The Feasibility of Using Body Worn Cameras in an Inpatient Mental Health Setting

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Research Article Open Access
Mental Health in Family Medicine (2017) 13: 393-400
Research Arcle
2017 Mental Health and Family Medicine Ltd
The Feasibility of Using Body Worn Cameras in an
Inpatient Mental Health Setting
Hardy S
Senior Research Fellow, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood Hospital, Northampton, UK
Benne L
PMVA Manager, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood Hospital, Northampton, UK
Rosen P
PMVA Trainer, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood Hospital, Northampton, UK
Carroll S
PMVA Trainer, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood Hospital, Northampton, UK
White P
Programme Workstream Lead, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood Hospital, Northampton,
UK
Palmer-Hill S
Head of Innovaon Research and Clinical Eecveness, Northamptonshire Healthcare NHS Foundaon Trust, Berrywood
Hospital, Northampton, UK
Background
Body worn cameras (BWC) are mobile audio and video
capture devices that allow the wearer to record what they see
and hear. These devices can be secured to various parts of
the body using different types of attachment. The advantages
of professionals wearing a camera include transparency,
identifying integral problems within the organisation and
improving evidence documentation [1].
BWCs are used internationally by police ofcers. A
randomized controlled eld trial carried out in the USA suggested
that police BWCs reduce the prevalence of use-of-force by the
police as well as the incidence of citizens’ complaints against
them [2]. In England, an evaluation of their use in Hampshire
and the Isle of Wight also showed a reduction in complaints, and
a decrease in occurrences and crimes [3].
In their 2015 report regarding the use of body worn
cameras in health care settings, the International Association
for Healthcare Security and Safety (IAHSS) Foundation
[1] describe some examples in the United Kingdom which
claim that the use of BWCs on security ofcers can decrease
violence in health facilities [4]. However, there are no published
evaluations available to support these claims. A report from the
Greater London Authority in 2014 [5], found that nearly 66,000
frontline workers, including nurses, were recipients of physical
or verbal attacks in the past three years and recommended the
trial of body worn cameras to see if they assist in reducing
crimes against workers.
There are a number of perceived benets from wearing
body worn cameras which include: strengthening health
care professionals’ accountability by documenting incidents;
ABSTRACT
Background: A study of police wearing body worn cameras
showed a reduction in complaints, and a decrease in occurrences
and crimes. Mental health staff working in inpatient settings
do not routinely wear cameras. The aim of this project was
to examine the feasibility of using body worn cameras in an
inpatient mental health setting.
Method: Reveal trading as Calla supplied 12 Reveal cameras
which were worn by the Prevention and Management of
Violence and Aggression team and nursing staff on ve
psychiatric inpatient wards in Northampton and England
following training.
Results: The training provided prepared staff to use the
cameras effectively. There were very few technical issues
with the body worn cameras though some renement to the
harness is required to improve comfort. Both staff and patients
considered that their use in an inpatient mental health setting
was benecial. Compared to the same period the year before,
there was a reduction in complaints and incidents during the
duration of the pilot. The cost of equipment was £7,649 and
storage of footage for three months was £569. Other costs were
for staff time, 48.5 hours to set up and seven hours per week
to maintain.
Conclusion: We have demonstrated that it is feasible to employ
body worn cameras in an inpatient mental health setting. Their
use is acceptable to both patients and staff. Costs could be
offset by the reduction in complaints, incidents and restraints,
but further research is required to support this.
MeSh Headings/ Keywords: Mental health; Body worn
camera; Inpatients

Hardy S, Bennett L, Rosen P, Carroll S, White P, Palmer-Hill S.
394
preventing confrontational situations by improving health care
professionals’ conduct and the behaviour of patients being
recorded; resolving incidents and complaints by providing
a more accurate record of events; identifying and correcting
internal problems by revealing staff who engage in misconduct;
strengthening health care professionals’ performance by using
footage for training and monitoring; and improving evidence
documentation for investigations. Body worn cameras have
some limitations: the camera does not follow the eyes of the
wearer as the event occurs; it is unable to capture a 360 degree
view of the situation that might be occurring; the wearer may be
unsure when to turn the body worn camera on; and a camera can
never replace a thorough investigation.
