‘Just because you can doesn’t mean you should’: a systematic scoping review of the ethical, legal, and policy context for the use of wearable technologies in mental health services

Abstract Background The integration of monitoring and surveillance technologies including CCTV, biometric sensors and smart wearable technologies to support mental health care is developing at rapid speed and attracting significant investment internationally. Keeping pace with new technology developments and their implementation within health settings presents significant opportunities but also creates ethical challenges that necessitate robust safeguards to protect individuals’ rights. The Mental Health Commission in Ireland commissioned a scoping review to help inform the development of a new code of practice for the use of wearable surveillance and monitoring technology in mental health services. Methods We searched ten databases for peer-reviewed and grey literature published between January 2018 and January 2025 on the use of surveillance and monitoring technology in mental health settings. Results Of the 2,262 retrieved articles, 147 articles reported on wearable device technology or addressed some of the key ethical, legal and policy considerations for its design, development and implementation. Conclusions This review of the literature highlights some of the benefits of using technology but underlines that the evidence base remains limited. Exploring perspectives from service users, carers/family members and professionals, it is clear that there is a fine balance between providing safety, and protecting privacy and autonomy. There are complex ethical and legal issues to be considered and it is important to apply a rights-based, trauma-informed, person-centred approach to the use of wearable technologies for monitoring and one which should be based on the most relevant, highest quality evidence available. The recommended approach seeks to inform decision-making that protects individuals’ rights, improves care and addresses the needs and concerns relating to the increasing use of surveillance technologies from the perspectives of service users, families/carers and professionals/service providers. This paper aims to inform stakeholders to help navigate the ethical tensions and recognise rights-based values associated with digital mental health technologies. This also extends to staff and the negative impact technology may have on organisational culture and morale. Devices that are co-designed, affordable, comfortable, non-stigmatising and easy to use, may help protect safety, autonomy, promote early intervention and, when applied within the appropriate legal and ethical frameworks, create the potential to transform care but greater research evidence is required.