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Can electronic monitoring (GPS ‘tracking’) enhance risk management in psychiatry?

  • John Tully, Dave Hearn and Thomas Fahy
Summary

Electronic monitoring has been used in criminal justice and some health settings for three decades. Technological interventions are becoming more common in psychiatry, but may be a cause for ethical concerns and controversy. We discuss electronic monitoring as an aid to security and public safety in a forensic setting.

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Copyright
Corresponding author
John Tully, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. Email: john.tully@slam.nhs.uk
Footnotes
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Declaration of interest

The authors are all employees of the forensic psychiatry service at South London and Maudsley Foundation Trust, where electronic monitoring has been introduced for monitoring of patients on leave. They confirm that they have not received fees or benefits from the developers of the electronic monitoring devices.

Footnotes
References
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1 France, A. Escaped lag killed OAP for drug cash. In The Sun 2009; 16 Jun (http://www.thesun.co.uk/sol/homepage/news/2482862/Escaped-lag-Terrence-OKeefe-killed-OAP.html).
2 Samuels, Z. GPS tracking mental health patients – human rights concerns. Black Mental Health UK, 2010; 22 Jun (https://groups.yahoo.com/neo/groups/uksurvivors/conversations/topics/60843).
3 Geoghegan, R. Future of Corrections: Exploring the Use of Electronic Monitoring. Policy Exchange, 2012.
4 Bales, B, Mann, K, Blomberg, T, Gaes, G, Barrick, K, Dhungana, K, et al. A Quantitative and Qualitative Assessment of Electronic Monitoring. Florida State University, College of Criminology and Criminal Justice, Center for Criminology and Public Policy Research, 2010.
5 Travis, A, Hill, A. Half of all tagged offenders break curfew rules, says report. In The Guardian 2012; 14 Jun (http://www.theguardian.com/uk/2012/jun/14/half-tagged-offenders-break-curfew-rules).
6 Yeh, S. Cost-benefit analysis of reducing crime through electronic monitoring of parolees and probationers. In J Crim Just 2010; 38: 1090–96.
7 Barnes, PJ. Report on New Jersey's GPS Monitoring of Sex Offenders. New Jersey State Parole Board, 2007.
8 Miskelly, F. A novel system of electronic tagging in patients with dementia and wandering. Age Ageing 2004; 33: 304–6.
9 Sky News. GPS tags for dementia patient ‘barbaric’. Sky News 2013; 1 May (http://news.sky.com/story1085308).
10 O'Neill, D. Should patients with dementia who wander be electronically tagged? No. BMJ 2013; 346: f3606.
11 Lovett, I. Neighborhoods seek to banish sex offenders by building parks. In The New York Times 2013; 9 Mar (http://www.nytimes.com/2013/03/10/us/building-tiny-parks-to-drive-sex-offenders-away.html?pagewanted=all).
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Can electronic monitoring (GPS ‘tracking’) enhance risk management in psychiatry?

  • John Tully, Dave Hearn and Thomas Fahy
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eLetters

Electronic Monitoring of Forensic Patients

Alexander I F Simpson, Chief of Forensic Psychiatry
09 September 2014

Tully et al raise important questions about the introduction of electronic monitoring (EM) of forensic patients. Incidents of absconding by forensic patients can give rise to calls for increased security and surveillance. As the authors point out, adoption of EM of forensic patient as a panacea for these problems is short sighted. Tully et al cover many of the concerns about EM, but one area is missing. That is, evidence we have from criminal justice sector experience of EM is primarily of its effects of recidivism and AWOL reduction during the use of EM; evidence is very limited of the effects after the use of EM. In other words, EM must eventually cease: is the use EM during community re-integration actually preparing the patient for greater freedom and their rehabilitation or simply delaying reoffending? Criminal justice experience with EM focusses almost entirely on the effectiveness of EM during its use, such as on bail or as an alternative to incarceration usually combined with home detention . EM combined with home detention is superior to imprisonment in these studies, but we already know that non-custodial responses to crime in general have superior outcomes to incarceration (see for example Wermink et al ). What we know very little about is the outcome after the use of EM. Whilst GPS technology use may improve the person's performance in following rules, it is not clear that this sort of "rule following" encourages the person in the ultimate tasks of forensic rehabilitation. Does it improve the therapeutic alliance to help the person make the life changes necessary to recover from illness and illness related offending? Or does EM appear a physical manifestation of distrust and create distance between the patient and the treatment team? If the only way that a person can safely have community contact is to wear an ankle bracelet, is it questionable that they are ready for that level of community contact? EM may allow the person more apparent personal freedom than their clinical risk would otherwise allow. As Tully et al point out, adoption of the GPS technology may appear appealing, but its costs and effects are not clear nor its impact on therapeutic engagement and eventual community engagement. Short term reductions in AWOL may give the appearance of progress that the patient has not actually achieved. Long term outcome is equally as important as short term compliance. Alexander I F Simpson and Stephanie R Penney