There are no set of universal industry standards for the use
of body worn cameras in healthcare settings. Each department
or facility need to develop their own set of standards, roles and
responsibilities, and policies and procedures to comply with
governance requirements [1]. In a qualitative appraisal of the
use of CCTV cameras in Broadmoor Hospital (a high-security
psychiatric hospital in England), patients believed the absence
of sound recording led to a lack of context when reviewing
the images [6]. This was one of the reasons that BWCs were
introduced. The nurse wears the clearly marked camera which
is usually switched off. It displays a red light when in use. The
employment of the BWCs has been judged to be useful by both
nursing staff and patients [6], but no report on their feasibility or
effectiveness has been published to date.
This pilot project using BWCs in a mental health setting
took place at Berrywood Hospital, which is a psychiatric facility
in Northampton, England, run by Northamptonshire Healthcare
NHS Foundation Trust (NHFT). The ve wards in the pilot
included one male and one female recovery, one low secure
unit, one acute admission and one intensive care. At present
CCTV cameras are not employed in ward settings; however,
there are CCTV Systems in use in other areas of NHFT such as
car parks and corridors. These are commissioned, governed and
managed in accordance with the Information Commissioner’s
Ofcer Code of Practice 2014. The CCTV systems are in place
to deter malicious and inappropriate behaviour, detect crime,
and promote staff and patient safety.
NHFT employs a Prevention and Management of Violence
and Aggression (PMVA) team which includes full time staff, a
part-time administrator and a number of part-time ward based
instructors, all based at Berrywood Hospital. They provide
training, clinical support and advice on the prevention and
management of violence and aggression across the Trust. They
work closely with their service user colleagues in both policy
development and co-produced training packages in order to
reduce conict and containment in mental health and learning
disability services in the Trust.
The aim of this pilot project was to examine the feasibility of
using body worn cameras in an inpatient mental health setting.
A number of specic objectives were set:
• To nd out whether wearing the camera is comfortable
and if it causes restriction
• To test and rene information technology support and
security requirements
• To determine the level of training and support required
by staff using the BWCs
• To explore the experience of staff using BWCs, practical
issues faced, their perceptions of its usefulness
• To explore the experience of staff who work alongside
colleagues who are wearing BWCs, practical issues
faced, their perceptions of its usefulness
• The acceptability of staff wearing BWCs to patients
• To observe any change in the level of reported incidents
• To examine the costs of utilising BWCs.
Method
Intervenon
Reveal trading as Calla supplied 12 Reveal cameras free
of charge to NHFT for the purpose of this pilot. The cameras
are protected by a pin number so data cannot be downloaded
if the camera gets lost. The date and time, and the amount of
storage time are displayed on camera. Reveal trading as Calla
also provided and administered the secure cloud-based solution
which stores the recordings that have been captured. D a t a
from all cameras was uploaded to Reveal trading as Calla’s
secure cloud from one computer located in the reception area.
One member of the nursing staff on each of the ve wards at
Berrywood Hospital, a member of the PMVA team and the
night manager wore a BWC during their shifts. These members
of staff were chosen because they are trained in full range of
interventions from a PMVA perspective. They chose to wear a
harness camera tting. This tting was selected as it can go over
the uniform and it is sturdy and practical. Extra harnesses were
available to allow for washing. The staff wore the camera at all
times; it was switched off and then activated when an incident
occurred. The use of the BWC device can be categorized in four
separate phases of operation:
a. Collecting the camera from the charging/docking bay
(located in reception). This includes: switching the
device on and checking that it is operating accordingly.
b. Attaching the device, and the robustness/ergonomics of
the camera. It is invariably worn on the on left side of the
chest of the outer garment.
c. Using the camera to record an incident. This includes:
travelling to the incident; switching the camera on by
sliding the function button (an audible beep, active light
illuminates and the front display screen then shows);
sliding the function button back after the incident to
switch off.
d. Returning the camera to the docking station. On
completion of a shift, the camera is docked, data is
uploaded and unit is re-charged.
