Video-Algorithmic Patient Monitoring in Mental Health Inpatient Settings: Qualitative Study of Patient or Consumer, Clinician, and Vendor Perspectives

Clinical Snapshot

Key Findings

• P Value: Not applicable — qualitative study

• Effect Size: Not applicable — qualitative study; no quantitative effect sizes reported

• Primary Outcome: Seven themes identified: (1) contestation over the rationale for VAPM in mental health settings; (2) VAPM reshaping care and therapeutic relationships; (3) perceived harms of VAPM; (4) perceived observational support for safety and reduced disruption; (5) serious privacy implications of VAPM; (6) the need for appropriate governance; and (7) the potential for VAPM to transform, not merely augment, service delivery

• Nnt Or Sensitivity: Not applicable — qualitative study; no diagnostic or therapeutic metrics reported. Stakeholder groups diverged markedly: patients/consumers prioritised privacy, dignity, and coercion concerns; nurses were cautiously interested in safety and suicide prevention benefits; managers and vendors emphasised safety gains. The study concludes that purported benefits remain largely untested and unquantified while risks are subjectively experienced as real and immediate.

• Confidence Interval: Not applicable — qualitative study

Clinical Application

VAPM is technically feasible and increasingly trialled in acute care settings, but this study highlights that clinical and ethical feasibility — particularly regarding patient consent, therapeutic alliance, and governance frameworks — remains unresolved. Implementation without robust stakeholder engagement, particularly with consumers with lived experience, is likely to generate significant resistance and potential harm to therapeutic relationships. This study is directly conducted in the Australian context and is highly relevant to Australian mental health policy. The findings are pertinent to: (1) the Australian Commission on Safety and Quality in Health Care (ACSQHC) standards for mental health inpatient care; (2) the National Mental Health Strategy and consumer participation frameworks; (3) TGA regulatory oversight of software-as-a-medical-device (SaMD) classifications that may apply to VAPM systems; (4) RACGP and RANZCP guidance on therapeutic relationships and patient dignity; (5) state-based mental health legislation governing involuntary patients and surveillance in inpatient settings; and (6) the National Disability Insurance Scheme (NDIS) and broader disability rights frameworks that intersect with mental health consumer rights. The study's emphasis on meaningful consumer participation aligns with the National Standards for Mental Health Services (Standard 2: Safety) and the Lived Experience workforce agenda. Australian clinicians and hospital administrators should note that no PBS-listed or TGA-approved VAPM system for mental health inpatient use currently exists, and the evidence base for safety outcomes remains absent. Mental health inpatient units considering or implementing VAPM; acute psychiatric settings; hospital administrators and clinical governance bodies; mental health consumers and their advocates

Abstract

BACKGROUND: Video-algorithmic patient monitoring (VAPM) combines remote, noncontact sensors and algorithmic analysis and is increasingly trialed in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises ethical concerns regarding safety, privacy and surveillance. Little is known about how those encountering VAPM in mental health care contexts anticipate its use and potential impacts, including where it has not yet been implemented. OBJECTIVE: This study aimed to explore the views of patients or mental health consumers, specialized mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and anticipated implications of VAPM in mental health inpatient care. METHODS: This qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, and the workshop discussion was audio-recorded, transcribed, and thematically analyzed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. RESULTS: In total, 16 stakeholders participated, exploring themes concerning (1) contestation over the rationale for VAPM in mental health settings, (2) VAPM reshaping care and relationships, (3) perceived harms of VAPM, (4) perceived observational support for safety and reduced disruption, (5) serious privacy implications of VAPM, (6) the need for appropriate governance, and (7) the potential for VAPM to transform, not augment, service delivery. General views differed across groups. Patients or service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasized safety gains. CONCLUSIONS: 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.

References

1. 1.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. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/42475737