The complaints about locum psychiatrists have a clear pattern. Patients say they routinely experience inconsistent care or get contradictory advice. Some describe an indifference that borders on box-ticking. “I had 14 locums [and] they all had different views and opinions on my care,” said one respondent to a survey of 469 patients by the advocacy group Vox Scotland. “The last locum did not bother to call me back. That was four months ago. I’ve had no contact from my mental health team since then.” Vox Scotland surveyed patients after hearing of repeated cases of poor experiences with locums, the agency psychiatrists on whom Scotland’s mental health services increasingly depend. For some, the anger is palpable. “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,” one respondent said. “Online appointments are not accessible to many neurodivergent people like me. Suicidal? Nothing says care like a five-minute Zoom and a prescription 20 miles away with nobody to collect it.” The Vox respondents testified about experiences with all 14 Scottish health boards, which have spent £134m on locum psychiatrists since 2019. Nearly a third said all or most of their care came from locums, of whom half were dissatisfied or very dissatisfied with the overall quality of care. A fifth of those polled said they did not know whether they were seen by locums or NHS psychiatrists. “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,” another said. “Each time you see someone different you have to pour your heart and soul out,” said another. “There is no rapport or relationship with locum psychiatrists for vulnerable people – it is impossible to do from receiving notes from the last person.” These findings, now being collated by Vox for a report due out this year, bolster growing concerns among senior psychiatrists that the system is in crisis. Spending on mental health has been cut, even while overall health spending has grown. Over the last five years, the number of NHS psychiatrists has fallen by 17% in Scotland, or 130 people, to 651 full-time posts. Dr Amanda Cotton, a 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 are absolutely starting to show”. Dr Jane Morris, the Scottish chair 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 purely exists to purchase professionals from locum agencies,” she said. “Not only would that be a very expensive way of spending taxpayers’ money but it would lose a great many of the checks and balances, quality assurances and that sort of sense of belonging. The NHS still in Scotland does have a sentimental tug on people. We still want to work for it. People still want to be cocooned by it, and I don’t think we’re too late to make that happen again.”