Staff from each ward may respond to an incident on another
ward. It was agreed that all staff wearing a camera would record
the incident. Staff wearing cameras were guided in their training
to talk to the camera to give their thoughts about what they can
see and what they intend to do. If staff decided to switch the
camera off because they feel this could be exacerbating the

The Feasibility of Using Body Worn Cameras in an Inpaent Mental Health Seng 395
situation, they were advised to say they are going to do so and
why. If it was appropriate to record the sound but not visuals,
staff were directed to turn the camera around. They were
instructed to explain to patients and other staff that the wearing
of the camera is for their safety.
Preparatory work
Before the intervention could be introduced to the wards
there was a need to adapt the Trust’s security policy, implement
the necessary information technology (IT), comply with
Information Governance (IG) regulations, develop and deliver
appropriate training, and inform patients and visitors.
Trust BWC policy: The related policies and procedures
are described in NHFT’s Security Policy; staff were advised
to adhere to this policy when using the BWCs. A Standard
Operating Procedure (SOP) was written by the second author
for insertion into the policy. This was based on the West London
Mental Health trust’s photography policy for Broadmoor
Hospital and the Commissioner’s Ofcer Code of Practice 2014.
Information Technology: For the correct IT to be put
in place, the IT team commissioned by Northamptonshire
Healthcare Foundation Trust: liaised with Reveal trading as Calla
in relation to the IT elements that needed to be implemented;
bundled and deployed software (identied during details
scoping); provided technician support for the installation of
docking stations; proxy changes where identied; and analysed
the bandwidth requirements for data transfer and its effect on
core services using the NHFT network.
Information Governance: The IT team provided NHFT with
expert advice in relation to compliance with the Data Protection
Act and IG. A full privacy impact assessment and completion of the
self-assessment tool from the surveillance camera commissioner
were recommended. Actions from these included: display of fair
processing notices; agreed retention periods for recorded data;
conrmation of compliance for information security on both
devices; and cloud storage and data processing agreements with
Reveal trading as Calla.
Training: Training to use the cameras was provided by
Reveal trading as Calla at Berrywood Hospital. The duration of
training is 90 minutes and includes:
• The purpose of wearing a camera
• Description of how the camera works – no infra-red so it
sees what you see
• Practical aspects of collecting, using and returning the
camera
• Security of data, use of log in
• How the data is stored and how to search for footage
(only ward matrons have access to footage and this is
from their own ward)
• How to send footage to the police if necessary.
Ward managers and/or a member of the PMVA team
cascaded this training to ward staff. Additionally, two members
of the PMVA team and the night managers received further
training as administrators. They were shown how to appraise
the videos and to keep footage for 31 days unless there is an
incident that needs to be reviewed.
Informing patients and visitors: All wards were provided
fair processing notices in the form of with posters which were
displayed in areas of high visibility. These stated that: the
cameras record video and audio information, but only when
activated by the wearer; staff wearing the cameras will clearly
let people know when they begin any recording; cameras will be
activated if staff believe that safety may be compromised when
responding to incidents; and all recorded data will be processed
in accordance with the Data Protection Act 98. The posters
were regularly replaced if removed by patients. Staff verbally
informed patients about the cameras by including prompts in
morning meetings, patient experience groups and community
meetings.
Data collecon
1. To nd out whether wearing the camera is comfortable
and if it causes restriction we asked staff to complete a
questionnaire.
2. To test and rene information technology support
requirements, the IT team provided a summary of queries
and actions taken.
3. To determine the level of training and support required by
staff using the BWCs we asked for immediate feedback
following the training and then after two months. We used
evaluation forms specically created for this purpose.
4. To explore the experience of staff using BWCs and those
who work alongside them, practical issues faced, and
their perceptions of its usefulness, we carried out surveys
and a focus group.
5. To nd out the acceptability of staff wearing BWCs to
patients we created a patient questionnaire. This was
given to all patient’s resident in the ve participating
wards during a designated week.
6. To observe any change in the level of reported restraints
(identied as low level supportive holds and emergency
responses), incidents (identied as verbal abuse and/
or violence) and complaints of incidents we compared
routinely collected data during the period of this study
with routinely collected data for the same time period
before the intervention.