References: 1. Tully J, Hearn D and Fahy T. Can electronic monitoring (GPS 'tracking') enhance risk management in psychiatry? British Journal of Psychiatry 2014: 205, 83-85.

2. Yeh S. Cost-benefit analysis of reducing crime through electronic monitoring of parolees and probationers. J Crim Just 2010; 38: 1090-96.

3. Wermink, H., Blokland, A., Nieuwbeerta, P., Nagin, D., & Tollenaar, N. (2010). Comparing the effects of community service and short-term imprisonment on recidivism: a matched samples approach. Journal of Experimental Criminology, 6(3), 325-349.
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Conflict of interest: None declared

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Can electronic monitoring (GPS 'tracking') enhance risk management in psychiatry?

Eleanor Watson, ST5 Forensic Psychiatry
09 September 2014

The authors justify the introduction of electronic tagging of medium secure patients without indication of the size of the problem of absconding or the incidence of serious harm other than to reference an article in The Sun newspaper which is neither informative nor free of bias.

Decisions around leave for patients detained within a medium secure unit are clearly complex. Consideration should always be given to the riskof absconding and associated risks if the patient were to abscond. Thus patients who are high risk of absconding and a serious risk to the public would not receive leave, whether they were tagged or not. Another factor considered is the clinical teams' trust of that patient to use leave appropriately. Tagging patients would be a very clear indicator of a lack of that trust.

The suggestion that patients enter into electronic tagging with consent is questionable, many patients in our experience abide by suggestions of their clinical team in order to progress through the system. Given there is yet to be a strong argument that tagging is necessary and primarily in the patient's best interest (as opposed to a matter of public protection) can one justify this coercion? We would be very interested to know the process in which patients' perspectives were taken into account and whether this has varied the intervention.

An electronic tag would inform the clinical team if the patient were to breach the conditions of their leave in terms of approximate location and time of leave, however, it would not inform the team as to what that patient was doing with their leave and would not necessarily prevent serious incidents occurring as referred to.

The use of a device that's main purpose has been pioneered by the criminal justice system appears to take us closer to making our hospitals prisons. A recent report by the Criminal Justice Joint Inspection (1) reiterates their 2008 findings that enforcement thresholds were not sufficiently stringent. With notable problems implementing this system within the criminal justice system is it justifiable to implement into Forensic Services given the cost of such a system? (2)

Given the recent concerns about certain international security companies, provision of such tags raises ethical issues. Confidentiality must also be considered, would said companies have access to patient namesand locations?

The comparison of electronic tags to other uses of technology within psychiatry, such as mood monitoring via text message, is bizarre.

The principles approach (3) gives us a framework in terms of judging whether an intervention respects autonomy, beneficence, non-maleficence and justice. Debate of these principles will exceed the remit of this letter; however it is worthwhile considering autonomy and beneficence in particular relating to the patient, we suggest that there is a breach in both. The weighing of these principles will not be easy and it will be a matter of debate whether the principle of justice will outbalance the former.

As the authors' state robust research in this area is needed, we lookforward to reviewing the evidence.

1 It's Complicated: The Management of Electronically Monitored Curfews. HM Inspectors of Probation. June 20122 Shaw D. Satellites used to track mentally-ill violent criminals. BBC News 2010; 25 August 2010 (http://www.bbc.co.uk/news/uk-11076823)3 Gillon R. Philosophical medical ethics. Chichester: John Wiley & Sons Inc., 1985.

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Conflict of interest: None declared

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