Inspired by my recent joint post with @chaosandcontrol, the lovely @wenurses are holding a Twitter chat on Thursday 17 January 2013 on the topic of social media in mental health inpatient settings. I thought it would be useful to post some information about the statutory position on access to social media, by way of some background information. Big thanks to @barlowjeffm for his invaluable help with putting this together.
So what guidance is already out there that mental health NHS Trusts need to consider when developing a policy on the use of social media in inpatient settings? Here is what we have found. It is worth noting that most of the information out there does not specifically address social media, and tends to refer to phone calls, texting and taking photos. However, many of the same principles apply.
NHS constitution
The NHS constitution says ‘in England, you should be allowed to use your mobile phone in an NHS hospital. This includes using your phone on a ward, as long as it’s not a risk to your safety or that of other patients and doesn’t affect the operation of electronically sensitive medical equipment.
‘All NHS trusts should have a written policy on the use of mobile phones which you can ask your hospital to see. There should be signs up in all hospital areas which say clearly whether you can use a mobile phone there or not’
Department of Health
The Department of Health guidance on Using mobile phones in NHS hospitals was published in 2009. It states that ‘patients will be allowed the widest possible use of mobile phones in hospitals, including on wards, where the local risk assessment indicates that such use would not represent a threat to: patients’ own safety or that of others; the operation of electrically sensitive medical devices in critical care situations, the levels of privacy and dignity that must be the hallmark of all NHS care’
NHS Choices
NHS Choices has guidance about use of mobile phones in hospital settings. It refers to making calls, sending texts and taking pictures. It does not make any reference to the internet or social media.
Mental Health Act Code of Practice
The Mental Health Act Code of Practice makes specific reference to email and internet access as well as phones. It states that ‘many mobile phones have cameras and give access to the internet. This creates potential for the violation of the privacy and dignity of other patients, staff and visitors to the ward, and may constitute a security risk. It would therefore be appropriate to stipulate the circumstances in which photographs and videos can be taken, for example only with specific permission from hospital staff’.
With regard to mobile phone charging, it states ‘the normal rules governing the use of the hospital’s power supply to charge mobile phones or other such electrical devices may need to be varied for detained patients (given the restrictions with which such patients are faced’.
It also makes specific reference to internet access: ‘managers should also have guidance on patients’ access to e-mail and internet facilities by means of the hospital’s IT infrastructure. This guidance should cover the availability of such facilities and rules prohibiting access to illegal or what would otherwise be considered inappropriate material’.
Deprivation of liberty
The Mental Capacity Act (2005) Deprivation of Liberty Code of Practice states that denying social contacts constitutes restraint and therefore is a significant factor as to whether the care and treatment amounts to a deprivation of liberty.
Care Quality Commission
Key points from the CQC Symposium on Restrictive Practices (30 October 2012) are relevant to a discussion about access to social media access on inpatient wards. Inspections raised thematic concerns about the use of blanket rules and restrictions as well as exercising petty and arbitrary controls, for example over privacy and contact with friends.
This is what we have found. If we’ve missed anything or got anything wrong, please let me know. And remember this is the just basics. Any NHS Trust will need to properly involve people with experience of using inpatient services, carers and staff in developing a good policy. And they will need to develop working practices which support it, such as building it in to ward orientation processes and crisis plans.
Hi Victoria. Your background research is a really great starting point for discussion on better understanding social media and patients’ needs in hospital and mental health settings. What your blog has prompted me to think is this: why do we need a policy?
HI Victoria, really great blog. My observation from this and the discussion on @wenurses is that it’s easy to think that attitudes are specific to say mental health issues, the NHS or medical professionals. But the comments are really reflecting what we see all over the place.
I know a major supermarket that blocks internet access for all employees except a few working in head office. It is so bizarre that people can’t use the internet for what most people see as basic research for their job and is really inefficient. Because bosses don’t understand social media – and clearly don’t trust their employees – they shut it down.
There are more problems in social media caused by fear in bosses than anything else. Leaders have got to get proficient in social media so they can start managing it in their organisations – whether public or private sector. And they have to set simple and clear guidelines to help their teams – and then trust everyone. Staff and inpatients.
Or is this making it all too simple?!
Hi Victoria. You raise an important point about the extent to which concerns about use of social media are affecting people in the work place as well as in hospital. The common theme for a blanket ban approach appears to relate to lack of trust by people with responsibilty for organisations and hospitals respectively. It can apply to employees as well as patients.
I supposed there are a number of added complexities in the context of a mental health inpatient setting. Firsly, as you will see if you click on the link in my most recent post, the CQC have identified a trend in units for institutionalised attitudes and behaviours on wards in general which has a tendency to mitigate against the rights and choices of patients. The second issue raised in the chat is one about both ‘capacity’ and the choices people might make when they are very vulnerable and unwell, and the choices they may make when they are well. This is why considering social media use in Advance Decisions and/or crisis plans is so critical – so people can plan for when they become ill and staff can help them implement the decisions they made then when they may lack capacity to do so. The issue of privacy of course applies across organisational and inpatient settings. However, it is worth noting that often when people are on an inpatient ward they are at their most vulnerable, and so privacy and dignity is especially important. There is also the social stigma of using mental health services – friends and family might react different to a picture of someone in their workplace than to a picture of someone in an inpatient ward.
Hi
A really useful article – but i can’t find the detail in the NHS constituion or DH policy on mobile phones.
Can you help?
Hi there. Thank you for your feedback on the article. You can find the DH policy here: http://webarchive.nationalarchives.gov.uk/20130107105354/http:/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_092812.pdf 🙂