7. To examine the expenditures of utilising BWCs we have
identied which costs should be measured:
a. Setting up the service by determining staff time to
deliver and attend training, staff costs to create and agree
policies, IT costs, cost of cameras and storage factors.
b. Continuing to provide the service – staff time to
download recordings, IT input, servicing and repairing
cameras, storage.
Parcipants
The participants included:

Hardy S, Bennett L, Rosen P, Carroll S, White P, Palmer-Hill S.
396
1. All nursing staff on the wards where BWCs are being
used
2. Staff in the response team who are using BWCs
3. Patients on the wards where BWCs are being used.
Analysis
Descriptive analysis was used to compare patient outcomes
before and after the intervention. Thematic analysis was
employed for the patient and staff questionnaires.
Approvals
The protocol and related materials were given approval by
the trust’s Innovation and Research Department. The project was
given approval by the trust’s executive governance committee.
Results
Training and support required by sta using the BWCs
Initial training was provided by Reveal trading as Calla and
then cascaded to ward staff by the participants.
Initial training for using BWCs provided by Reveal
trading as Calla: The initial training was undertaken by nine
staff from Berrywood Hospital including ve Ward Matrons,
one night Manager, and the three members of the PMVA team.
Participants were asked to score the course delivery and their
condence to use the cameras, with ve being ‘agree strongly’
and one being ‘disagree strongly’. All scored ve for each of
the following areas: the structure of the training was easy to
follow; adequate time was allocated for discussion; the trainer
listened and responded to questions; understanding how using
BWCs can be of benet; condence in collecting the camera
from the docking bay, switching it on, checking the date and
that it is operating accordingly; attaching the camera to the
harness securely; feeling capable of using the camera to record
an incident and switching if off afterwards; assured in returning
the camera to the docking station on completion of their shift.
They all answered positively to the question asking if they felt
condent in cascading the training. Comments were asked for
but none were given.
Administrator training provided by Reveal trading as
Calla: The three members of the PMVA team were trained to act
as administrators. This included uploading, storing, accessing
and deleting recordings. They were asked to score between one
and ve as described above. All scored ve for the structure
of the training being easy to follow, having adequate time for
discussion, the trainer listening and responding to questions, and
uploading recordings. Mean scores for the other tasks, storing
recordings, accessing recordings and deleting recordings were
lower at 4.7, 4 and 4.5 respectively.
Participants were asked for suggestions to improve the
training, one suggested:
‘Would have been good to a have a 'live' session to play/
learn/make mistakes with’. Other comments included:
‘Will feel more condent when I've had a go’
‘Will see when I have my own login (stored, access, delete)’
Cascaded training: The training was cascaded to 25 staff
members from the ve participating wards; they included
charge nurses, matrons, ward managers, staff nurses, and health
care assistants. In the main, scores for all areas of the training
were ve with the lowest score being four. Comments for
improvement included:
‘Show the playback quality’
‘Have more devices to practice with’
Other comments included:
‘Look forward to the feedback and evaluation’
‘Really good and proud to be involved in study’
How well the training prepared staff for practice: Two
months into the pilot, staff who wore the cameras were asked
whether the training prepared them for the situations they
encountered. Thirty-eight staff responded to this question.
Eighty-seven percent felt that they were ready, with 42%
stating they were fully prepared and 45% were mostly prepared
following a little practice. Twelve percent of staff stated that
they did not attend any training. Comments included:
‘Like anything new, it took time to fully get to grip with it’
‘I had to decide when to use it in real situations’
‘Rather easy to get on with, just have a play around and soon
gured it out’
Ninety-ve percent of the 39 respondents who wore the
cameras stated that they were prepared for any queries regarding
body worn cameras from patients and relatives, with 56%
being fully prepared and 39% after a little practice. Comments
included:
‘I knew what to say and how to say it to allay patient and
relatives’ fears’
‘General conversations around who has access to footage’
Staff involved in the focus group thought that the only
aspect not covered in the training was that there is a delay before
lming starts after switching on the camera, and they only found
this out on looking at the footage. This has taught them to be
more mindful about switching it on quickly.
