HIW’s Policy Statement on the Use of CCTV in Regulated Mental Health Settings

Background

The use of CCTV in Independent Mental Health settings in Wales has been a topic of debate for some time, regarding its impact on patient dignity, privacy and safety. Understanding legitimate concerns that CCTV can infringe on patient rights, there are benefits when reviewing patient care, in particular to incidents enabling providers to understand circumstances of events, outline learning and identify training needs. 

Benefits of CCTV use

Evidence Collection

CCTV footage can assist with investigation of incidents and ensure accountability. It helps in understanding the circumstances leading to and during an event and can be beneficial in reviews.

Protection of Patients and Staff

Mental health professionals often face challenging situations with unwell patients. CCTV can be used as an aid when looking into accusations of misconduct and provide evidence in cases of aggression or violence. It can also be useful in safeguarding matters to ensure staff have acted in accordance with expected standards.

Whilst CCTV may provide additional protection to vulnerable patients, or enable a clear picture to be gained of the circumstances surrounding an incident or complaint, a provider should be able to demonstrate to HIW that they have given due consideration to any less intrusive steps that may be taken to ensure the same aims are achieved, and explain why those steps are not considered appropriate. 

Challenges to the use of CCTV

Privacy Concerns

CCTV can give rise to concerns around dignity and privacy of patients and can create a sense of constant surveillance, which may be detrimental to a patient’s mental health, particularly if the patient suffers with elements of paranoia. It is essential this is considered and risk assessed on a patient specific basis to minimise negative impact on the therapeutic relationship

Ethical Issues 

The use of CCTV presents a number of ethical, practical, and legal considerations for providers who are obliged to secure the safety, welfare, privacy, and dignity of patients. Importantly, CCTV should not be regarded as a substitute for proper recruitment procedures, training, management, and support of staff, or for ensuring that numbers of staff on duty are sufficient to meet the needs of patients. Strict protocols should be in place to ensure that CCTV is used appropriately and securely and in line with the conditions of registration. 

CCTV should not be used as an alternative to in person observation or be viewable live other than in specific circumstances covered in registration conditions.

Legislation

The main legislative requirements relating to the use of Surveillance cameras (e.g. CCTV) are found in the General Data Protection Regulation 2016 (GDPR) and the Data Protection Act 2018. However, consideration should also be given to the following: 

• The Protection of Freedoms Act 2012
  • The Human Rights Act 1998
  • The Regulation of Investigatory Powers Act 2000
  • The Public Interest Disclosure Act 1998.
  • Freedom of information Act 2000.
  • Deprivation of liberties
  • Mental Capacity Act 2005
  • The CCTV Code of Practice produced by the Information Commissioner [1]
  • The Surveillance Camera Code of Practice produced by the Surveillance Camera Commissioner (as amended) 2021 [2]   

A provider who installs and uses CCTV, will become the data controller, and required to establish the legal basis for processing the CCTV data under the GDPR i.e. the use of CCTV must be lawful, fair, and proportionate.

The Information Commissioner’s Office has published a Data Protection Code of Practice for surveillance cameras and personal information which applies to all types of organisations, not just the public sector 

For health settings, the key provisions of the Code advise:

• Providers must have a legitimate, necessary, proportionate and fair purpose for installing surveillance, in order to meet a pressing need.
• Providers must consider alternative means of dealing with the problem before they proceed with surveillance.
• Providers should consult with patients and residents, their families and staff about installing surveillance. Where someone doesn’t have capacity, they should consult with an authorised person i.e. someone who has ‘health and welfare’ power of attorney.
• Providers should consider conducting a ‘privacy impact assessment’ to ensure they have looked at all privacy issues and the means of addressing them. This should include thinking about what sensitive information is likely to be captured by the surveillance, who it could adversely affect, and what alternatives could be used.
• Use of surveillance in the workplace should interfere as little as possible with workers’ legitimate expectations of privacy.
• Providers must have clear procedures for how they handle information gained from surveillance including disclosure, storage, and disposal.
• Providers must notify the Information Commissioner on an annual basis about their surveillance set-up. They must also identify a named data controller for their organisation.
• In the run-up to the annual notification date, providers should take the opportunity to review whether surveillance use continues to be justified.
• Providers must display prominent notices warning visitors to health and care facilities of the type of surveillance that is in operation there, and who can be contacted about the scheme.
• It should be made prominent and clear to staff when, how and why surveillance is taking place, and who they can contact about it. 

There has been research carried out on this topic which highlights pros and cons of CCTV but none have reached a definitive conclusion for or against. [3] [4]

Conclusion

Registered providers are required to meet fundamental standards set out in the Independent Health Care (Wales) Regulations 2010 and the National Minimum Standards for Independent Health Care Services in Wales. These include standards about person-centred care (regulation 15), dignity and respect (regulation 18(1)), and safeguarding patients from abuse (regulation 16). Privacy, which is reflected in article 8 of the European Convention of Human Rights, states that everyone has the right to respect for privacy. This right should therefore be protected as far as possible. Although it is recognised that circumstances may arise where justification exists to demonstrate it is lawful, necessary, and proportionate to restrict that right. 

HIW’s expectation is that CCTV is not to be used for patient observations unless there is clear reasoning based on an individual care plan and for the protection of patient wellbeing and staff safety. HIW would not accept CCTV observations to be undertaken in communal ward space. In limited circumstances, and only when clearly documented as required, CCTV observations can be utilised in seclusion suites or other enhanced care locations within a ward.

While the use of CCTV in mental health hospitals raises valid concerns about patient privacy and dignity, its role in providing prompt investigation and accountability is significant. Proper regulation and respectful implementation can help to ensure that CCTV is used only where it is appropriate and safe to do so, ensuring that CCTV is used appropriately in regulated mental health care settings. HIW will consider applications to use CCTV in mental health hospitals on a case-by-case basis. A questionnaire covering what the setting needs to consider has been developed and will be discussed with the provider prior to decisions being made on whether to grant this element of registration.

[1]CCTV and video surveillance | ICO 

[2] Update to Surveillance Camera Code of Practice - GOV.UK 

[3] https://www.kcl.ac.uk/news/little-evidence-to-support-increasing-use-of-surveillance-technology-on-mental-health-wards

[4] https://www.researchgate.net/publication/356173693_Surveillance_Practices_and_Mental_Health_The_Impact_of_CCTV_Inside_Mental_Health_Wards