1.3.2 ‘Digitising mental health law
Some governments have sought to digitise processes of involuntary psychiatric intervention.65
CASE STUDY: Electronic Forms and Mobile Technology in Involuntary Psychiatric Interventions
In the UK in 2020, regulations were amended to speed up applications for compulsory psychiatric ntervention orders by providing an online communication platform between mental health professionals involved in involuntary interventions. This web-based interface allows social workers, nurses, psychologists and others who are interacting with a person in crisis to locate and communicate with medical practitioners via videocall who may assess the person and authorise involuntary intervention. One online platform to emerge with government support is reportedly used by over 70% of National Health Service Trusts at the time of writing.66 David Bradley, the Chief Executive of South London & Maudsley NHS, strongly endorses the practice, describing it as ‘[t]he Uber of finding doctors for the health service’.67 Relevant doctors can enter their availability on a personal calendar and ‘build a profile containing their location, specialities and languages spoken, and monitor their activity via a dashboard’.68
Proponents suggest the electronic forms and digital platforms will improve access to care, reduce errors, and improve information sharing, which ultimately reduces the distress of the individuals and prevents delays in the provision of healthcare.69 However, some mental health services users have raised concerns about the unknown impact of the digitised process on people subject to orders, which are potentially serious and warrant closer attention.70
In recent years, the processing of data about those subject to involuntary psychiatric intervention through electronic records systems has harmed people with lived experience in some cases. Concerns about police agencies sharing data concerning self-harm were raised in Canada, where municipal police collated non-criminal information about individuals who had self-injured or attempted suicide.71 The information was then circulated to US border authorities, who used the information to deny several Canadians entry into the US. (This example will be discussed at page 52). The ease with which people’s sensitive data concerning involuntary treatment can be accessed by various government departments, has raised concerns about the potentially unlawful uses of that data.
CASE STUDY: ‘Serenity Integrated Monitoring’ – Sharing Sensitive Information and Flagging ‘High Intensity Users’ of Mental Health Services
CASE STUDY: ‘Serenity Integrated Monitoring’ – Sharing Sensitive Information and Flagging ‘High Intensity Users’ of Mental Health Services
The program involved police officers, described as ‘High Intensity Officers’, regularly contacting the person to dissuade them from ‘unnecessary’ interactions with emergency health services, and to instead arrange more ‘appropriate’ support.73 Major concerns with the program were reported in May 2021
[w]hen tagged under the system, patients can be denied care, prevented from seeing doctors or psychiatrists, and sent home. An NHS doctor told [journalists] that he had to turn away a woman who had attempted suicide on multiple occasions because she had been assigned to the SIM scheme. He considered resigning as a result.74
The Royal College of Psychiatrists reported that where a person ‘remained unwell and continued to self-harm, attempt suicide or report suicidality, in some cases they were prosecuted and imprisoned or community protection notices were applied which required them to stop self-harming or calling for help, with imprisonment as a potential sanction if they breached the notice’.75
StopSIM Coalition, a ‘grassroots network of service users and allies’, raised concerns that the program ‘allows “sensitive data” (information like medical records, ethnicity, religion, sexuality, gender reassignment and financial information) to be shared between services without the subject’s consent … (for example, as a consequence of calling [emergency services] when feeling suicidal)’.76
The SIM program is being reviewed by the National Health Service at the time of writing, although it reportedly remains in place in 23 National Health Service mental health trusts in England77 and is being trialled in three US states.78
The SIM program will be discussed later in the report in sections on accountability and privatisation (page 58). SIM also appeared to have disproportionate impacts along lines of race and class (discussed at page 69)
- 65 In the UK, for example, a largescale government review of mental health legislation recommended the ‘digitising of the Mental Health Act’ HM Government, Modernising the Mental Health Act: Increasing Choice, Reducing Compulsion Final Report of the Independent Review of the Mental Health Act 1983 (Crown, December 2018) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/778897/Modernising_the_Mental_Health_Act_-_increasing_choice__reducing_compulsion.pdf.
