We are Scotland’s national collective advocacy organisation for mental health.

Your Views: Psychiatrists in Scotland was conducted as an online questionnaire open to members of the public with experience of care from a psychiatrist in Scotland in the last five years.

Our report presents the findings of our survey into the quality of care experienced by people across Scotland from psychiatrists, highlights the issues they are experiencing, particularly with regards to care provided by locum psychiatrists, and advocates for any changes and extensions of good practice.

 

Background

VOX Scotland identified from member feedback that the quality and continuity of care received from psychiatrists is an important issue for our members and for many other people in Scotland.

VOX Scotland had been made aware of some of the challenges in the current system in terms of recruitment and retention of permanent psychiatrists and the use of locum psychiatrists in many areas of Scotland, some of whom do not have standardised qualifications, training and conditions, while incurring high costs for health boards.

We have heard about these challenges, not only from people with lived experience, but also from the Royal College of Psychiatrists in Scotland in their State of the Nation Report. VOX Scotland members had also raised concerns about the impact these challenges are having on the continuity and quality of their care under psychiatrists in Scotland.

Purpose of Research

 

The purpose of this research questionnaire was to find out what adults (18 or over) with recent experience (in the last five years) of care under one or more psychiatrist(s) in Scotland think about the quality and continuity of care they have received.

Our intention in undertaking this research was to gain a clearer and more comprehensive picture of people’s experiences in all areas of Scotland and be able to then identify any common or particular issues, good practice and recommendations for improvement.

 

Who We Engaged With

We wanted to gather information on experiences of care from psychiatrists from a wide range of people in every health board area of Scotland. This was important so we could hear and report on views from across the country and be able to identify any issues particular to certain areas and any issues in common.

To this end, while we promoted the research within our VOX Scotland membership, the questionnaire was open beyond that to anyone over 18 with experience of care under one or more psychiatrists in Scotland in the last five years. These stipulations were to ensure we gathered views on recent care from psychiatrists in Scotland.

We promoted the research through networks and social media advertising and tried to gather views from as representative a sample as possible, recognising that it may be harder to reach some people with experience of psychiatrists (particularly current inpatients) and that people may be hesitant to engage or report on their experiences for various reasons.

The questionnaire was open for seven weeks and, as will be seen in the findings, we heard from people in every health board area and had a large number of responses (469). The equalities monitoring questions demonstrate gaps in responses particularly from people from minority ethnic backgrounds and from men.

We recognise that our sample was self-selecting, which may make negative or strong viewpoints more likely. However, the trend of results and qualitative answers show genuine and individual experiences from respondents with a mixture of positive and negative perspectives.

 

What We Wanted to Achieve
  • A better understanding of the quality and continuity of care under psychiatrists experienced by adults in Scotland
  • An understanding of any issues particular to certain geographical or health board areas or any rural, remote or urban issues
  • An understanding of any good practice taking place
  • An understanding of any issues particular to locum or permanent psychiatrist care
  • To provide information to our members, the wider public, the NHS and Scottish Government on findings
  • To advocate for any changes or extensions of good practice based on our findings

Recommendation 1

Improve continuity of care, by systematically reducing reliance on locums in psychiatry in Scotland.

There should be particular emphasis on reducing the use of locums who do not have the qualifications required for substantive posts (MRCPsych and CCT/CESR). Simultaneously, increase permanent posts with particular attention to those geographical areas most in need of permanent psychiatrists and to the particular needs of rural and remote Island communities This plan should ensure people are not suddenly left with no care at all.

As part of the recruitment and retention strategy, address the disparity between the pay and conditions (including flexibility) received by locums as compared to permanent psychiatrists ensuring substantive posts are attractive and sustainable. Consider how health boards can cap expenditure on locums.

Recommendation 2

Implement a standardised system of psychiatrist job titles/roles which reflects the training and qualification levels achieved. 

Implement a clear and consistent system across health boards, where communication on the status and title (whether locum, permanent consultant, trainee) is transparent and open in communications with those who are being cared for.

Recommendation 3

Ensure that all psychiatrists are routinely trained in trauma-informed practice, racial bias and cultural competence, and neurodivergence both in terms of recognition and diagnosis and in understanding and adapting care to meet needs and this training is regularly reviewed and updated.

Recommendation 4

Ensure relevant training, support and implementation takes place for psychiatrists to meet all elements of the core mental health standards, with emphasis on ensuring individuals can be involved and engaged in decisions about their care, awareness and promotion of advocacy rights and services, and a fit for purpose, impartial and authoritative complaints and feedback system as standard.

Recommendation 5

Focus on making transitions work for individuals, whether from inpatient to outpatient care, CAMHS to adult psychiatry, adult to older adults’ psychiatry, or moving from one psychiatrist to the next, understanding the importance of continuity of care and of structured meaningful beginnings and endings.

Have clear reasoning for discharging patients and ensure conversations are had with individuals before discharge decisions are made. Ensure good communication with other services and mental health nurses (as per the Scottish Mental Health Nursing Review underway) particularly during transition, with the individual concerned clear on the plan and ways to get in touch.

Skip to content