Centering equity in mental health crisis services

243 ate adaptations in psychiatric intensive care units, secure mental health services, emergency departments, and wards for other age groups. However, the staff short­ ages and considerable pressures faced by those working in mental health care also create considerable barriers for those im­ plementing interventions and undertak­ ing related research. A narrative review of the literature found a relatively small body of research on the use of closed circuits television (CCTV) to increase security for patients and staff in acute psychiatric units, but recognized the trade­off with privacy. CCTV increased sub­ jective feelings of safety amongst patient and staff, but there was no evidence that it increased objective security or reduced vi­ olence. CCTV and, more recently, infrared cam­ eras have also been used to conduct close ob­ servations and monitoring of vital signs in patients, including in seclusion. Such tech­ nology can be less invasive for patients, reduce sleep disruption when making checks, and can be preferred by some pa­ tients as it avoids staff entering a person’s private space. This may reduce triggers for conflict and aggression, and subsequent psychological harm associated with con­ tainment measures. Video monitoring can also allow over­stimulated patients to be left alone, while enabling staff to carry out their observations. On the other hand, the use of electronic surveillance can be seen as distancing and dehumanizing. Studies suggest that the main factor in comforting patients and re ­ ducing trauma during an episode of se clu­ sion or restraint is contact and commu­ nication with staff. Symptoms of fear, dis ­ trust or delusions can be worsened in some patients, and there are concerns that CCTV might increase paranoid thoughts or trig­ ger distressing memories of prior abuse involving videos. Video cameras might di­ rectly contribute to an atmosphere of de­ tachment, control and fear, which could promote occurrence of the very events that surveillance is supposed to reduce. Video­ ing patients, especially in distress, can fuel feelings of shame and touches the right to privacy. These concerns and the need for more re­ search are important, as the increasing avail­ ability and affordability of digital technol­ ogies has seen body worn cameras (BWC) being introduced to inpatient units, in emer­ gency departments and for paramedics in ambulances. BWCs are small devices that can be worn on clothing, which record sights and sounds in the vicinity of the wearer. Men tal health staff are being asked to wear BWCs and to switch them on dur­ ing inci dents, or sometimes at the request of a pa tient. It is hoped that the use of BWCs will defuse situations, reduce aggression, and increase accountability and evidence­ gathering around serious incidents. How­ ever, a recent systematic review of the liter­ ature identified only two low­quality eval­ uations of BWC use in mental health wards, with mixed results though some indication of reductions in more serious incidents. In conclusion, addressing the activity and engagement needs of patients on busy pressured wards can be regarded today as a priority, whereas the idea of using elec­ tronic surveillance in acute mental health settings is not supported at the moment by convincing research evidence and is gen­ erating significant concerns.