Lived Experience Report Highlights Need for More Permanent Psychiatrists to Improve the Continuity and Quality of Care
VOX Scotland has today (Wednesday, 18th December) launched their report Your Views: Psychiatrists in Scotland and called on the Scottish Government to work with them to develop and implement an action plan to improve the experience of people across Scotland who receive psychiatry care.
The report documents the findings of a VOX Scotland survey looking at the experience of those who have received care from a psychiatrist under NHS Scotland within the past five years and builds on data provided under Freedom of Information detailing the use and cost of locum psychiatrists in Scotland’s health boards.
The survey, carried out over the summer, received almost 500 responses covering every health board area, giving a comprehensive picture of care experience across the country, and highlights the scale and impact of the use of locum psychiatrists with almost one third of respondents having received care from ‘all’ or ‘mostly’ locum psychiatrists in the last five years and almost two-thirds expressing that they felt receiving care from a locum had negatively impacted the continuity of care they received.
Launching the report, VOX Scotland Manager, Natalie Stevenson said:
“The responses we received showed a direct correlation between access to a permanent psychiatrist over a sustained period of time and the quality and continuity of care received. Most respondents who received locum care saw two or more psychiatrists and this often resulted in low continuity of care, poorer outcomes and significant distress.
Across more than one hundred qualitative answers from those with experience of locum psychiatrist care, whilst some reported receiving a high quality of care, many shared the detrimental impact of their psychiatrist(s) changing over short periods of time. The growing lack of permanent psychiatrists is a significant cause for concern, both in terms of the impact on those receiving care and cost to health boards. We echo calls from the Royal College of Psychiatrists in Scotland to urgently address the need for better recruitment and retention of NHS Psychiatrists, and a systematic cessation of non-qualified locums acting as consultant psychiatrists.
Our findings also highlighted areas where action is desperately needed in the provision of psychiatry care across the board. This includes improving transitions for people moving within the mental health care system, and greater training and support to ensure the care provided aligns with all elements of the core mental health standards.
We look forward to presenting the findings of our research to the Scottish Government and working collaboratively to ensure a strong future workforce, full delivery of the core mental health standards, and better quality psychiatric care for everyone who needs it.”
Some quotes from respondents to the survey:
“More permanent positions. I had the same wonderful psychiatrist for 15 years. This last 10 years have been horrendous. Every new locum has new ideas, medication changes, but are never here long enough to see the medication work or not. Then the cycle begins with the new one.” (Respondent – ‘all locum’)
“Less locums, continuity, hate the fact I don’t see the same person every time. Unreliable, they don’t update GP for months about medication changes.” (Respondent – ‘all locum’)
“Need less locums. Having a permanent psychiatrist would improve quality of care. It’s hard when you as the patient have more of a clue about your illness than the professional making decisions which affect your life and health.” (Respondent – ‘mostly locum’)
“There is no care left in people or the system and it’s criminal what they have been allowed to do, especially over these last few years taking everything online. Online appointments are not accessible to many neurodivergent people like me. Suicidal? Nothing says care like a 5 minute zoom and a prescription 20 miles away with nobody to collect it.” (Respondent – ‘mostly locum’)
“Quality of care when I see psychiatrist is mixed. I feel locums tend to almost work through a checklist e.g. are you eating, sleeping etc. with no real idea of personal situation.” (Respondent – ‘mostly locum’)
“Whenever possible locum psychiatrists who are there for a very short period of time should not make major changes in medication then be unavailable or moved on when things go wrong, or you have major effects of rapid withdrawal of old drug and side effects of incompatible new drug. The next locum then very reluctant to discuss the problem and wishes to replace the drug again in rapid succession. This leads to high distress.” (Respondent – ‘even mix’)
“My current psychiatrist is working under huge and unsustainable pressure. This has a very negative impact on my care – I almost never see her and as soon as I’ve left the office her attention is swept away by other things, meaning agreed medication changes etc. are never followed through which is hugely detrimental to me. Current failings in the service mean I effectively get no care until inevitable crisis and detention. Psychiatrists cannot do their jobs properly with things so broken.” (Respondent ‘all permanent’).
End.
Notes to Editors:
The survey received 469 respondents from across Scotland. The full report can be found at https://voxscotland.org.uk/your-views/
About VOX Scotland
VOX Scotland is Scotland’s only national mental health collective advocacy organisation run for and by people with lived experience of mental illness. We represent our members’ views to Scottish Government, the NHS and others to influence mental health policy and practice, making sure that our laws and services reflect their needs and interest. You can find out more about VOX Scotland on our website Vox Scotland | Scotland’s national voice on mental health.
Survey Context
At VOX Scotland we have increasingly heard concerns from our members across the country regarding psychiatrist care in Scotland; they have highlighted the frequent use and turnover of locum psychiatrists, the difficulty accessing psychiatrists and their dissatisfaction with the lack of continuity and quality of care they have been receiving. Our ‘Your Views: Psychiatrists in Scotland’ online questionnaire sought to examine these issues by engaging with members of the public across all health boards in Scotland with experience of care from psychiatrists in the last five years. We aimed to measure the quality of care people are receiving against the Core Mental Health Standards, and listen and respond to people’s experiences and views on the care they have experienced.
The survey builds on data requested by one of our members under Freedom of Information detailing the use and cost of locum psychiatrists in Scotland’s health boards (presented in the report) and highlights the human impact alongside the financial impact.
Headline Quantitative Results
- 469 people from across all fourteen Scottish Health Boards participated in research about people’s experiences of care from psychiatrists in Scotland in the last five years.
- The research was inspired by the concerns and campaign work of Vox Scotland members.
- Nearly a third of all respondents received care from ‘all’ or ‘mostly’ locum psychiatrists.
- Not everyone knew who was providing their care, nearly a fifth of people said they were unsure whether their care had been under locum or permanent psychiatrists.
- More than half of those respondents who had experience of locum psychiatrist care said they were either dissatisfied or very dissatisfied with the overall quality of care they have received.
- This compares to just under a third of those respondents with experience of permanent psychiatrists reporting being dissatisfied or very dissatisfied.
- Across all questions about psychiatrist care (including communication, trust in expertise and decisions, follow up between appointments, understanding of mental health needs and concerns, and engagement and involvement of individuals in decisions on their care) respondents rated permanent psychiatrists substantially higher comparatively than they rated locum psychiatrists.
- For people who did not know whether they had seen a locum or permanent psychiatrist, the ratings across all questions were markedly lower than for people who knew who was providing their care.
- Nearly half (43.5%) of all participants said that they had never been asked for their preference or never been able to request their choice of appointment method in relation to psychiatrist appointments in Scotland in the last five years.