    Bookings

    G22 and general CL

    Monday

    J2

    Registrar

     

    J2 
    021 4042151

    Eating Disorder

    Monday

    J2

    Dr Charles

     

    J2
    021 4042151

    Maternity

    Friday

    MH

    Dr Charles

    E Benjamin

    J2
    021 4042151

    Oncology

    Wed

    LE

    Dr Charles & Prof
    Hoare

    L Frenkel

    LE32
    021 4044470

    Adolescents:
    Chronic illness

    Wed

    G8

    Prof
    Hoare

    A Marais

    J2
    021 4042151

    Pain

    Tuesday

    E26

    Dr Pieterse 

    L Frenkel

    E26
    021 4046122

    Transgender

    Thursday

    J2

    Drs Wilson & Torline

    A Marais

    J2
    021 40421521

    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.

  • Neuropsychiatry Services

    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 treatmetn 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 relationshiops 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 manange 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 (021-4042151).

    Neuropsychiatry clinic services

    OPD Clinic

    HIV Neuro- Psychiatry

    General Neuro- Psychiatry

    Old Age
    Psychiatry

    Memory Clinic

    Consultant

    Prof Joska

    Dr Lewis

    Prof Joska

    Prof Joska/Combrink

    Day

    Friday

    09h00-12h00

    Monday 

    14h00-16h30

    Wednesday 

    13h30-15h30

    Wednesday

    09h00-10h00

    Referral criteria

    HIV infected 
    individuals with complex neuro-
    psychiatric disorders

    Complex
    neuro-psychiatric disorders other
    than HIV

    >59 y.o.

    Complex 
    neuro-
    psychiatric 
    disorders that cannot
    be managed/
    assessed at 
    CHC or
    district level

    Patients with primary memory or neuro- cognitive disorders

    Usually >59 but may
    be younger if primary neuro-degenerative condition suspected

    Those with established aetiology e.g. TBI and secondary dementia 
    are generally not seen
    at memory clinic

    Contact

    021 4042151

    021 404 2176

    021 4042151

    021 404 2151

     

  • Addiction Services

    •  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 2151. 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.
  • Ambulatory Psychiatry/ Out-patient services

    •  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, womens health and the psychiatric service. Groups for anxiety management, depression and post-head injury are also offered.
  • Transgender Clinic

    About us

    From the 1970s Groote Schuur has offered an inconsistent psychiatric, surgical and endocrine service to transgender patients. In 2009, a multidisciplinary team was formed in order to offer a more integrated and coordinated service. The team currently comprises three psychiatrists (child and adult), a clinical psychologist, a plastic surgeon, two endocrinologists (paediatric and adult), a family physician, a clinical social worker and sexologist, a general practitioner representing the private sector, and a representative from the NPO ‘GenderdynamiX’. Our team is dedicated to offering gender-affirming care, and we follow the Standards of Care of the World Professional Association for Transgender Health (WPATH- SOC 7).

    The Team

    Dr Kevin Adams

    Dr Kevin Adams, a Cape Town-based Plastic and Reconstructive Surgeon, has considerable experience and interest in gender affirming surgery, as well as training and research. He provides outpatient consultation and gender affirming surgery services for Groote Schuur Hospital.

    Ronald Addinal

    Ronald Addinal is clinical social worker who is further specialised as a sexologist and sex therapist. Currently he is a lecturer in the Department of Social Development at UCT and has also volunteered his expertise in organisations such as Triangle Project (an LGBTQIA NPO) and GenderdynamiX (a Transgender Rights NPO). Ronald is internationally and nationally regarded an expert in the psychosocial healthcare needs of Transgender children, adolescents and adults. He served on the WHO task team for South Africa for the Clinical Utility research on the ICD-11 diagnostic criteria for Gender Incongruence and Paraphilias.

    Dr Michelle Carrihill

    Dr Michelle Carrihill is a Senior Specialist in the Paediatric Endocrine Diabetes Unit at Red Cross Children’s and Groote Schuur Hospitals.

    Dr Elma De Vries

    Dr Elma De Vries is a specialist family physician at Heideveld Community Day Centre and a senior lecturer in the Division of Family Medicine at UCT.  Dr de Vries provides a link for general practitioners to access advice regarding gender-affirming care.

    Gender DynamiX Representative

    A member from the GDX management represents the needs and interests of the transgender community.

