Background: Amanuel Mental Specialized Hospital which is situated in the capital, AddisrnAbaba is the only mental health hospital in Ethiopia. The hospital has a huge burden in offeringrnboth inpatient and outpatient services for patients who come from all regions of the country.rnHaving access to this hospital for treatment and continuing follow-up is also a challenge forrnmany patients. Studying the characteristics of patients seen at this hospital will be a good inputrnfor the decentralization of mental health services which the country is implementing. rnObjective: To assess socio-demographic and clinical characteristics of new patients seen, andrndecisions made by clinicians who did the first evaluation, at AMSH. rnMethodology: A retrospective chart review of 384 new cases who had been seen at AMSH fromrnSeptember 11, 2019, to March 9, 2020, was done in August 2020. Sampling was done byrnsystematic random sampling method. Data analysis was done by using SPSS V25. rnResult: The majority of patients were from Oromia 196(51%) followed by Addis Ababa 105(27.3 rn%). The majority of cases 298(77.6%) were labeled as regular after triage. The majority ofrnpatients 327 (85.2%) came without a referral. Schizophrenia spectrum and other psychoticrndisorders 180(46.9%) were the most common diagnosis followed by depressive disordersrn63(16.4%) and epilepsy 29(7.6%). The majority of cases 338(88%) were managed as outpatientrnand prescribers with BSc or MSc in psychiatry 91(48.4%) were the most common cliniciansrnidentified to do the first evaluation for the new cases followed by GPs 48(25.5%). Of totalrnpatients, 359(93.5%) did not require medications other than risperidone, chlorpromazine,rnhaloperidol, diazepam, clonazepam, amitriptyline, fluoxetine, sodium valproate, phenobarbital,rnand benzhexol(Artane). rnConclusion: The majority of new patients come to AMSH for a service that can be provided atrnprimary health care units. Increasing public awareness about mental health services andrnstrengthening mental health services provided in primary health care units and other hospitals byrnstakeholders is recommended to decrease patient overload at AMSH and help the patients inrngetting mental health services in their vicinity.