I want to start this blog by making it absolutely clear that:
- I am not against CCTV. I know it can be a very important, useful and powerful tool in health care settings BUT they can breach human rights and raise ethical and lawful considerations
- This is a particularly difficult topic to cover in a short blog and I probably won’t do it the justice it deserves but I hope this initial dive sparks some interesting debate!
This blog has been prompted by the seemingly, unregulated and ‘un-thought-about’ exponential roll out of CCTV in health and social care settings. Watching on, in horror, it has left me wondering where the balanced debate is at?
And whether people like me, who have had their most vulnerable and sometimes deeply troubling moments recorded, have been asked what they think. Is this ‘tool’ being given too much power and is it truly making a difference to the care that is provided?
Here are few of the arguments I have come across…
Argument 1 – “I need CCTV so that I know my loved one is safe”
For families, the idea that CCTV will provide an added layer of protection for their loved ones is alluring. Recently, we have been reminded of abusive practices being captured on camera with the 10th anniversary of Winterbourne View.
However, does CCTV provide this protection? Are your children/family members safer with CCTV about?
Whorlton Hall demonstrated that CCTV cannot cure an abusive, closed culture. People intent on abusing will enact abuse, finding places to torment their vulnerable victims out of the range of cameras.
A friend of mine who has spent over 500 days locked in a room (long-term segregation) with nothing more than a mattress for company and whose every move was recorded on CCTV, was routinely sexually abused. CCTV did not catch the sexual abuse and horrific sexual exploitation this person suffered on a regular basis. Instead, the CCTV was used to criminalise this young person when they kicked off about the abuse they were suffering.
Let’s be clear, CCTV cannot alter staff attitudes, it cannot upskill those that haven’t been trained for their roles sufficiently and it cannot pay deserving staff a better salary. It certainly cannot reliably capture abuse or those intent on perpetuating misery.
Argument 2 – “We use CCTV really effectively. We use it for staff training to see where they’ve gone wrong”
Comments similar to the above have been communicated to me numerous times in the past few weeks by providers. However, if CCTV is being used solely for staff learning, this is not a proportionate use of CCTV and is a breach of peoples human rights. Full stop.
From a practice leadership perspective, it is also ineffective. If a service requires CCTV to be installed to monitor staff responses to people, then it will always be an “after the event” tool.
Staff behaviour is obviously already entrenched. Practice leaders in settings using CCTV (mainly for this purpose) would do well to think about primary prevention where good practice leadership can be so potent.
Practice leadership researcher, Roy Deveau, shared with me that CCTV might also encourage a view that a behaviour is solely a property of an individual. Good practice leaders should encourage staff cultures that look holistically and see behaviour as a manifestation of the environment and interpersonal dynamics.
And finally, CCTV encourages not being present as good practice leadership requires. So many times, I hear that CCTV is encouraging distanced nursing where a camera is being used instead of a human.
This can be extremely distressing for people receiving care as this short video explains: https://twitter.com/AQuinnUnbroken/status/1343862203838050306?s=20
Finally, Roy Deveau explains that, “there is a danger of hospital approaches to supervision and support being punitive rather than developmental”.
Argument 3 – “There is CCTV everywhere. No-one moans about CCTV in supermarkets. What’s the big deal?”
- There is not CCTV in your house, capturing your most intimate moments, 24/7.
- There is no CCTV when you get frustrated or angry or behave badly with your family.
- You are not forced to watch back your most horrifying moments or have an inquest about your behaviour.
- People in services who are subject to CCTV 24/7 do not have this luxury.
So yes, CCTV is on our streets, in our supermarkets and pretty much everywhere we go. However, we choose to go to these places and we can choose to leave when we want to.
CCTV is a Human Rights Issue
Human rights are not optional. They are not a nice thing that we can use and talk about when they suit us. They are the law.
CCTV can breach Article 8 of the Human Rights Act. So, for me, in every single case it is being used it must pass the proportionality test: is it lawful, legitimate, proportionate?
If CCTV cannot pass this test in the setting it is being used, then its use is unlawful! Full stop.
At present I fear that we are diluting every person’s human rights, in every care setting (that is routinely using CCTV and not considering human rights), on the odd chance that we catch a rogue perpetrator or where ‘some learning might occur when staff get it wrong’?” This is not ok!
In every setting we must question:
- What is the purpose of this CCTV? Is there a problem in the service that needs to be overcome? Is the CCTV a sticky plaster?
- Can the CCTV be justified? How is CCTV the least restrictive option?
- What other alternatives that don’t breach peoples’ rights have been considered?
- Why aren’t other alternatives being used?
Where CCTV is being used and it passes the proportionality test, the following should be considered:
- Closing the power differential. e.g. can patients wear body cameras if they want to?
- Mandatory human rights training for staff to help them understand the human rights implications if they wear body cameras or are in charge of footage
- Patient consent to recording
- People’s reduced ability to advocate and challenge the system
- Clear complaints/viewing process that is time bound
- The use of CCTV in LTS, seclusion and ambulances. This can feel very difficult and traumatic for patients
- Criminalisation of people in distress
- Data collected on the use of CCTV – e.g. criminalisation, catch abuse etc… Do we know what CCTV is being used for? Does this need to be recorded and regulated by CQC?
I am really happy that CCTV is readily available as a tool that can be used for good in care and treatment settings. However, in order to ensure CCTV is being used to improve care for people in distress there must be debate, regulation and thought given to how we are currently allowing this incredibly powerful tool to permeate our institutions.
Alexis Quinn is the Restraint Reduction Network Manager / Coordinator, Autism campaigner, activist and international speaker. She is the author of Unbroken, which tells her story of being detained under the mental health act against her will, and the harmful restrictive practices to which she was subjected. She now writes about her experience and campaigns for systematic change to stop abusive practices, promote neurodiversity and end the stigma surrounding mental health.
To find out more about the Restraint Reduction Network, please visit: www.restraintreductionnetwork.org or join the debate @theRRNetwork