    Dr Adele Marais (Chair of Transgender Clinic)

    Dr Adele Marais is a Clinical Psychologist and Senior Lecturer in the Department of Psychiatry and Mental Health at UCT. She co-initiated the Groote Schuur Transgender Clinic with her psychiatry colleague (Dr Wilson) in 2009, and is currently the chair of the clinic. She also sees transgender clients in her after-hours private practice based at Groote Schuur Hospital.

    Carol Musikanth

    Carol Musikanth is a psychotherapist in private practice. She is a strong advocate for Transgender rights and runs a Transgender parent support group once a month.

    Dr Simon Pickstone-Taylor

    Dr Simon Pickstone-Taylor is a Child and Adolescent psychiatrist who is an Honorary Senior Lecturer in the UCT Psychiatry department. He has a particular interest in gender identity development in children and adolescents. He runs the Gender Identity Development Service at Red Cross War Memorial Children’s Hospital for youth up to the age of 18 with gender diversity and provides clinical and research supervision for trainees and clinicians. He works in private practice at the Neuro Diversity Centre in the Boland.

    A/Prof Ian Ross

    A/Prof Ian Ross is an endocrinologist working exclusively in the public sector.  The outpatient Endocrinology Clinic at Groote Schuur Hospital provides assessment and advice regarding gender affirming hormonal replacement therapy. Due to the nature of this treatment, careful monitoring is undertaken at each follow-up visit at this clinic. Treatment protocols are based on international guidelines, but they are almost always adapted to the individual who consults us.

    Dr Arianne Spitaels

    Dr Arianne Spitaels is a Senior Specialist in the Paediatric Endocrine Diabetes Unit at Red Cross Children’s and Groote Schuur Hospitals.

    Bev Toker

    Bev Toker is a medical social worker and counsellor in private practice with years of experience in dealing with assessments, individual and family support and linking clients to the team and hospital services.

    Dr Anastacia Tomson

    Anastacia is a medical doctor, an author, and an activist in the field of LGBTQIA+, and particularly, transgender rights. She practices as a GP in Sea Point, and also collaborates with public sector entities and NGOs in working towards improved access to healthcare for queer identified folk.

    Dr John Torline

    Dr John Torline is a privately-practicing general psychiatrist based in Cape Town. After completing his specialist training, he joined the Groote Schuur Transgender Clinic where he consults once a month.

    Dr Don Wilson

    Dr Don Wilson has been in a member of the UCT Department of Psychiatry since 1983. In 2015 he retired from his position as Head of Clinical Unit at Groote Schuur Hospital. He has been involved in gender affirming care and research at Groote Schuur since the 1990’s and currently attends the Transgender clinic twice a month.

    Transgender clinic Groote Schuur Hospital

    Referrals

    Our clinic accepts referrals of people (18 years and older) who experience that the sex they were assigned at birth is not congruent with their experienced gender identity. We can assist with assessment of gender dysphoria, including assessment of identities across the spectrum of gender diversity, and we facilitate access and make referrals to other gender affirming services.

    A GP or another health professional can refer a client directly to the Transgender Clinic by completing the referral form, and sending it to: GSH.PsychOPD@westerncape.gov.za.

    Please note: we do not accept referrals for people with psychosexual issues in the absence of gender identity concerns. If a client seeks gender affirming surgery, Groote Schuur Hospital has a very long waiting list for these procedures, and therefore these procedures can only be undertaken many years after initially being referred.

    Appointments

    First Appoinment

    A client’s first appointment at the Groote Schuur Transgender Clinic will be at the Psychiatry Outpatient Department (OPD), where Dr Marais (clinical psychologist) and either Dr Wilson or Dr Torline (adult psychiatrists) will see them. The assessment and a client’s need for gender affirming interventions will inform referrals to the Endocrine and Plastic Surgery department.

    Endocrinology Appointments

    Endocrinology OPD does not contact clients telephonically to inform them of their appointment dates. Following the appointment at Psychiatry OPD, we advise clients to wait 2-3 weeks, and then contact Mrs Fredoline Lincoln, on 021 404 6151 or fredoline.lincoln@westerncape.gov.za to assess the progress with arranging an appointment. Clients should provide their name and Groote Schuur Hospital (GSH) folder number, and ask her to check the date of their scheduled appointment in the Endocrine new patient clinic. The hospital will also send clients a SMS two weeks prior to their appointment with confirmation of the date.

    Surgery Appoinments

    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.