Twenty-two staff who did not wear the cameras and therefore
did not attend the training responded to the same question,
i.e. were they prepared for any queries regarding body worn
cameras from patients and relatives. Eighty- two percent said
they were prepared, with 68% being fully prepared and 14%
after a little practice.
Informaon technology support requirements
There were a few minor problems in setting up the software.
Initially it could not connect to Reveal trading as Calla’s web
servers. This was because the trust’s internet proxy server was
blocking the connection. It was rectied by putting a rule in
place for the software to be allowed the connection. On the
rst attempt, the cameras did not upload the videos to Reveal
trading as Calla’s web servers. This was because the company’s

The Feasibility of Using Body Worn Cameras in an Inpaent Mental Health Seng 397
server was down and the problem was soon rectied. The IT
department were not asked to help with any problems during
the period of the pilot.
There were no concerns raised with BWCs in terms of IG.
Comfort whilst wearing the camera
Staff were asked to describe the level of comfort they
experienced when wearing the camera and whether it restricted
their movements in any way. Thirty-six staff responded. Only
one person described wearing the camera as restrictive. Thirty-
six percent of staff had no issues wearing the camera and 64%
described some level of discomfort.
No issues: Overall staff described wearing the camera as
being comfortable and unrestrictive:
‘There was no discomfort- the holdalls are easy to use and
free from restrictions’
‘I don't experience any movement restriction in any way’
‘No discomfort really. The cameras felt slightly strange, at
rst. But ne when I'd got used to it.’
Discomfort: Most of the discomfort seemed to relate to the
harnesses and the difculty in adjusting them to t. A number of
female staff reported problems due to their anatomy. Comments
included:
‘Feel like they dig into your arm pits and if not adjusted well
they move a lot’
‘Quite awkward to wear for females, camera sat between
breast and armpit’
‘As a lady with boobs it kind of made me a bit uncomfortable’
‘Dependent on which harness you get sometime no matter
how much you attempt to adjust they dig in your armpit’
‘Too tight under the arm, if loosened camera harness slipped
pointing camera at oor’
‘I found the harness pulled on my neck and caused a
headache’
Operaonal dicules faced by sta
Staff were asked to describe any operational difculties
they encountered when using the camera and how these were
resolved. Thirty-four nurses who wore the camera responded.
Eighty-eight percent reported that there were none. The
problems encountered were minor and included:
• One user did not x the camera very well to the
attachment and it fell off while bending down.
• On a few occasions, a user found the camera would
switch on if knocked.
• One nurse found that the camera they were issued with
was not working, i.e. it would not turn on at all, or record.
They reported it and the situation was resolved quickly.
• The harness has to be completely removed to remove
eece when warm and there is difculty in wearing it
over a coat or jacket.
• The harness smells as is usually worn close to staff’s
skin. This was resolved by doing a wash routine but one
nurse thought that this affected the elastic and then it felt
less secure.
Seventy-nine percent of the 14 respondents who did not wear
a camera reported they observed no operational difculties. One
stated that staff were not taking them back to the docking station
in reception after use. Problems observed included difculties
adjusting the harness and problems switching the camera on and
off.
Praccal issues faced by sta
Sixty-four percent of the 39 staff wearing cameras who
responded to the question asking what were the practical issues
encountered, reported that there were none. The rest said any
issues were minor and easily resolved. Twenty-three staff who
did not wear a camera were asked if they observed any practical
issues; 69% did not, 22% they were minor and easily resolved
and 9% said the wearer needed assistance to continue to use the
camera.
On viewing the footage, it was usually clear why the
situation had been lmed. There was only one episode in which
it was not, this was because the wearer had not stated why they
were going to lm.
The cameras did not switch back on after the rst monthly
generator test during the pilot. In order for them to be recognized
again by the software they had to be disconnected from the
docking station and then re-docked. This procedure is now
carried out routinely after the test is complete.
