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A comprehensive psychiatric service for the city of Cape Town and a large rural catchment area in the southern and central Cape Province is described to show how the psychiatric facilities and services of the Department of Health, the Cape Provincial Administration and the University of Cape Town function together as an effective, co-ordinated whole. The principles on which this is based are described, namely, planning on the basis of what one multidisciplinary team can achieve, the development of specialized therapeutic units at different hospitals, and co-ordination of clinical activities by the Department of Psychiatry of the University of Cape Town. Emphasis is placed on community psychiatry. The different units and their functions are described, as well as teaching and research activities.

The problem of the care of the psychiatrically ill aged is large, and will increase. A comprehensive psychiatric service for the aged should cater for various types of patients, and should be conceptualised in terms of a whole community. It involves, in the first place, a sorting operation - patients who need purely residential care and medical treatment must be separated from those who require special psychiatric services. The setting up of a psychogeriatric assessment unit is a priority, followed by the provision of facilities to meet the needs of special patients. These include a small day hospital, beds for inpatients and a community service. The latter is central to any organisation of psychogeriatric services. The provision of new services should grow in association with and, perhaps, out of, existing facilities, and should aim at providing a comprehensive scheme.

The article presents a follow-up study of definitely and probably psychiatrically disturbed persons first located in I963 in Cape Peninstria, Australia. The researchers gathered data by the random sampling of a large community. Furthermore, a 10 per cent random sample of those previously judged to be free of psychiatric symptoms was reassessed. With this, it was found that those previously adjudged free of psychiatric symptoms tended to remain well and about half of those previously adjudged definitely psychiatrically disturbed were still included. It has been suggested that psychiatric disturbance was positively related to low socio-economic position. Psychiatric disturbance appeared to be positively related to physical illness in previously free of symptoms remained physically healthy.