    Services

    Psychiatry and Mental Health

    The first appointment at the clinic (at Psychiatry OPD) will involve a comprehensive assessment of the client’s gender dysphoria, as well as a mental health assessment, to determine if there are any mental health concerns with which we can assist. If a mental health condition is diagnosed, and treatment is started, the client will be given follow-up appointments at Psychiatry OPD in order to monitor progress. In most cases, this will be done in parallel to facilitating access to other gender affirming interventions.

    Referral to gender-affirming services

    Once seen by the mental health team at Psychiatry OPD, clients will be referred to the Endocrine and Plastic Surgery services.

    Endocrinology

    The Endocrine clinic provides transgender hormone therapy to reduce the differences between your body and your gender identity, while monitoring for side effects and using the principal that the lowest effective dose should be used to limit side-effects where possible. One should always bear in mind that the rate of progression differs from person to person and treatment is always individualised. While acknowledging that this form of treatment is relatively safe, there are potentially very serious side effects. Your consultant will take your general health, your risk factors for certain side effects, and your current medications into consideration. On average, we evaluate patients initially at 3 monthly intervals, and it may be reduced to 6 monthly appointments. A series of blood tests are usually requested prior to each appointment.

    Plastic surgery

    Psychology/ Counselling 

    There are unfortunately limited resources at Groote Schuur Hospital when it comes to psychotherapy and counselling services. The mental health team will refer clients to other available counselling services, which may include the counselling services at Triangle Project or practitioners in private practice.

     

    How to find us

    Psychiatry Out Patient Department (J2 OPD). We are on the H-floor of the Out-patient Building at Groote Schuur Hospital. Our contact number is 021 404 2151.

    Changing an appointment

    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: please contact Linda Newman on 021 404 2151; GSH.PsychOPD@westerncape.gov.za.

    Endocrine clinic: please contact Fredoline Lincoln on 021 404 6151; fredoline.lincoln@westerncape.gov.za.

     

    Information and support

    Our team is available to provide consultation and support to other clinicians wanting to offer gender-affirming services.

    For general queries about gender dysphoria, and local resources, please contact GenderdynamiX:
    021 447 4797  info@genderdynamix.org.za 
    https://www.genderdynamix.org.za/

    For specific queries related to the GSH Transgender Clinic, please contact Dr Adele Marais: adele.marais@uct.ac.za

    For queries related to hormone and GP support, please contact Dr Elma De Vries: Elma.deVries@westerncape.gov.za

    General practitioners - please have a look at the following resource: https://www.genderdynamix.org.za/general-practitioners

     

    Legal Issues

    The practitioners on the team can assist 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. Website: www.lrc.org.za;  mandy@lrc.org.za

     

    Support Groups and Organisations

    Gender Dynamix
    Unit 21, Collingwood Building, 10 Anson Street, Observatory, Cape Town
    021 447 4797
    info@genderdynamix.org.za

    Triangle Project

    Triangle Project has a clinical services programme with volunteer healthcare practitioners and LGBTQIA positive therapists offering specialized expertise in LGBTQIA care. Transgender persons can access individual counselling, relationship counseling, family counseling, support with negotiating social transition at school, college, university or the workplace. Depending on your financial circumstances services can be free or on a sliding scale.

    Contact:
    2nd Floor, Leadership  House, Corner Burg and Shortmarket Streets, Greenmarket Square, Cape Town 
    081 257 6693
    info@triangle.co.za

    There is a monthly transgender support group on a Saturday morning at Triangle Project (in Shortmarket Street , Cape Town). It’s facilitated by a clinical social worker - Ron Addinall. Visit the website or call Heather Adonis at Triangle Project for more information - 021 422 0255.

    Parent Support Group/Parent Counselling:

    The parent support group is facilitated by a psychotherapist (Carol Musikanth) who herself is a mother of a transmale young adult. The group takes place once a month on a Tuesday evening. There is no cost involved.
    Contact details:
    Carol Musikanth
    8 Chilworth Road, Camps Bay, Cape Town
    (Office) 021 438 8989
    E-mail carolmusikanth@gmail.com

    Social Work:

    Bev Toker medical social worker and counsellor in private practice with years of experience in dealing with assessments, individual and family support and linking clients to the team and hospital services.
    Contact details:
    32 Oceanhurst, Sea Point, Cape Town
    072 132 6197
    tokerbeverley@gmail.com

     

    Compliments, complaints, concerns

    We welcome your feedback. Please forward it to GSH.PsychOPD@westerncape.gov.za.