Sta percepons of the usefulness of BWCs
All staff were asked to give their opinions with regard to the
usefulness of BWCs in an inpatient psychiatric setting. Table 1
shows that staff wearing the cameras are much more positive
about the benets of wearing a camera. Comments from wearers
included:
‘I think it prevents lots of aggression and puts patients’
minds at ease knowing there is a record of what happened.’
‘I have seen a few occasions where the incident had de-
escalated and believe this to have been helped by the camera
being turned on. It would be good to see some sort of footage
used in training if appropriate to do so.’
‘Feel more reassured when having to utilize restraint
techniques that cameras are activated and capturing the incident.’
‘I am fully in support of the technology being used
permanently in the future. I can see nothing but positives from
it with recourse to its potential in reducing/de-escalating violent
incidents.’
Comments from staff who did not wear the cameras were
more mixed in opinion;
‘They cause more problems because the responding staff
will only capture from the time of arrival hence does not give a
clear picture of what has been happening prior to that.’
‘Body worn cameras have got pros and cons, nursing staff

Hardy S, Bennett L, Rosen P, Carroll S, White P, Palmer-Hill S.
398
feel they are being watched for wrong doing and on the other
hand patients do feel intimidated by their use.’
‘Initially skeptical, however can see that body worn cameras
have had a positive impact on both patients and staff.’
‘Patients have changed their behavior when they were told
it was being lmed. Useful to have a record in case of any
complaints about restraint and it makes staff more aware of their
body language.’
Examples were given by staff in the focus group where they
felt the use of BWCs may have changed behavior:
• A female patient kicking a door stopped when told she
was being lmed.
• A gentleman who had a habit of hitting staff seemed
to stop.
The PMVA team reported that they were impressed with
staff behavior when reviewing the footage, for example:
‘It was good to see the staff remaining caring and
compassionate even when they were faced with physical
aggression.’
Staff who were not wearing cameras were asked whether
they encountered any issues because they were not wearing a
camera and their colleagues were; 96% said they did not and the
rest said the issues were minor.
The acceptability of sta wearing BWCs to paents
Patients on the ve wards taking part in the pilot were
asked for their feedback regarding the cameras via a written
questionnaire. In the main these were handed out by staff
designated for the task, for example, one ward employed their
apprentice and a bank nurse, another ward used a patient. Sixty-
four patients were resident at the time. Only one form was not
returned. Six patients opted not to complete the form and 57
completed it.
Being informed that body worn cameras were in use:
Patients were asked if they were made aware that some of the
nurses were wearing body worn cameras on their ward. Sixty-
eight percent of those who completed the form said that had
been made aware (Table 2). The patients who reported that they
had not been made aware were from three of the wards with half
of these being from one ward.
Patients’ view on body worn cameras and behaviour:
Patients were asked whether staff wearing BWCs would have
an effect on staff and patient behaviour. Overall, 68% thought
that staff behaviour would change and 63% thought it would
change patient behaviour (Table 3). Just under a third of patients
thought that both staff and patients would be more careful what
they say and just over a third thought staff would behave more
professionally. Two fths of patients thought that patients may
be less likely to be violent or aggressive. Comments made by
patients in regard to behaviour were positive:
‘It may make staff more condent to approach and help
distressed patients, it makes them feel safer at work so happier
and more able to help patients.’
‘Wear all cameras for my own good.’
‘I feel sorry for patients who are still at a point where there
is some level of control over behaviour - it will certainly act as
a deterrent or tool to de-escalate.’
Benets and problems of sta wearing cameras
idened by paents
All patients were asked what they considered were the benets
and problems with staff wearing BWCs; 42 patients composed a
written explanation. Of these, 83% described the benets which
included: safety for everyone; respect for staff; better treatment
for patients; accurate recording; and clarifying situations in
possible unjust accusations. Examples of comments are:
‘Better behaviour from staff and patients, also clarity of any
issues because of video.’
Staff opinion Camera
(n=41)
No camera
(n=23)
They do not make very much difference 2% 9%
They cause more problems 0% 13%
They can prevent confrontational situations because staff behave more professionally 61% 48%
They can prevent confrontational situations because patients improve their behavior if being lmed 90% 61%
They provide an accurate record of events so incidents may be resolved more quickly 90% 87%
They may reveal when staff are not behaving professionally 59% 48%
Footage can be used for training purposes 73% 65%
Table 1: Comparison of camera wearers’ percepon of the usefulness of with BWC those not wearing a camera.
