A 2024 study found that the use of surveillance-based technology in inpatient and acute mental health settings is rising despite little evidence that these systems improve quality of care. A new study published in JMIR Human Factors finds that psychiatric patients and nurses have serious concerns that video-algorithmic patient monitoring (VAPM) compromises privacy and dignity, harms patients, undermines trust between patients and staff, and feels coercive, especially in inpatient settings where patients are often unable to refuse monitoring. This research, led by Piers Gooding from LaTrobe University in Australia, additionally reports that participants feared surveillance could replace face-to-face observation and therapeutic engagement, resulting in a loss of meaningful human interaction and damage to the therapeutic relationship. The authors write:
“Most consumer participants were of the view that VAPM should be rejected, following its characterization as a form of intrusive surveillance that dehumanized patients and those who were supposed to care for them. Some participants, particularly nurses, saw potential use in specific circumstances and only if there was compelling empirical evidence to support its use, and ideally with patient consent. Most consumer and nursing participants articulated the view that the technology risked undermining nursing practice by replacing nursing functions and limiting the ability of nurses to develop therapeutic relationships.”
Harms Linked to Surveillance
Recent research has found that surveillance of students exacerbates anxiety and other mental health symptoms while diverting money away from funding effective mental health treatment. Surveillance of students has also been linked to reduced healthy personal sharing. These harms likely disproportionately affect minority students.
A 2024 study reported that surveillance in inpatient mental health settings could make distress and paranoia worse in patients with first-episode psychosis and trauma. According to that study, patients experiencing psychosis often incorporated visible cameras into their delusions. Past research has reported that CCTV surveillance is linked to self-censorship, loss of autonomy, institutional distrust, and reduced psychological well-being.
Another 2024 study found that people monitored with closed circuit television demonstrated hyper-vigilance, a nervous system on continuous high alert commonly seen in people diagnosed with PTSD. This state of hyper- vigilance can negatively affect sleep, emotional regulation, memory, and cognitive functioning. While the evidence for harm and reduced psychological well-being related to surveillance is well established, one systematic review found insufficient evidence that these systems improved safety, reduced self-harm or violence, improved care quality, or reduced costs in psychiatric inpatient settings.
Study Details
The goal of this study was to explore patient, provider, and other stakeholder views about the use of cameras, sensors, and algorithmic analysis to remotely monitor people in inpatient mental health settings. The authors used their own professional networks to identify Australian stakeholders for participation in a three hour online workshop around the current evidence for VAPM. The participants then broke into smaller groups to discuss VAPM use in Australian psychiatric inpatient settings. These discussions were transcribed and analyzed for recurring themes. In total, the authors used data from 16 participants including three patients, seven nurses, two mental health service managers, two VAPM technology vendors, one legal academic, and one public-health academic.
The authors identified seven themes in the discussion transcripts. (1) “Contestation over the rationale for VAPM in mental health settings” revealed differing opinions about the usefulness of VAPM in inpatient mental health settings. While one mental health system manager argued that inpatient psychiatric wards should use the same monitoring capabilities present in intensive care settings, patients and nurses were more suspicious of VAPM for mental health settings arguing that mental health care depends heavily on conversation, relationships, and understanding subjective experiences which an algorithm simply cannot do. One patient said “there’s no electronic monitoring that will tell you that my hope was just crushed […] The only way you can know that we’re thinking and feeling that is to talk with us and listen to us.”
Under the theme (2) “VAPM could reshape care and relationships,” participants worried that these surveillance technologies could replace observation and therapeutic interaction. One patient described this technology as “grotesque” and moving in “the complete opposite direction that we should be heading for good care.” A nurse participant described similar concerns, saying that VAPM could be “dehumanising for the person you’re serving, but also the workforce.” Some nurse participants did see one potential benefit for this technology in avoiding having to wake patients up for nighttime observations.
