There’s been some debate sparked off by the Chaos and Control blog, which suddenly went private in the same week that it won Best PTSD/Extreme Stress Blog in the TWIM Awards. The author, Littlefeet, has since gone public again to announce the closure of her blog, and the reasons why.
I won’t bore you with the long story but the short story is that I was readmitted to hospital on 28 December and discharged today (3 January). On 29 December, I was notified by staff that my blog had come to their attention. Staff read through the archives and my phone was confiscated for 24 hours. I made a verbal agreement with staff that I would not blog while I was in hospital. Given that I wasn’t blogging about other patients and when specific staff were mentioned, they were anonymised, I felt this approach a bit heavy-handed. However, their argument was that patients who were more unwell than me could blog anything, regardless of the truth.
All of which begs the question: is it okay for patients on mental health wards to write blogs? And is it okay for the wards to stop them?
My gut feeling is that Littlefeet may have fallen foul of the institutional nervousness about social media that’s currently doing the rounds. It’s not something that’s restricted to mental health services – in fact it would be safe to say that it’s not restricted to the NHS. It’s also not only about blogging – quite a few mental health wards have banned camera phones, for example.
A lot of this nervousness has good reasons. There’s been cases where staff have been hauled up on disciplinaries due to social media – because they’ve breached confidentiality, because they’ve said something defamatory about a colleague, or crossed a client-professional boundary.
That said, social media comes with benefits as well as risks. First of all, there’s the sense of personal reward and development gained from expressing one’s views and ideas. There’s also a public gain from the sharing of information, ideas and viewpoints. As I’ve said before on this blog, I think we’re moving into an era where journalism is becoming an act of citizenship rather than something people do for a living.
I have to confess to a degree of personal bias here. I’m a fan of the Chaos and Control blog, and I voted for it in the TWIM Awards. I’ve also met Littlefeet a couple of times (in a social, not professional capacity. She’s not my patient.) She’s a very pleasant, highly intelligent woman. I also don’t think I’m betraying any confidences here by confirming that she does indeed have little feet.
Even so, I’m finding it hard to come to any conclusion other than the ward have handled the issue poorly. If she had been blogging about other patients, or making defamatory remarks about the staff, then it might have been more understandable. But she didn’t.
As for the ward’s justification, “that patients who were more unwell than me could blog anything, regardless of the truth,” I’m struggling to make any sense of that. It’s also not being patient-centred or focusing on individual needs and strengths. It reeks of managers who got anxious about the blog and then started reaching for justifications.
From browsing the comments about this decision (see not only Chaos and Control but also Claire OT’s blog) there seems to be a fairly wide consensus that it’s been poorly thought-out and badly handled. As some commenters have pointed out, it may be on dodgy ethical and/or legal turf.
How could the ward have handled it better? They could have sat down with Littlefeet and had a polite conversation, along the lines of, “We’ve noticed your blog, can we have a chat about it?” It wouldn’t be remiss to make sure she’s aware not to post anything libellous or that breaches anyone’s confidentiality and to check that she has the mental capacity to understand that request. But it would also be a good idea to discuss that positives that she was getting from the blog.
I hope that Littlefeet starts blogging again at some point. I’ve certainly enjoyed her distinctive and entertaining writing style, and would like to express my appreciation for providing the internet with an excellent and insightful first-person account of mental ill-health.
Unsafe Spaces 
I have to say I admire your moderation, Zarathustra! Not being a mental health professional – unless you count two years back in the 80’s – I watch from the outside as people talk in fairly high flown terms about treating people with regards for their rights as individuals. Yet it appears that admission to hospital means you are forbidden to blog? Where do they get the right to do that? If she were making threats against people or someting of the kind, then maybe, but otherwise I cannot see any legal or moral justification. I am beginning to see why MH service users get so eggy. The excuse given by the managers is truly pathetic – what does the potential behaviour of other patients have to do with her rights?
Staff are another issue altogether. Although I dont like it I can understand managers getting mervous about staff blogging. But forbidding patient sto communicate by a means that is commonplace for the rest of the population when they are not causing any harm, well I ‘m stunned.
If the hospital staff felt that Little Feet’s blogging was bad for her, as in somehow undermining her treatment (though I find it difficult to comprehend that), then their action makes sense; but if they felt it was bad for them then I’d say they were well out of order. Whatever the case, far better if they’d had that polite conversation with her rather than come in like the thought police, confiscating her phone…
And if they’d felt it was bad for her, they’d also have had to demonstrate that she doesn’t have the mental capacity to understand the consequences of this harm – the Mental Capacity Act is very clear that people have the right to make decisions other people might consider unwise.
Thanks to the Twitter debate going on at #nhssm I’ve come across a Care Quality Commission report that I think has some relevant points.
On page 65:
Except in particular secure hospitals, we do not believe that blanket bans on access to the internet can be justified. Although it may be sensible to stop certain individuals from accessing the internet, or certain internet sites that would normally be considered acceptable, this should be done on basis of individual risk assessments
(Emphasis added)
“Individual risk assessments” does not equal “their argument was that patients who were more unwell than me could blog anything, regardless of the truth.”
And that’s with regard to patients detained under the Mental Health Act. Littlefeet, if I remember correctly, was in hospital informally.
Oops, I forgot the link.
Click to access mhac_biennial_report_0709_final.pdf
I’m glad you saw that report – I was about to post on it. There’s also stuff in the MHAC/CQC reports about confiscating mobile phones. I think in a wider sense it raises important human rights issues under Article 10 (freedom of expression).
The right to freedom of expression is qualified with respect to:
‘national security, territorial integrity or public safety, for the prevention of disorder or crime, for the protection of health or morals, for the protection of the reputation or rights of others, for preventing the disclosure of information received in confidence, or for maintaining the authority and impartiality of the judiciary’
– it seems possible hospitals could try to rely on the health/morals and rights of others, but it would have to be *proportionate*. The proportionality test sets quite a high evidential threshold, and so the hospital would have to show good reasons, and to have exhausted other avenues (like having a chat about the confidentiality of other patients, for example). It seems unlikely that’s met here. The mobile phone confiscation might also raise human rights issues about private life and privacy of correspondence (Article 8) and also the right to enjoyment of one’s property.
All in all, it might be useful to remind that ward that they are a ‘public authority’ who is bound to respect the human rights of patients under the HRA…
Fantastically eloquent and diplomatic post.
A friend of mine was on a mental health ward here in Bedford and they tweeted during their stay in hospital and I’m pretty sure tweeted about their patient care (or the lack of it that came to light) and their stay.
I think their family then took those tweets to a friend of ours who is a GP at a local surgery to see if it was normal for them to have been treated that way.
Something they said implied that the hospital hadn’t taken into consideration other medical conditions that may be present.
Ah, that ward in Bedford. The one where the dealers used to wait in the car park for you. And the psycho-geriatrics upstairs to remind one of one’s future.
I met a lovely shrink from there. I asked him about my future. He looked a bit shifty. I pressed him… He reluctantly told me.
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I had to smuggle my mobile into my room when I was in (I wasn’t blogging at the time, but internet forums were my lifeline, as well as talking to my family – the only people who bothered to talk to me beyond purely practical matters, btw)
The hcp turned a blind eye, but it was made very clear that it was against the rules. They said it was to make me take part in the ward activities. I asked what these were. A TV (Jeremy Kyle), a pool table, or an art room consisting of crayons and coluring books – everything else needed supervision that they were too busy for.