Stop Oxevision

Content note: suicide, sexual violence

Surveillance began at the very first contact. Firstly with the police, and body worn cameras. Then held under ‘common law’; with two medical recommendations in a room with just a sofa and a camera. I was monitored throughout by CCTV live streaming to both clinical staff and security officers for over 48 hours. I tried to sleep in the corridor initially, changed in the bathroom, I turned the cameras around. At that point, it was not nursing staff that responded, but security personnel.

All wearing body worn cameras… I could not escape the surveillance. I could not leave.

Approximately half of female inpatients in psychiatric units have experienced sexual assault (O’Dwyer et al 2019). I am one of those. Up to 10% of women with a serious mental illness have experienced sexual assault in the past year (Khalifeh et al 2015). Marginalised groups are at greater risk of sexual violence and less likely to report it, for reasons, such as fearing not being believed or experiencing discrimination (Krug et al 2002, NHS England 2018, Human Rights Campaign 2020). While women and girls are more commonly affected by sexual violence than men and boys, the rape and sexual assault of males are some of the most under-reported crimes worldwide.

The rise of technology has led to a new term ‘Technology-facilitated sexual violence’ where it is used to facilitate sexual violence through criminal, civil, or otherwise harmful sexually aggressive and harassing behaviours. One type that most will be familiar with is the use of image-based sexual abuse’; nonconsensual sharing of sexually explicit media, nonconsensual pornography, or ‘revenge porn’ (Fisico & Harkins, 2021). In a survey of participants ranging in age from 16 to 64, 1 in 3 had experienced at least one type of IBSA victimisation (Powell et al., 2020). Nearly everyone will have heard of it, will be, in some way, in fear of it happening to them.

Staff that work in mental health settings, can and do perpetrate acts of sexual violence. These staff are representative of our communities, and by some estimates, as many as 35-47% of the population have an interest in performing an act of voyeurism (Ahlers et al., 2011; Joyal & Carpentier, 2017).

As recently as 2018 a review of incidents related to sexual safety, the Care Quality Commission (CQC) (2018) described sexual incidents as ‘commonplace’. One concerning factor was that 97% of 1,120 sexual incidents were classified as ‘low harm’ or ‘no harm’, even though more than one third involved sexual assault or harassment and some occurred multiple times; something that indicates the low level of acknowledgement staff have of the psychological impact of such experiences. Should we really be creating opportunities for vulnerable people to be further harmed? Can we even trust that if a person was misusing the footage it would be taken seriously?

If we consider trauma as a wider phenomenon, whereby it includes any experience that put a person, or someone close to them at risk of serious harm or death, 60% of men and 50% of women reported to have experienced a traumatic event at some point in their lives, (Floen and Elklit, 2007). A lifetime trauma exposure of 90% has been reported among those who are in contact with psychiatric services. Common outcomes of trauma exposure include feeling threatened, flashbacks, panic attacks, sleep problems, feeling vulnerable and confused about what is safe. Oxevision can and does cause trauma symptoms to re-emerge.

I was admitted to a ward in a Trust where ‘oxevision’ is according to the Standard Operating Procedure “part of normal practice” and “consent for its use whilst within inpatient services is deemed implicit upon admission”. The threat was a camera in the corner of the room, just above my bed, but angled in a way that it even viewed the bathroom.

The resulting hypervigilance was real.

I was no longer someone who had experienced a number of traumatic events relating to loss of control and power at the hands of others; I was right back in the state of terror, of fear, paranoia, on high alert. Not able to self regulate. Worsening the symptoms that I was admitted with, I did not feel safe not knowing who was looking at the screen. Who was watching me and for what purpose. I could not build therapeutic relationships with people I could not trust. In an environment that felt so harmful, so triggering.

I tried to sleep out of sight of the camera. Then later, under the desk – where I realised I could circumvent the technology, in communal areas or even the garden, such was my level of distress.

At least then, whilst I knew I was exposed, I knew who was watching me; they didn’t need to use a camera. I even had a care plan written that recognised that I did not sleep in my room, would sleep in the bathroom, communal area, or outside in the garden.

Eventually the monitoring device was switched off. But only after I had to speak to the male ward manager, the largely male MDT, to ‘justify’ it, speaking at lengths what trauma had happened and why this was impacting any sense of care or recovery now. Without anyone or anything to contain the distress that was brought up. The things that I raised will now forever be etched onto my notes. I feel further shame.

The relief at having the system switched off was short lived though; even when off the infrared sensor is active, so I became obsessive on checking the i-pad or office computer. I doubt many people could advocate for themselves in the way I do. Or would have the foresight to write an Advance Statement, to be used in future admissions, withdrawing consent. That said, it isn’t legally binding.

I know some will say that surveillance is justified in ‘promoting safety’ at the cost of dignity.

However, that assumes that people in psychiatric hospitals want to be kept safe. I was detained for a reason; I wanted to end my life and actively sought opportunities.

I actually believe that Oxevision promotes ‘unsafety’ for many people. Knowing that staff would ‘disturb me less at night’ – I interpreted as there would be less chance of an intervention. Knowing that the bathroom, the door way were out of sight I read as these were the places in which to harm myself without detection. Even knowing that an alert would not be raised for 3 minutes I saw as adequate time to cause lasting damage if not death to myself. And so I chose these places. I changed my ‘risk profile’. All of these things actually increased the severity of my suicide attempts. The ‘count down’ added to the adrenaline. I was doing research into the quickest and most likely to be effective ways of ending my life. I know, I was not, am not the only one that has actively sought to ‘defeat the system’.

It worries me how patients could collude with each other to set multiple alerts at once, and the harm that could come from this. There is already a constant stream of ‘Oxehealth Alert’ coming from the i-pad, that I doubt one person could manage alone.

Beyond that, there are various ‘risks’ of relying on surveilence software such as:

1. The software displaying the wrong data

2. A person’s location or activity poses a risk, but the staff member does not act on it

3. A person’s vital signs pose a risk, but the user does not have the knowledge to recognise that they should be escalating a concern

The ways that I demonstrated my distress, was usually periods on enhanced observations. These actually gave me the opportunity to build therapeutic relationships with staff on the ward. A sense of respite from a brain that was actively looking for ways to endanger myself. That in turn allowed me to develop my own coping skills and engage in recovery. Video based patient monitoring assumes that patient’s finds observations more imposing, more of an infringement on human rights and dignity, but at best, a monitor in the corner of my bedroom can never replace the support of another human being. At worst it promotes neglect.

Oxehealth makes a lot of assumptions that I do not agree with; “Our Digital Care Assistant is paying attention to every room when you can’t be there….” (https://www.crunchbase.com/organization/oxehealth) and “Oxehealth works alongside patients, doctors and nurses to develop technology to transform the diagnosis, care and experience of mental health patients.” (https:// nhsaccelerator.com/innovation/oxehealth/). In my opinion, any type of surveilence must be for a specified purpose, with a legitimate aim and necessary to meet an identified pressing need on wards that are already adequately staffed. Until that happens, I believe it will cause far more harm than it will ever help.