CCTV In Inpatient Areas Dr Riya Basu ST

CCTV In Inpatient Areas Dr Riya Basu, ST 6 General Adult Psychiatry, Dr Richard Burrows, CT 3, Dr Sajid Muzaffar, Consultant Forensic Psychiatrist, Birmingham, England AIMS AND HYPOTHESIS This study looks at the opinions of doctors of various levels of experience about the use of CCTV, its potential benefits and possible risks. From the literature evidence, or lack of, we hypothesise that the majority of the medical body would not be in favour of use of CCTV in inpatient units. Severe concerns and cannot support Definite support BACKGROUND Use There is variable use of CCTV in hospital psychiatric wards. A preliminary audit undertaken by the university of Hull in 2008 noted that out of 100 NHS mental health trusts it found that 34 used CCTV monitoring in the inpatient areas, which included 157 wards located in 85 hospitals and that 6 had CCTV in some or all patient bedrooms and that CCTV was used in seclusion. 4. This seems to contrast with an earlier study in 2002 which reported a low level of modern technology use such as CCTV, possibly representing a rapid increase in use. 1. Research There is generally noted to be lack of research in this area including the views of service users. 4. 7. Additionally, although it may be thought obvious that CCTV could improve safety, Home Office research has produced the findings that CCTV is an ineffective tool if the aim is to reduce overall crime rates and make people feel safer. 5. A 2015 article from Israel gave generally a positive report regarding CCTV use. 6. Closer to home, the Gloucester Partnership NHS Trust secure services conducted a small research project using infrared CCTV to perform night‐time observations. Feedback from patients about this limited study was noted to be generally positive and did highlight that night‐time observations could take place with CCTV without disturbing patients. 2. 3. Guidance ‐ Mental Health Act Commission 8. Highlight that the use of CCTV within inpatient areas complex and they reference the human rights act 1998 “right to respect for his private and family life” in respect to CCTV possibly infringing upon this. It is stressed that if used CCTV should cause the minimum interference to the individuals involved. They also highlighted that real‐time unrecorded use of CCTV is easier to justify. Guidance ‐ Care Quality Commission 9. Described not requiring providers to use CCTV, although recognising that it may be the best or the only way of providing care safely or to a good quality. Exploration of other ways of providing the care such as providing more staff, which was felt to be less intrusive, was advised. Issues surrounding consent may be complex and it was highlighted that for those who lack capacity that surveillance, which is felt to be intrusive, may require application to the court of protection. Furthermore, special consideration was given with regards to covert surveillance where it stated that they expected it to be only used for a limited time and purpose, rather than regular. METHOD A CCTV advisory committee was convened including clinicians from the inpatient setting, secure services and older adult services. A literature search was conducted to inform the main areas for exploration. An online (Survey Monkey) survey of 20 questions was distributed to all Consultants, trainees and career grade doctors in the Trust. RESULTS • Data collection period: 28/12/16 – 14/1/17. • 115 responses out of 281 invites – 41% response rate. Results of medical opinion on use of CCTV & Body worn cameras in Inpatient Units Choose one statement for each situation: Can see Severe Some some concerns No views reservations Definite Rating Answer Options benefit but and cannot either way but can support Average cannot support Communal areas like inpatient lounges, TV 10 21 0 40 21 0. 45 rooms etc. Interview rooms 24 23 1 35 8 ‐ 0. 22 Patient bedrooms 56 23 2 11 0 ‐ 1. 35 Seclusion areas 1 14 6 40 31 0. 93 Seclusion rooms 3 15 7 36 30 0. 82 Toilets/bathrooms 58 20 2 10 0 ‐ 1. 40 Activity areas 13 18 6 40 14 0. 26 Body worn cameras 36 16 12 18 8 ‐ 0. 60 Record specific incidents like restraint 8 20 8 39 16 0. 38 Patients visits 26 26 7 25 8 ‐ 0. 40 Response Count 92 91 92 92 91 90 91 92 RESULTS OF SELECTED QUESTIONS IN GRAPHICAL FORMAT Can powers provided by the MHA be used to justify recording patients on a CCTV? Would you support recording individual patient consultations for educational, research and therapeutic purposes? Would your views change if the CCTV was not recording but only monitoring? Will use of recordings help in ensuring better compliance with medication? No; 8 Yes; 20 Yes; 23 Yes; 22 No; 75 No; 70 No; 72 Yes; 84 How will presence of recording devices impact paranoid patients? Will help in their recovery and treatment; 5 In your opinion what is the most likely impact of recording interactions with patients on therapeutic relationship? No Impact; 13 No impact; 9 Beneficial; 25 Will increase paranoia and mistrust and have negative impact on their treatment; 86 RESULTS OF REMAINING QUESTIONS GROUPED TOGETHER UNDER THEMATIC TITLES Legality To “Can an objecting patient or a patient who lacks capacity ever be subject to CCTV? ” 19 responded “Never” (20. 