(3) “Perceived harms of VAPM” included increased distress and anxiety, exacerbation of paranoia, retraumatization, loss of privacy and dignity, reduced trust, feelings of coercion, avoidance of services, and staff becoming overly reliant on the technology. Patient and nurse participants were particularly concerned with potential harms that could result from the use of VAPM. One patient said:
“I’d be trying to hit it with the chair, put water on it to anything I could to damage it because I’d be I’d feel really unsafe from it. The more distressed I was, the more I’d feel like that.” The same participant also reported that “if there’s monitoring in the bedroom, then I’d self-injure on the toilet.” Another patient said “if I went into a ward that had these in every single bedroom, I’d probably flip [my] lid.”
Two participants also feared that VAPM could be especially traumatic for domestic abuse victims where surveillance had been used by their abusers. Some participants also worried that this technology may provide a false sense of security for mental health workers that could reduce active engagement by making the staff believe that the system would detect problems.
(4) “VAPM as observational support for safety and reduced disruption” included positive perceptions of this technology. Technology vendors, mental healthcare service managers and some nurse participants believed this kind of surveillance could identify deterioration, detect suicide attempts, prevent sexual assaults, identify falls and medical emergencies, and reduce intrusive nighttime observations. One manager reported that “some of our patients unfortunately pass away in the middle of the night,” and believed VAPM could help prevent such occurrences. However, a 2026 article published in BMC Psychiatry reported that the VAPM Oxevision (rebranded as LIO) failed to identify deterioration of a patient’s condition. This patient died in their bed in the middle of the night, a tragedy this system was unable to prevent.
(5) “VAPM has serious privacy implications” dealt with both concerns around monitoring and how the collected data would be stored, accessed, and used in the future. Patients feared that continuous monitoring would intrude on spaces where a person would normally expect privacy, including while sleeping, changing, and using the restroom. Participants were also worried about who would have access to the data produced by VAPM systems, how long it would be stored, whether it would become part of their permanent medical record, if it could be subpoenaed by a court, and if it could affect future treatment. One patient said “We hear lots of examples from consumers of incidences from 10, 15 years ago being brought up now … that affects their treatment now.” Many participants expressed concern that the behavioral and physiological data colelcted by VAPM could result in unforseen long-term consequences.
(6) “VAPM requires appropriate governance” dealt with participants’ beliefs that any implementation of VAPM should be accompanied by strong safeguards and regulations. This would include patient consent, clear rules about when and where monitoring occurs, limits on data collection and retention, transparency about who can access this data, patient participation in decisions about implementation, protections against misuse, and independent evaluations and human-rights assessments to ensure this technology is not abused or abusive. This theme also revealed issues around patient consent in inpatient settings. Even if patients technically have an option to refuse monitoring, participants wondered if that refusal would be honored considering the often coercive nature of psychiatric treatment.
(7) “VAPM could transform, not simply augment, service delivery” included participants’ concerns that this technology would change the organization of mental healthcare. One patient described VAPM as a “slippery slope” where eventually “we stop having any interaction, any sort of relational space between clinical staff and the consumers.” Participants also feared that psychiatric institutions would use VAPM to reduce, rather than augment, staff. A public health academic participant called VAPM “an excuse to reduce staff numbers.” A nurse participant echoed this concern, saying VAPM was “an excuse to reduce the nursing resource and also that human interaction between nurses and consumers.” The authors conclude:
“The findings suggest that the anticipated risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult—the risks are set out in the anticipated experiences of those with lived experience, and the benefits remain hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as nonnegotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted.”
This research had five main limitations. The sample of participants was small and potentially not representative of stakeholders as a whole. All participants were recruited from Australia, limiting generalizability to other populations. Participants were mostly discussing anticipated harms and benefits as most did not have real-world experience with VAPM. The design of the study was exploratory, meaning the findings likely do not reflect all stakeholder views, but rather can be used to identify important concerns. The data was collected in 2021. VAPM technology and the policy around it may have changed since this data was collected.
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Gooding, P., Kennedy, H., D’Alfonso, S., Kariotis, T., Daniel, C., & Hamilton, B. (2026). Video-algorithmic patient monitoring in mental health inpatient settings: Qualitative study of patient or consumer, clinician, and vendor perspectives. JMIR Human Factors, 13. (Link)
