The death of Seni Lewis in detention led to legislation supporting the use of body cameras in mental health hospitals. But it's not just attending police who are wearing cameras, with nurses now also using them in some settings. Rachel Rowan Olive, who has been hospitalised for her mental health, is among those not reassured by the practice.
This article contains references to self-harm and other themes that some readers may find distressing.
The use of body-worn cameras by staff on mental health wards is spreading. With increased media attention on physical restraint following the shameful death of Seni Lewis and the passing of Seni’s Law, people are looking for alternatives. A recent report in the mainstream media cited a survey suggesting that body-worn cameras are “acceptable to staff and patients” and suggested they could improve safety.
"Where cameras have been trialled, staff control when they are turned on."
I’m a patient, and it’s not acceptable to me. There are many ways this will (re)traumatise people. For example, imagine being a survivor of revenge porn or sexual abuse involving non-consensual filming, then being non-consensually filmed by people saying they are there to help you. These are not hypothetical scenarios or issues affecting a rare few: people with severe mental health problems are much more likely to have experienced sexual or domestic violence than the general population. Women with severe mental health problems are more likely than not to have been abused. Coercion, abuse and violation change with the times, and technology is increasingly used by perpetrators to victimise and humiliate.
Another example: we know there are people in hospital who believe they are being spied on by the state. This is not necessarily an ungrounded fear in the context of the welfare panopticon and the expanding Prevent agenda [which places a statutory duty on public bodies to identify and report individuals considered at risk of radicalisation - editor's note]. But how could you trust NHS staff if you not only think they might be spies, but actually see them filming?
Beyond these specific triggers, though, the major ethical concern is control. Where cameras have been trialled, staff control when they are turned on - so they would capture immediate flashpoints but not the dozens of mundane dehumanising frustrations that lead there. We know from the evidence base on physical restraint and aggression that the ‘need’ for such measures relates at least as much to staff as to patient behaviour. Yet it’s patients the cameras are pointing at.
The threat of restraint is ever-present, even when it is rarely used, and its impact extends long after the incident report is written, filed, and forgotten. The same will go for abuse of this new power. When I have been detained on a ward, I have not always been easy to care for: once I emptied a bottle of water over another patient; sometimes I just curled up in a ball and screamed. But these things never came out of the blue. I doused my fellow patient after a morning of provocation where staff had watched her follow me round the ward, swear at me, then come at me when I told her to back off, all without intervening. After the water incident, she left me alone.
- See also: The complaints I never made
- See also: #DearGP activists pursue mental health solidarity through satire
Perhaps if the staff had said “I’m turning my camera on now” I wouldn’t have chucked it at her. Perhaps if they’d said this when I was screaming, I would have stopped, though I probably wouldn’t have been able to. But even if I had, my terror and frustration would have come out somehow. Maybe I would have held it in until they let me off close observation, then self harmed: the more power other people have over me, the more I need to exert my power to hurt myself. Maybe I would have reclaimed control over my body by denying it things. You cannot hold that much desperation without erupting.
If anyone is going to be wearing recording equipment on psychiatric wards, it should be the patients. I would record the click of the slats in the bedroom doors as the nurses watch you without speaking to you; the healthcare assistants marching down the corridor yelling “DINNER” like they’re calling their dog to the kitchen (at 5pm, because it’s cheaper to get the caterers then). I would record myself being told to ask for help when I needed it, then being ignored when I do. I would record the intimate details of other patients’ lives I overhear because the staff don’t bother to go into the office to discuss them; the defensive response when I challenge it; the nurse telling another patient it’s her fault I have self harmed; the endless, endless noise (footsteps, shouting, music, lunch trolley, doors, TV). I would record having to ask for a plastic mug to drink from because you can’t trust nutters with ceramics. I would record myself sitting right up against the narrow slits in the window shutter, close as I can get to fresh air. I would record myself calling the Samaritans and howling because none of the people paid to support me have shown an ounce of compassion. But I don’t think these are things that clinicians would turn their cameras on for.
It is also worth noting how doctors have publicly responded to the idea of patients audio recording consultations: reactions generally range from defensive to suspicious, with maybe an occasional stopover at empathy. This is despite the fact that it is both legal and understandable for patients who struggle to remember information or have had previous traumatic experiences with clinicians to want recordings. Against this background, it is at best problematic to blithely assert that videoing inpatients - who are much more vulnerable than a GP in their consulting room - is perfectly ethical.
Ultimately, body worn cameras are a tool for control dressed up as a safety initiative; they are a quick and dirty way to reduce incidents on paper without bothering to address their causes.
A range of options on how to access support in a crisis can be found here.