Surveillance is not ‘safety’

"Surveillance is not 'safety' by Sophina Mariette" alongside a photograph of the Oxevision camera/sensor equipment in the top corner of a patient's bedroom

I’ve seen first-hand the steady increase and reliance on new technology, which is now wide-spread across NHS mental health wards. Technology is promoted to improve patient safety and ease pressure on staff but not as a tool to improve compassionate support for patients or to aid their recovery. For me, the reality was that I felt unsafe, uncared for, scared and alone.

Oxevision is a white framed box that is installed high up on the wall often positioned above a bed. This technology records patients pulse and respiration rate at staff’s request. It tracks the patient’s activity (including time spent in the bathroom) and sends alerts to staff. It also has a camera and the live footage of patients in their bedroom can then be seen on a screen in the office and a handheld monitor. This footage is then held for 24 hrs. It is surveillance in patients’ bedrooms.

My first encounter with Oxevision was on an adult mental health ward that was doing a pilot scheme. It was a ward for high-risk patients ruled by staff who were often cruel and confrontational. The nurses told us the new technology would use a “secure optical sensor” and “infra-red images” yet they denied the use of cameras. It wasn’t until I was alone in my room and a staff member walked in demanding that I hand over contraband that I had the chilling realisation that they were watching me through a camera.

I noticed staff behaving differently; more whispering amongst themselves and rearranging the furniture. Support workers began deliberately repositioning chairs when observing patients in the bedrooms. I overheard staff discussing “blind spots” and where to sit so they would be safe from being viewed on the office screen, mostly concerned about continuing to get away with using their mobile phones on duty. Patients don’t have access to what the camera can see, but staff do and they know how to hide. As a patient I could not escape the camera lens.

A few years later, I was admitted to a newly built ward fully equipped with body worn cameras for staff, CCTV in the communal areas and Oxevision in the patients’ bedrooms. The presence of surveillance was disconcerting, it exacerbated my hypervigilance and triggered memories of previous traumas. It created an environment of suspicion and threat and became psychological restraint.   

Upon admission there were no discussions about Oxevision. There were no signs or posters on the ward explaining what it was. I was not asked to consent to being on video, for my data to be shared with a private company or to the possibility of footage being used in a court of law. It was a blanket restriction and my human rights were overlooked. I asked in the ward round for more information about Oxevision but I never received any. There was little in place to warn patients that they can be seen undressed in their bedroom. The lack of information felt deliberately dishonest to avoid managing patients’ concerns. I mostly learned about Oxevision by searching the internet, but the information available was limited.

Many Trusts have implemented Oxevision without any policies in place but continue to use the technology regardless. I asked for it to be turned off but was told it was impossible as there was no procedure to turn it off. My distress was irrelevant and I had no choice but to accept the surveillance. I did not have the power to decide, and there was no one I could speak to who could. I had capacity but was sectioned, under constant surveillance and felt I’d lost all control over my life. They still would not turn it off when I was an informal patient despite having the right to refuse treatment. Since discharge I now know that Oxevision can easily be switched off via the settings. 

Throughout my admission it was obvious that most staff were also uneducated on what Oxevision was and how it functioned; I would receive conflicting information. There was confusion about how long the footage was held for and what parts of the room it could see; I was unsure who to trust. And I was never warned the footage could be used to prosecute me. I did not feel safe; staff controlled footage is not ‘safety’. 

It terrified me that there was no way of knowing when I was being watched or by whom. I was reminded of past trauma and I believed I was unsafe on the ward. I spent many nights lying on the bed frozen with fear, I wanted to run but I couldn’t escape. Many times, I saw staff watching patients on the Oxevision screen whilst using their mobile phones. There was nothing to prevent them filming the footage for personal use. As a patient I felt vulnerable and at risk of abuse from staff. 

At first, I hid in my bathroom to escape the intrusiveness and the fear I felt in the presence of Oxevision. I did not feel safe to exercise, cry or (at times) eat in its presence. Due to staff not being forthcoming with the reality of Oxevision in the beginning, I soon didn’t trust staff who said there were no cameras in the bathrooms. I would stand and stare at my bathroom wall for long periods of time hunting for evidence. The stress took its toll on my physical health and I became underweight. 

When staff did daytime checks, they would open my door to check on me but instead of meeting my eyes their gaze was firmly focused down at the Oxevision monitor. They were checking the Oxevision footage was correct and working properly and not seeing me as a person. They didn’t even stay long enough for me to ask for food or water which was inaccessible to patients. Despite Oxevision promoting that the technology frees up staff time there were often no staff available to talk to when I was struggling. It felt surveillance was being used as an alternative to human interaction. I felt invisible and uncared for.

The technology was inescapable and compared to previous admissions my self-harm had decreased. But where did that distress go? I needed to hurt myself even more than before in order to manage the insurmountable pressure in my head and pain in my soul. In an attempt to regain control, I self-harmed with food and exercise. This has caused me far more anguish than cutting ever did and, in many ways, I am still worse off.

I was psychologically harmed by the use of Oxevision on a mental health ward. I was discharged with more trauma and paranoia than when I was admitted. I am always looking for the presence of surveillance; it triggers a flood of panic and bad memories. I still struggle with my food intake and the need to be in ‘control’.

I am angry about the treatment I was subject to. Blanket surveillance has been implemented on such a large scale without consideration of consent, patients’ privacy or the psychological effects. I believe it breaches basic human rights and that I suffered unnecessarily and unlawfully.

I want to see NHS wards move away from technology that appeals for an easy fix, and focus instead on investing funds into the mental health system, creating safe staffing levels and a culture of compassion and empathy amongst staff. Surveillance is not ‘safety’.

Sophina Mariette is a survivor of mental health services having spent 15 years in the system and the best part of a decade on mental health wards.

For more information on Oxevision, visit the Stop Oxevision website and read the open letter/sign the petition.