Mental health campaigners have protested against the significant use of temporary psychiatrists in Scotland, claiming it would lead to substandard and harmful medical care.
Peter Todd, a campaigner based in Caithness in the north of Scotland, said the NHS’s heavy reliance on local psychiatrists was evidence of a growing mental health crisis across the country.
Scotland’s NHS boards told him that since 2019 they have spent more than £125 million on locums to replace the dozens of consultants who have retired, left the NHS or not been recruited.
Todd said that in his experience, which was echoed by other patients in his area, the heavy reliance on locums led to poor continuity of care and poorly kept notes. As a survivor of child sexual abuse, he said every new psychiatrist meant repeating his lifelong experiences and medical problems; a process that reinforced the trauma.
“When you see a regular psychiatrist you only have to explain it once, but when you see one observer after another you feel like you are a tape recorder repeating yourself over and over again,” he said.
NHS Tayside, which has faced a series of significant shortages, has spent more than £29.8 million on local psychiatrists since April 2019; NHS Grampian £22.3 million, and NHS Fife £17 million over the four years from 2019 to 2023.
The true cost of the crisis emerged earlier this month when NHS Western Isles confirmed it had spent more than £1.2 million on locums to fill two psychiatric posts at the general hospital in Stornoway in 2022/2023, and these payable per hour.
With a population of 26,600 people, it has had to spend more than £4.3 million on freelance psychiatrists to fill these posts since the 2019/20 financial year.
Like other rural health boards, NHS Western Isles is struggling to recruit doctors on current pay scales, forcing them to pay well above normal. Last month it offered new GPs a salary of up to £150,000 for a 40-hour working week, 40% higher than normal.
The Scottish Liberal Democrats said NHS data showed there were 117 locum psychiatrists working in October last year, compared to 462 permanent psychiatrists, with up to 46% of posts on some boards unfilled.
NHS Grampian said the Covid pandemic was not a cause of the crisis. “Recruitment and retention was an issue before the pandemic, and this continues,” the company said in a statement.
“Some doctors have opted for early retirement, partly due to a change in their pension rules, and fewer well-trained psychiatrists are entering the job market. This is not a problem unique to Grampian.”
Dr. Jim Crabb, from the Royal College of Psychiatrists, said much more needs to be done by the NHS and the Scottish Government to encourage and value psychiatry. Mental health care has not received the promised 10% of health care expenditure and is being cut by 5% per year.
“Funding has always been bad,” he said. “Despite serious illnesses such as schizophrenia, depression and anxiety costing economically developed societies more than conditions such as asthma and arthritis, much less is spent on mental health care than on physical health care.”
NHS Tayside said they were facing significant recruitment challenges; it takes 13 to 15 years to train as a consultant psychiatrist. Data showed that 42% of consultant psychiatrists were over 50 years old, and many were planning to retire early.
“This spike in retirements will far exceed the number of new consultants,” the report said, so efforts were underway to recruit area physicians.
“Despite these efforts, numbers of trainees are relatively low and this, combined with the length of training, means that recovery from the current position of high use of proverbs in psychiatry will take a number of years,” the report said.
Willie Rennie, a Scottish Liberal Democrat MSP who is campaigning for mental health funding, said: “It’s all very well for ministers to pay lip service to mental health, but the proof is in the pudding when it comes to budget time.
“As well as training more staff, there also needs to be a serious look at how we attract and secure staff to work in all types of communities, so that everyone has access to mental health care wherever they live.”
A Scottish Government spokesperson said recruitment had improved recently, but agreed more needed to be done “to secure the best value” for healthcare spending.
“We are considering how we can better support the recruitment and retention of psychiatrists, including actively exploring potential solutions to address issues such as the use of locums and how we attract new or existing psychiatrists to take up posts in Scotland,” they said she.