The complaints about local psychiatrists have a clear pattern. Patients say they routinely experience inconsistent care or receive conflicting advice. Some describe an indifference that borders on checking off boxes.
“I had 14 observers (and) they all had different views and opinions on my care,” said one respondent to a survey of 469 patients by advocacy group Vox Scotland. ‘The last observer didn’t bother to call me back. That was four months ago. I have had no contact with my mental health team since.”
Vox Scotland surveyed patients after hearing of repeated cases of bad experiences with locums, the agency’s psychiatrists on whom Scotland’s mental health system increasingly depends.
For some, the anger is palpable. “There is no longer any concern in the people or the system and it is criminal what they have been allowed to do, especially in recent years by putting everything online,” said one respondent. “Online appointments are not accessible to many neurodivergent people like me. Suicidal? Nothing says care more than a five-minute Zoom and a prescription from twenty miles away, without anyone picking it up.”
Vox respondents testified about experiences with all fourteen Scottish health boards, which have spent £134 million on local psychiatrists since 2019.
Nearly a third said all or most of their care came from locums, half of whom were dissatisfied or very dissatisfied with the overall quality of care. A fifth of those surveyed said they did not know whether they were being seen by locums or NHS psychiatrists.
“Every new locum has new ideas, medications change, but are never here long enough to see if the medications work or not. Then the cycle begins with the new one,” said another.
“Every time you see someone else you have to pour your heart and soul out,” said another. “There is no understanding or relationship with local psychiatrists for vulnerable people – that’s impossible when you’re receiving notes from the last person.”
These findings, now being collected by Vox for a report due this year, reinforce growing concerns among senior psychiatrists that the system is in crisis. Mental health spending has been cut, even as overall health care spending has increased. Over the past five years, the number of NHS psychiatrists in Scotland has fallen by 17%, or 130 people, to 651 full-time positions.
Dr. Amanda Cotton, spokesperson for the Senior Medical Managers in Psychiatry group, said NHS staff were “stretching further and further to try to continue to deliver the services that people expect, but I think it’s fair to say that the cracks absolutely starting to disappear. show”.
Dr. Jane Morris, the Scottish president of the Royal College of Psychiatrists, believes the trends raise very difficult questions. “I don’t want to be a scaremonger, but we could see ourselves as an NHS that exists purely to buy professionals from locum agencies,” she said.
“That would not only be a very expensive way to spend taxpayers’ money, but it would also lose a lot of the checks and balances, quality assurances and that kind of sense of belonging. The NHS still operating in Scotland has a sentimental tug on people’s minds. We still want to commit ourselves to it. People still want to be cocooned by it, and I don’t think we’re too late for that to happen again.”