88%); 63 (69. 23%) “Can be if there is no other way of safely carrying out the care and monitoring routinely” and 9 (9. 89%) “Can be if it makes observations easy”. To “Should there be a difference in the way CCTV is used for patients with capacity vs lack of capacity” 48 responded “Yes” (51. 61%) and 45 “No” (48. 39%). Therapeutic alliance To “Will it encourage an adversarial culture between patients and staff? ” 70(71%) responded “Yes” and 29 (29%) “No“. In response to the question “Is use of CCTV an invasion on privacy? ” 78 responded “Yes” (78. 79%) and 21 “No” (21. 21%). To “Do you believe that it will risk discouraging face to face interactions? ” 67(68%) responded “Yes” and 32(32%) “No”. To “How do you think most of the patients will view the power equation between staff ‐ patients if CCTV is used to record patients? ” 15 (15%) responded “No concern” and 84 (85%) “As an intrusion on privacy”. Assessment and treatment To “Can CCTV be used as an alternative to face observation when managing risk of self‐harm? ” 0 responded “Always”; 43(47%) “Never” and 49(53%) “Sometimes”. To “Can CCTV be used as an alternative to face observation when managing risk of harm to others? ” 0 responded “Always”; 36(39%) “Never” and 56 (61%) “Sometimes”. To “Would you like to see use of CCTV as an alternative to face observation when managing physical health issues like falls/seizures etc? ” 45(49%) responded “Never”; 44(48%) “Sometimes” and 3(3%) “Always”. To “Will use of recordings of incidents help to improve the understanding, develop formulations and eventually help in developing significantly better strategies to help the patient to manage such outcomes in future? ” 49(50%) responded “Yes” and 49 (50%) “No”. To “If CCTV is used should it be used with principles of proportionality and individual risk based individualised care in mind? ” 74 responded (80%) “Yes” and 19 (20%) “No”. If restricted to communal areas will the use of CCTV make areas safer? Will not make any difference to safety of communal areas; 23 Can safely replace all or part of direct staff observation; 3 Can be used in addition to current levels of staff observation of communal areas; 66 Detrimenta l; 77 OUTCOMES Discussion of the results of the survey: With regards to situations that it may be used there was support for it being used in some specific circumstances and not others. There was generally concerns raised regarding the impact on therapeutic relationships. Conclusions: We did not feel that the literature search provided us with robust evidence to base our decisions on. The medical opinions on use of CCTV were variable. Recommendations / motions put forward from our medical advisory committee: • Only to be used in specific approved areas üDefault not to use it üSupport for communal areas/ seclusions/ activity areas / research • Not to record footage • Guaranteed safeguards • Assurance: not to replace face to face interactions References: 1. Bowers L, Crowhurst N, Alexander J, Callaghan P, Eales S, Guy S, Mc. Cann E, Ryan C. Safety and security policies on psychiatric acute admission wards: results from a London‐wide survey. Journal of Psychiatric and Mental Health Nursing. 2002 Aug 1; 9(4): 427‐ 33. 2. Mc. Millann I. Patients empowered to cope the Australian way: National mental health nursing conference, University of Cambridge, 17‐ 18 july. Mental Health Practice. 2006 Sep 1; 10(1): 36‐. 3. Page M, Meiklejohn C, Warr J. CCTV and night‐time observations: Is it ethical–and practical–to use closed‐circuit television in place of traditional methods to observe psychiatric inpatients at night? Mathew Page and colleagues describe a research project, led by Bournemouth University, designed to seek answers. Mental Health Practice. 2004 Jul 1; 7(10): 12‐ 5. 4. Desai S. The new stars of CCTV: what is the purpose of monitoring patients in communal areas of psychiatric hospital wards, bedrooms and seclusion rooms? . Diversity & Equality in Health and Care. 2009. 5. Desai S. Violence and surveillance in mental health wards: Suki Desai considers the negative impact on vulnerable people. Criminal Justice Matters. 2011 Mar 1; 83(1): 4‐ 5. 6. Stolovy T, Melamed Y, Afek A. Video surveillance in mental health facilities: is it ethical? . The Israel Medical Association journal: IMAJ. 2015 May; 17(5): 274‐ 6. 7. SOCIAL CARE INSTITUTE FOR EXCELLENCE. Electronic surveillance in health and social care settings: a brief review. Social Care Institute for Excellence. 2015. 8. Mental Health Act Commission. The use of CCTV in NHS and independent mental health units: A framework for assessment. http: //www. sshf. nhs. uk/sfh/docs/Microsoft_Word_CCTV_GUIDANCE_FINAL. pdf. 2005. 9. Care Quality Commission. Using surveillance Information for providers of health and social care on using surveillance to monitor services. http: //www. cqc. org. uk/sites/default/files/20150617_provider_surveillance_information. pdf. December 2014 (updated in June 2015) Appendix: Additional search conducted using Medline with full text, Cinahl with full text and Google Scholar using search terms of CCTV AND inpatient AND (mental OR psychiatr*)