Method No of patients (%)
Posters 20 (51)
Informed on admission 5 (13)
Informed at morning meeting 15 (38)
Given written information 5 (13)
Other 1 (3)
Table 2: Methods of being informed about BWCs idened
by paents (n=39).
Opinion Staff
behavior
Patient
behavior
It makes no difference 30% 35%
They might be more careful what they say 32% 28%
They may be less likely to be violent or
aggressive n/a 40%
They may be more professional 35% n/a
Table 3: Number of paents who think that sta wearing
BWCs changes behavior (n=57).

The Feasibility of Using Body Worn Cameras in an Inpaent Mental Health Seng 399
‘Staff have evidence of patients kicking off.’
‘Makes things safer for clients and staff.’
‘Able to record specic actions and dialogue between
patients and staff.’
Twenty-four percent of the 42 patients who responded
listed a problem with staff wearing cameras; 10% of them also
listed a benet, meaning 14% provided a negative view only.
Problems comprised of: concerns regarding the improper use
of the camera; worry about who sees the footage; and having
a negative effect on patients. Examples of comments include:
‘When you have to react quickly do you really have time to
think about turning the camera on?’
‘Who views or will view the pictures, what happens after
they have been viewed?’
‘It causes patients to be more irritable and angry when they
think they are being observed.’
‘I could see some patients may see as a threat.’
The level of reported incidents
Clinicians working at NHFT report clinical incidents
using the Datix system. This system can be used to manage
incident reporting, risk registers, complaints, claims, requests
for information, safety alerts and CQC standards in the UK.
Incidents were measured by checking the number submitted
during the time period of pilot project and comparing this with
the number in the same time period the year before (Table 4).
We were able to check for the number of physical restraints as
a record is kept routinely by the PMVA department (Table 4).
It can be seen from table 4 that verbal abuse has increased on
three of the wards. The staff on Ward 4 report that for one month
of the pilot they had a particularly challenging group of patients.
Violence has reduced on three of the wards and increased on
two. Restraints can be classied as low level supportive holds
and emergency restraints used in situations where there is a
high or immediate risk of harm. Low level restraint increased
on two wards, reduced on two wards and stayed the same on
one. Emergency restraint reduced on three of the wards.
Complaints
Three complaints were made during the period of the pilot,
one of which was withdrawn. None of these were related to
a particular incident or restraint. During the comparison time
period the year before, three patients made complaints and one
withdrew. One patient made six complaints and the other made
two; both patients complained about an instance of restraint.
The rst patient thought restraint was a last resort and did not
consider that staff had talked to her and calmed her down.
She reported that restraint was used inappropriately and with
excessive force, and she was not informed about an injection.
The costs of ulising BWCs
We have described the cost of setting up the service and the
cost of continuing to provide the service.
Setting up the service
• Staff costs to deliver and attend training and staff costs to
create and agree policies. Time spent on training was 90
minutes for nine trainers who between them trained 25
staff for a 90minute period. One senior member of staff
wrote the policy which took three hours.
• IT costs. The IT technician spent 48.5 hours to set up the
service and deal with any problems. This was less than
the 51.5 hours they had estimated.
• Cost of cameras. The cameras and related equipment
were provided free of charge for this project. The costs
to purchase are: camera and software £6,540; accessories
£1,109.
Continuing to provide the service
• Staff time to upload recordings and review recordings
required three hours of time per week from a senior
member of the PMVA team.
• Sorting out problems with the cameras required three
hours of time per week from a junior member of the
PMVA team and one hour per week from the senior
member. The IT Service Desk Manager conrmed that
they did not have any calls regarding BWCs or the
software.
• Storage was provided free of charge for this project but
would have cost £569 for the three-month period.
Discussion
The education prepared staff effectively to use the cameras.
