Functional Creep and the Orwellian Nightmare: An Aotearoa stocktake of security camera use in adult mental health facilities Karyn Black Consumer Leader, Kāhui Tū Kaha Contact: karyn.black@kahuitukaha.co.nz

A note on the title: Orwellian: Authoritarian Functional creep: The use of technology beyond its initial purpose

Purpose of an inpatient unit provide a supportive, therapeutic and caring environment prepare patients to return to the community be a safe workplace for inpatient staff and a safe environment for patients be a home where patients live and have visitors

Current CCTV use: Official Information request were sent to 18 District Health Boards Request asked if the inpatient unit had CCTV operating inside the hospital area *, if yes; to provide information of instalation date, number of cameras and their location Responses were provided for 20 inpatient units over the period of August and September 2017

Current CCTV usage DHB Installation date Number of cameras Location Southern, Invercargill 2003 DNA ++ Southern, Dunedin 1992 onwards Communal areas, foyers, hallways and front entrance Canterbury + Unable to find data 4 Front entrance, reception, loading bay Nelson/Marlbourough 2011 6 Main and rear entrance, medication room, intensive care unit, special care unit Capital and Coast 2012 and 2014 3 Reception, corridor, vehicle entrance Whanganui 2012-13 10 3 lounge areas, reception entrance, reception foyer, visitor foyer, courtyard, staff entrance to carpark Lakes District 2007 onwards 9 Inpatient corridor, inpatient garden, admission lounge, main ward, intensive care, entrance to admin Hawkes Bay 2016 8 Public entrance (external and internal) main reception, vehicle bay, inner hall from vehicle bay, maintenance bay Waikato Main entry, security booth areas, rear entrance, front entrance, vehicle entrance Waitemata, West 2007 Waitemata, North Mid 2015 Auckland   1 Medication room Northland 2011 and 2017 5 Reception, outside main entry, swipe access, security gate, internal garage Notes + Canterbury DHB advised that their cameras were not operational ++ Some DHB’s withheld information about the number of cameras and their location Bay of Plenty, Counties Manukau, Hutt, Mid Central, South Canterbury, Tairawhiti, Taranaki and West Coast all confirmed that they do not have cameras installed in their inpatient units. Wairarapa DHB does not have an inpatient unit. Information was requested from DHB’s under the Official Information Act.

Key findings from CCTV use: 12 inpatient units reported currently have CCTV systems 8 inpatient units reported no CCTV use Earliest camera installed was in 1992, most resent in 2017 Number of individual cameras vary from 3 – 10 Most common camera location is entry, reception, car garages. 5 inpatient units have cameras operating in treatment areas

CCTV and the Mental Health Act Part 6: Rights of patients 68. Further rights in case of visual or audio recording (1) Every patient is entitled to be informed where it is intended to make or use a videotape or other visual or audio recording of any interview with, or any other part of the treatment of, the patient. (2) Nothing referred to in subsection (1) shall be done without the prior consent of the patient or (where the patient is not capable of giving consent) the prior consent of the patient’s personal representative.

Perspective on CCTV use: 40 people took part in the survey 14 people who use mental health services 7 whānu members 19 people who work in mental health services

How do you feel about the use of security cameras within public areas of mental health inpatient units?

How do you feel about security cameras operating in the reception area of mental health inpatient units?

How do you feel about security cameras operating inside treatment areas of mental health inpatient units?

Mental health professional Response data, listed in order of overall preference, for survey question: what would improve safety in a mental health inpatient unit? Safety measure Service user Family or friend Mental health professional Total Day program/activities 12 7 13 32 Outside garden area 11 14 Staff trained in de-escalation 6 18 31 Quiet spaces 10 5 15 30 Sensory modulation room 9 24 Environmental visibility 4 22 Staffing 20 Open wards 16 Security cameras in reception 2 Security cameras inside inpatient unit 1 3 Security staff on site Patient/personal room keys Bag/personal item searches Locked wards

Survey summary Tended to be a general support for cameras in public areas Shifted towards a general lack of support for cameras operating inside inpatient units. In terms of way to improving safety CCTV cameras were ranked 10/15 in terms of overall options. Overall coercive practices were ranked lower compared to measures that improve the therapeutic landscape

Concerns relating to CCTV use Limited understanding of the problem Limited understanding of patient experiences of violence No evidence of CCTV’s efficacy in preventing or reducing violence Recovery and the therapeutic environment Implications relating to the Mental Health Act