Changes in the official status of African languages in South Africa suggested an examination of the impact of multi-lingualism on the practice of institutional psychiatry. For a range of theoretical and institutional reasons, a 'language gap' between clinician and patient can be rendered irrelevant in terms of the routine production of psychiatric texts in which 'symptoms' are described and 'cases' are constructed. In contrast to the way in which the role of interpreting is obscured in some hospital settings, it is highlighted in forensic settings. Here the extent of the dependency of the clinician on the interpreter is made more visible. Through this ethnographic exploration of the institutional management of multi-lingualism, the status of 'the patient who requires interpreting' emerges as an institutional construct, being determined in large measure by the routines of institutional practice. The requirements of the institution that the patient move through the process of a hospital admission, and the different requirements of each stage of this process, inform the decision as to whether interpreting is necessary. Furthermore, the differing requirements of the members of the multi-disciplinary teams renders the status of 'the patient who requires interpreting' as variable and contested. Through this analysis the institutional management of multi-lingualism emerges as a site at which discourses of race in psychiatry are reproduced.