- 66 This platform emerged from a public private partnership, with funding from the NHS Innovation Accelerator (NIA), NHS England’s Innovation and Technology Payment Evidence Generation Fund, NHS England’s Clinical Entrepreneur programme and DigitalHealth.London’s Accelerator. S12 Solutions Website, www.s12solutions.com [accessed 3/3/2021])
- 67 S12 Solutions, ‘What is S12 Solutions?’ Twitter (21 Jan 2020) https://twitter.com/S12Solutions/status/1219262300667961349 [accessed 19/05/2021]
- 68 Doctors may also use the app to register assessments that were undertaken, provide supporting evidence for professional development, and complete payment claims for their assessment. The app also generates data about the Act assessment process.
- 69 Thalamos, ‘Mental Health Act Forms: The Benefits of Going Digital’, Thalamos.co.uk (10 November 2020) https://www.thalamos.co.uk/2020/11/10/mental-health-act-forms-the-benefits-of-going-digital/. Small pilot evaluations appear to support this view. S12 Solutions (2017d). Pilot Evaluation. NHS Innovations Accelerator. Available from: https://nhsaccelerator.com/wp-content/uploads/2019/05/S12-Solutions-pilot-evaluation1.pdf (accessed 13/07/2021).
- 70 M. Stevens, et al. The availability of section 12 doctors for Mental Health Act assessments - a scoping review of the literature. NIHR Policy Research Unit in Health and Social Care Workforce, The Policy Institute, King’s College London, p.16; Mental Elf, Digitising the Mental Health Act: A Public Debate #DigitalMHA (26 June 2020) https://www.youtube.com/watch?v=Yuzkctpv1dA.
- 71 Office of the Privacy Commissioner of Canada, ‘Disclosure of Information about Complainant’s Attempted Suicide to US Customs and Border Protection Not Authorized under the Privacy Act’ (21 September 2017) https://www.priv.gc.ca/en/opc-actions-and-decisions/investigations/investigations-into-federal-institutions/2016-17/pa_20170419_rcmp/.
- 72 The individuals were chosen based on local health authority ‘Mental Health Act data for the previous year to define which borough/ geographical area had the highest proportion of high intensity users of [Section] 136’. Aileen Jackson and Josh Brewster, THE IMPLEMENTATION OF SIM LONDON: Sharing Best Practice for Spread and Adoption (June 2018) 6 https://healthinnovationnetwork.com/wp-content/uploads/2018/11/The-Implementation-of-SIM-London-Report.pdf.>
- 73 Royal College of Psychiatrists (UK), ‘RCPsych Calls for Urgent and Transparent Investigation into NHS Innovation Accelerator and AHSN Following HIN Suspension’, www.rcpsych.ac.uk (14 June 2021) https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2021/06/14/rcpsych-calls-for-urgent-and-transparent-investigation-into-nhs-innovation-accelerator-and-ahsn-following-hin-suspension(accessed 9/9/21). Those flagged in annual Mental Health Act data tend to be very unwell and regularly phone emergency services or arrive at hospitals having self-harmed, attempted suicide, or threatened to take their own life.
- 74 Patrick Strudwick, ‘Campaigners Call for Inquiry after Mental Health Patients Turned Away by NHS under Controversial Scheme’, i (online, 16 June 2021) https://inews.co.uk/news/nhs-mental-health-stop-sim-inquiry-1056296
- 75 Royal College of Psychiatrists (UK) (n 75).
- 76 StopSIM Coalition, ‘STOPSIM’, STOPSIM (n.d.) https://stopsim.co.uk/
- 77 NHS Trusts refer to an organisational unit of the NHS that generally serves either a geographical area or a specialised function.>
- 78 Maryam Jameela, ‘Outrage Grows as Police Embed Themselves in Mental Health Services’, The Canary (online, 22 May 2021) https://www.thecanary.co/investigations/2021/05/22/outrage-grows-as-police-embed-themselves-in-mental-health-services/