The research, published in BMC Medicine, found little evidence that technologies like Vision-Based Patient Monitoring and Management (VBPMM), Body Worn Cameras, CCTV, and GPS tracking are an effective means of managing rates of self-harm and aggression on wards, or of improving the overall quality of care.
Surveillance technology has become increasingly common on inpatient mental health wards and is generally promoted as a means of improving safety and reducing staff costs. However, patient advocacy groups have raised ethical concerns about the potential harm that these technologies pose, particularly their negative impact on patients’ human rights, privacy and dignity, potential to exacerbate patients’ distress and paranoia, incompatibility with trauma-informed care, and use to justify providing fewer staff.
Vision-Based Patient Monitoring and Management technology, consists of an infrared camera that remotely monitors a patient's pulse and breathing rate at regular intervals, and continuously tracks their movements, generating location and activity-based alerts. Body Worn Cameras are devices worn by staff, who decide when to manually activate them to record interactions between staff and patients. CCTV provides continuous video-surveillance of wards, and GPS tracking can be used to track the real-time location of patients when they are away from the ward.
Researchers in this study explored the available evidence to clarify how these technologies are being used, examined their impact, and explored patient, carer and staff views and experiences of surveillance technologies.
The review included 32 studies of varying methodological quality, with half of the studies rated as low quality. Nine of the studies declared conflicts of interest, such as authors working for or receiving funding from surveillance technology companies, and a potential undisclosed conflict of interest was identified in one study.
Katherine Saunders, a Senior Policy Fellow at UCL and the study’s joint first author said “These conflicts of interest highlight the importance of critically evaluating the authorship teams and funders conducting and facilitating research into these technologies, their underlying motivations, and how these factors might influence their results. Robust research requires transparency, and therefore it is vital that all conflicts of interest are declared in any future studies on this technology”.
“Our analysis has produced a number of worrying findings. Primarily, despite widespread claims of the benefits that surveillance technologies would bring to inpatient mental health services, there is little evidence to back this up.”– Jessica Griffiths, a Research Associate at King’s and the study’s joint first author
Jessica Griffiths, a Research Associate at King’s and the study’s joint first author said, “Inpatient mental health wards are designed to provide a physically and psychologically safe environment to help people in distress recover. Despite this, there are extensive reports from both patients and staff that they often feel unsafe. While some UK service providers have implemented surveillance technologies to try to improve safety and reduce costs, there has never been a comprehensive review on the evidence for their use in these settings."
One of the central claims for the use of these approaches is that they are cost effective. Researchers found that only four of the studies looked at cost-effectiveness – one investigated the use of GPS tracking on a forensic ward, which did not significantly decrease costs, while the other three estimated that VBPMM use in acute adult mental health wards, older adult mental health wards, and psychiatric intensive care units could result in cost-savings but had several methodological limitations.
Professor Alan Simpson, Professor of Mental Health Nursing at King’s, Co-Director of the MHPRU and the study’s senior author said, “Experiencing a mental health crisis can be an exceptionally difficult experience. Our previous research shows that service users value having the presence of skilled nursing staff at these times. Unfortunately, it appears that one of the main arguments made is that the use of surveillance technologies may lead to a reduction in one-to-one observations or direct staff contact with patients, and I worry about the long-term effects that this could have on therapeutic relationships and ward atmosphere.”
The research team included researchers with lived experience of being a patient on inpatient mental health wards. They highlighted the discrepancies between whether, and how, people were told these technologies would be implemented and used, and how they were used in practice.
Georgia, an expert by experience who contributed to a lived experience commentary about the review, said, “There are a host of ethical concerns that have been raised previously. I was not given the opportunity to consent to being filmed by Vision-Based Patient Monitoring and Management, and I only discovered that it had been implemented when one of the ward nurses said that she lost sight of me while I was visiting the bathroom in my room. The lack of training meant that staff did not know that I could remove consent, and one tried to deny that it was there at all, suggesting that I was experiencing psychosis.”
Further analysis of the qualitative data in the studies reviewed revealed mixed findings. Some staff members suggested that there could be benefits, allowing them to monitor and observe patients in a less obtrusive way. But both staff and patients felt there was potential for wide-ranging negative effects on service user welfare.
Professor Simpson concludes, “The claim that surveillance technology is beneficial to service user care is, right now, unsubstantiated and needs more investigations by independent researchers and to a higher quality. Few studies examined the impact of surveillance technologies on important outcomes such as patients’ mental health, self-harm, or the quality of care. None of the studies looked at other outcomes such as treatment satisfaction, therapeutic alliance, or impact on further service use. This needs to change if the NHS intends to place greater responsibility on the role of technology within these services.”
This study was possible thanks to funding from the National Institute for Health and Care Research (NIHR) Policy Research Programme.
The use and impact of surveillance-based technology initiatives in inpatient and acute mental health settings: A systematic review (DOI 10.1101/2024.04.04.24305329) (Jessica L. Griffiths, Katherine R. K. Saunders, Una Foye, Anna Greenburgh, Ciara Regan, Ruth E. Cooper, Rose Powell, Ellen Thomas, Geoff Brennan, Antonio Rojas-Garcia, Brynmor Lloyd-Evans, Sonia Johnson, Alan Simpson) was published in BMC Medicine.
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