This issue is raised for consideration because I came across a situation where one forensic inpatient was found with video content via Facebook, of another inpatient in another city committing suicide. The psychological impact was serious, to say the least.
[Caution: no details can be provided on any scenario given here, to avoid identifying ‘institutions’]
The Mental Health Act 1983 gives hospitals power over patients in physical spaces, but it is completely silent on activity in virtual spaces. This means a patient can be legally contained within the hospital walls but have completely uncontrolled access to the entire world online, bypassing the entire purpose of a secure unit. Section 17 can control movement within and to physical spaces, but not virtual spaces.
The New Mental Health Bill is silent on the issue. The upcoming legislative reforms to the Mental Health Act completely fail to address any of these digital-age problems. This guarantees a legislative black hole that will continue for the foreseeable future.
Hospital security is easily bypassed. Any security measure hospital puts in place, like filtered WiFi, is rendered useless by technology like personal 4G/5G mobile data and VPNs. Patients can effectively create a private, encrypted tunnel to the internet that is invisible to the clinical team, making a mockery of the “secure” environment.
The “Least Restrictive” principle is unfit for the digital age. Regulators like the CQC push a “least restrictive” approach, which is a restraint on how rights are limited. However, when applied to technology, this principle creates a paradox. Allowing an unmonitored smartphone isn’t a minor freedom. It is potentially the most high-risk option available, yet clinicians are pressured to permit it for fear of being seen as overly restrictive.
Clinicians are responsible for assessing a patient’s risk, but they are completely blind to a huge part of their lives i.e. their online activity. This means risk assessments are being conducted with incomplete information. A patient can present as a model of recovery on the ward while secretly engaging in extremism, criminal activity, or hate crimes online.
In one unit several gigabytes of porn was found floating around; exchanged among sex-offenders and other non-sex-offenders. Should forensic psychiatrists or perhaps psychologists be tasked with screening porn for the purposes of the least restrictive approach?
Clinicians are being asked to manage 21st-century digital risks without the legal authority, technological tools, or regulatory support to do so. This risks “moral injury” and burnout, as professionals are held responsible for safety in a domain they have very little power to control.
Over to my esteemed colleagues, if this post is allowed.