The session evaluations showed little difference in the
effectiveness of the initial training and the cascaded training,
demonstrating this as an effective method of preparing staff to
use BWCs. The training may be enhanced if more cameras are
made available for practice during the sessions. Consideration
should be given to providing an additional practical session to
increase staff condence before using the cameras in practice.
Some staff reported that they did not receive any training but
were required to wear a camera. A plan should be put in place
Ward 1 Ward 2 Ward 3 Ward 4 Ward 5
Incident Pre Pilot Pre Pilot Pre Pilot Pre Pilot Pre Pilot
Verbal abuse 0 3 0 5 2 0 3 8 8 8
Violence 16 14 613 16 826 47 17 5
Supportive hold 51133181711
Emergency restraint 4 10 1 4 16 2 15 2 5 0
Table 4: The number of incidents and restraints during the period of me when BWCs ulized compared with the same period
the year before.

Hardy S, Bennett L, Rosen P, Carroll S, White P, Palmer-Hill S.
400
to ensure all staff expected to wear the camera receive training.
Often a concern with using new technology is the amount
of time required to ensure it is working successfully. However,
there were very few technical hitches when setting up the
software and as the clinical staff trained to be administrators
were able to deal with any problems (which were minor), the IT
department did not have to be called out.
There were some issues with the harness that staff wore to
secure the camera. Reveal Trading as Calla will use this feedback
to develop a better solution for the healthcare environment.
Operational and practical problems were minor and easily dealt
with. Some of these may not have occurred if staff had been
given the opportunity for more practice. Sometimes cameras
were not returned to the docking station. This required staff to
go to another part of the hospital, so it may have been difcult
when they were busy or short of staff. Docking cameras into
stations located on each individual ward should resolve this
matter.
Most staff involved in the pilot were very positive about
the benets of utilising BWCs. This concurs with the views of
the nurses wearing them in Broadmoor [6] and provides further
evidence of their acceptability to mental health nurses.
Advising staff and patients about the cameras was carried
out using a variety of methods. However, nearly a third of
patients still reported that they had not been made aware that
they were in use and all reported different ways of nding out.
Given the nature of the patients’ illness where cognition is often
affected [7] it may be advisable to be particularly proactive in
advertising their use and to provide further written materials.
The staff are already planning to have the BWC information
included in the ward welcome pack.
The patients involved with this pilot were positive about the
benets of staff wearing cameras alleviating any apprehensions
that they may nd them objectionable. Again, this aligns with
the views of patients at Broadmoor who also judged them to
be useful [6]. As this was a feasibility pilot, we were limited in
the types of questions we could ask patients. It would be useful
to have more of their insights; we are planning to carry out
research in order to gain this.
The increase in verbal abuse during the pilot suggests
that the patients during this period may have displayed more
challenging behaviour than the comparison period. Despite this,
the level of violent incidents and emergency restraints decreased
on three out of the ve wards. There is a need for a longer period
of measurement and analysis of other factors such as stafng
and the severity of patients’ illness to determine whether the
use of BWCs had an effect on reducing violence and restraints.
There were no complaints regarding restraints during the
pilot period of BWCs compared to two in the same period a
year earlier. Though encouraging, the time period is too short
and the numbers are too small to suggest that this was due to
staff wearing cameras. Further research is required to measure this
precisely.
The costs of setting up and delivering the service were
reasonably small. There is the potential to make savings if
complaints and incidents are reduced.
Conclusion
By carrying out this pilot, we have demonstrated that it is
feasible to employ body worn cameras in an inpatient mental
health setting. Their use is acceptable to both patients and staff.
Costs could be offset by the reduction in complaints, incidents
and restraints but further research is required to support this.
Acknowledgements
We would like to thank Reveal trading as Calla (www.calla.
co) for providing the cameras and the training. We would also
like to thank the staff and patients at Berrywood Hospital who
took part in this pilot.
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ADDRESS FOR CORRESPONDENCE:
Benne L, PMVA Manager, Northamptonshire Healthcare NHS
Foundaon Trust, Berrywood Hospital, Northampton, UK; E-mail:
Lindsay.Benne@nh.nhs.uk
Submitted 05 April, 2017
Accepted 15 April, 2017