The purpose of this paper is to highlight the complexity of language service issues in institutional contexts. This is illustrated through the experiences of the National Language Project (NLP) in providing interpreter services at a Western Cape psychiatric hospital. A range of dilemmas, contradictions and challenges are considered, particularly as they apply to the development of post-apartheid health services. There is no attempt to prescribe solutions but rather an exploration of the problem confronting language service providers in such settings. Some of the difficulties presented are particular to psychiatric settings but others may apply across a range of health care and institutional contexts.