Stop Oxevision: five arguments against surveillance systems in psychiatric settings

Stop Oxevision is a patient-led campaign to highlight and protest against the use of Oxevision, a patient monitoring system from Oxehealth. In this article, the campaigners set out five areas of concern around the use of digital surveillance in psychiatric inpatient settings.

Oxevision is a video monitoring system developed by Oxford University and is the product of the private company, Oxehealth. It records patients in their bedrooms to allow staff to observe them remotely, track their movements and take their pulse and breathing rates.

The technology received funding from the NHS Innovation Accelerator programme and has since been used by mental health hospitals across England, despite lack of good quality evidence for its safety, effectiveness or impact on the Human Rights of patients. It is also installed on some Assessment and Treatment Units, where autistic people and people with a learning disability can spend many months or years. Surveillance can have wide-reaching effects on those subject to this restrictive practice over such a long period.

The target market for Oxevision is a captive population: incarcerated patients. This population is familiar with lack of choice and consent in their care and often do not have the means or capacity to speak up. Institutional oppression and lack of communication to patients that they have rights is misinterpreted in marketing materials and business plans as patients not opposing cameras in their bedroom.

Although our campaign refers to Oxevision, we are against all forms of digital surveillance including CCTV, body-worn cameras and other tracking systems. This campaign isn’t theoretical to us; we all have experience of inpatient care, including camera-based surveillance.

We highlight five areas of concern with the use of Oxevision:

Consent

Our campaign is based on hundreds of Freedom of Information (FOI) requests. We know from our research that some Trusts have installed Oxevision in a blanket way and some (including EPUT, TEWV, and RDaSH) rely on implicit consent meaning all patients are opted in upon admission with its use not reviewed on a case by case basis.

The presence of Oxevision is often not communicated with patients. Trust posters and information leaflets have been found to not inform patients what Oxevision is, failing to mention that Oxevision is a camera. The use of Oxevision without consent risks breaching patients Human Rights. 

As trauma survivors, mad and neurodivergent people we are familiar with having things done to us without our consent; the lack of choice and control on wards contradicts with NHS’s own personalised care approach and can be (re)traumatising for patients.

Privacy and dignity

Trusts argue that Oxevision promotes patients privacy and dignity, however, we strongly believe that cameras in bedrooms are incompatible with this. In 2023, a CQC inspection reported that Oxevision could see into patients' bathrooms and that patients had been seen in a state of undress on camera.

Cameras in bedrooms have a disproportionate impact on minorities and religious groups. For example, Oxevision would enable patients to be observed during prayer. Only two trusts identified such risks in their equality impact assessments but they still failed to take action to mitigate this.

Psychological impact

Many Trusts that use Oxevision have it installed in all bedrooms, where patients can be detained for months or years despite no research into the long term effects of being surveilled in this way. However, from listening to those with lived experience we know that cameras in private spaces can feel dehumanising, intrusive and induce or exacerbate paranoia, hypervigilance and psychosis. It has the potential to be (re)traumatising and is incompatible with trauma informed care. We have spoken to people who spent entire admissions sleeping on the bathroom floor, in communal areas, even in the garden, to avoid the camera, despite begging staff to turn it off.

Surveillance as restrictive practice

Surveillance is a restrictive practice and has potential implications as to its legality under the Human Rights Act, Equality Act and GDPR. Its use has not been shown to be proportionate (least restrictive), legitimate or lawful. Being filmed whilst in crisis and distress could be classed as inhumane and degrading treatment under the Human Right Act 1998, particularly if its presence exacerbates distress. The use of surveillance without consent risks breaching patients rights.

Data sharing  

Video footage can also be saved by staff to potentially use in criminal investigations. This is very concerning in a wider context of the criminalisation of distress. Patients have a right to privacy and should have control over how their data is used and shared.

Since our campaign began we have seen mental health trusts make changes—most notably creating policies that weren’t there before. However, these changes don’t go nearly far enough and the policies are often inadequate. As a campaign we are calling on NHS England, the CQC and other professional bodies to take decisive leadership and halt the roll out of Oxevision and other surveillance on psychiatric wards.

Surveillance is not safety.