1. 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:

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

3. 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

4. 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

5. 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 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.

6. 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

7. 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.

8. 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

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

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

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

12. 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

13. 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

14. 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