There is little evidence to support the increasing use of surveillance technologies on inpatient mental health wards, finds a new study involving UCL researchers.
The research, carried out by researchers at the National Institute for Health and Care Research Policy Research Unit in Mental Health (MHPRU) at UCL and King's College London (KCL), 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. They also highlight the potential to exacerbate patients' distress and paranoia, incompatibility with trauma-informed care, and use to justify providing fewer staff.
Researchers involved in this study, which is published in BMC Medicine, explored the available evidence to clarify how surveillance technologies are being used, examine their impact, and explore 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.
Joint first author, Dr Katherine Saunders (UCL Centre for Behaviour Change), 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."
Joint first author, Dr Jessica Griffiths (KCL), 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.
"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."
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.
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 through lived experience who contributed to a 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."
Professor Alan Simpson, Professor of Mental Health Nursing at KCL, Co-Director of the MHPRU and the study's senior author, concluded: "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.
*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.
