Stop Taking Our Picture: a statement on the practice of mental health providers publishing photos of patients on social media

By Hat Porter, Nell H and Zahra Motala and supported by the National Survivor User Network.

For many years, patients, campaigners, and survivors have been raising concerns about psychiatric wards sharing photographs of patients on social media. Sometimes, efforts are made to disguise patients’ identities by blurring or covering their faces with emojis, however, some service providers regularly share clear, identifiable images of patients. In especially egregious cases, perinatal mental health services have shared clear and identifiable images of patients and their babies on their social media pages. These images appear on trust social media pages or accounts run by individual wards, with certain NHS mental health trusts and private service providers posting prolifically. We have also seen instances wherein mental health staff have shared images of patients from personal social media accounts. 

This statement outlines our concerns about wards sharing photographs of patients. We call for: 

  • All trust, ward, and staff members’ social media accounts to delete any posts containing photographs of patients immediately. 
  • Mental health provider communication teams to review (with particular respect to the sharing of photographs of patients, in line with the concerns outlined below) and reiterate their guidance on social media use for staff in order to safeguard patients’ privacy and safety. 
  • Stakeholders, charities, and professional and regulatory bodies to support our call in emphasising that sharing photographs of patients on social media represents unprofessionalism and negligence and presents potential safeguarding concerns. 

To protect patients’ privacy and not draw further attention to photographs, we have chosen not to reference any specific examples of images that have been shared, or to name NHS mental health trusts and private service providers who regularly share photographs of patients on social media. However, we have made separate complaints to particular individual providers who have repeatedly shared photographs of patients.

Sharing photographs of patients is a breach of privacy and confidentiality 

Some service providers regularly share images of patients with their faces visible, rendering them clearly recognisable. In some cases, patients’ names are even detailed within the accompanying text or caption. Even where efforts are made to hide patients’ faces, patients may remain identifiable to those who know them well as clothing, tattooing, hair colour and other distinctive features remain visible. In the context of a psychiatric ward, self-harm scars or recent wounds can be visible, thereby risking both identification of the individual and their experiences and expressions of distress, raising questions about the acceptability of medical establishments revealing personal or medical information. We would hope general medical wards would not post pictures of a patient’s injuries – psychiatric patients should be afforded the same privacy.

Not only are the identities of patients poorly anonymised, their identities are compromised by the use of social media accounts stating the hospital and ward they are located on. Many patients have faced trauma and abuse and may be put at risk by a photograph being shared which allows abusers to make contact with them. For patients who do not want to publicly share that they have been in hospital, having their photograph shared online will remove their choice and control over this information, now and in the future. Additionally, further sensitive information could be inferred or assumed about the individual from the nature of the ward they are on, for example in cases of forensic wards and ‘specialist’ wards for people with a specific mental health diagnosis. 

It is not clear whether patients have consented to their photographs being shared

There is no clear indication as to whether consent has been sought from patients for their photographs to be shared online – or whether they consented to the photograph being taken in the first place. Indeed, we have heard from people who have found images of themselves on social media which they were not even aware had been taken and shared. There is also no indication of whether the patient has been assessed to have capacity to be able to make an informed decision about whether they would like their photograph to be shared online, and if they’re able to understand the potential implications and risks of this. 

Since the photographs and social media accounts appear to be run by members of mental health staff, it may also be challenging for patients to make contact to request that their photograph is deleted if they decide they do not want this online once they have been discharged from hospital. 

In addition, the knowledge of staff taking photographs for social media may be disturbing and upsetting for other patients on the ward who would not want to be photographed or appear in the background of a photograph. We know that people are often detained on psychiatric wards and therefore also question whether any consideration has been given to the power dynamics involved in the request of a photograph being posed from someone with great authority over a patient’s liberty and choices. 

Whilst sharing images of patients without their knowledge and consent is a violation of patients’ privacy and may be considered abusive, we emphasise that even with agreement, wards and service providers sharing photographs of patients online is inappropriate and unacceptable in all circumstances. 

Staff should not be using personal mobile phones whilst at work or to store patient information and images 

It is not clear whether the photographs shared on social media are taken using ward tablets or cameras, or whether these are taken on staff members’ personal devices. We should not need to say that it is highly unprofessional and inappropriate for staff to take photographs of patients using their own mobile phones, or to ever send these between personal devices. Where personal mobiles have been used the original photo with unblurred or uncovered faces would remain on the staff member’s phone. This also raises questions about where the images are stored, and for how long, as well as about the data security and information sharing processes of the software or apps used to edit images. 

There are also significant and grave risks posed by mental health staff being distracted by using their mobile phones whilst at work. The Royal College of Nurses have highlighted that staff should not use their mobile phones whilst at work. Within the last month alone, two inquest reports have highlighted staff members were distracted by using their mobile phones and did not conduct observations as required prior to the patients’ tragic deaths. Although we do not know whether staff members post social media images whilst on shift, or in their own time, where photographs are clearly taken on hospital wards or during ward-based activities and groups, we are concerned this may distract staff and pose a risk to patients. 

The photographs shared on mental health ward social media pages do not reflect the reality of being in hospital

These images are often shared by wards apparently aiming to highlight the positive work they do. Yet the overly joyful tone of smiling emoji faces and motivational quotes presents a stark contrast to the realities of the severe mental illness, distress and trauma that can result in a psychiatric hospital admission, or the distress experienced whilst detained in these settings. Whilst it is important to highlight and encourage good practice on mental health wards, this must be sensitive to the risk of causing hurt and distress to patients who experienced harmful practice within those exact hospitals, or families grieving loved ones who died within those services. What each patient experiences as good practice is nuanced and cannot be reflected in a photograph or jaunty social media post, making these images often appear performative. 

We also ask that staff making any social media posts interrogate the purposes they serve and question who benefits from the decision. Whilst social media may be used to share activity ideas and promote good practice, this should never come at the expense of patient privacy and dignity. Sharing ideas does not need to distort the reality of these wards, where patients are often distressed, detained and potentially being given treatment against their will. We question whether the tone of these accounts, which is often self-congratulatory and excessively positive, is necessary to share good practice and make professional connections. The purpose of these accounts should never be to do PR for providers.

We conclude this statement by expressing our exasperation that, as patients and survivors, we have needed to outline what we feel should be self-evident. It is unprofessional and unacceptable for mental health staff to share photographs of patients on social media, regardless of whether efforts have been made to cover their faces.