By Robert van der Watt and Kevin Groves.

The design of closed circuit television (CCTV) systems within the health care sector can present numerous and diverse challenges to the security consultant or advisor. The various health facility categories such as hospitals, elderly care facilities, medical clinics and mental health units, present unique security risk contexts that require a tailored approach not only in terms of design but also stakeholder management.

If careful and timely consideration of critical design processes and parameters takes place, CCTV can not only provide seamless integration, but also support the health facility’s day-to-day operations. This article will touch on some fundamental design processes and parameters such as a security risk assessment, stakeholder engagement, camera and housing selection, monitoring and recording arrangements and relevant standards.

Security Risk Assessment And Stakeholder Engagement

Unlike many buildings which serve only a single function, health facilities typically have many functions relating to the provision of care, medicine, advice, counselling, interviewing, monitoring and treatment to persons of all ages, ailments and conditions. Each department such as emergency, ambulatory care, renal analysis and birthing suites operates and functions differently.

Undertaking a security risk assessment (SRA) with key stakeholders such as medical staff, facilities management and security staff early in the CCTV design process enables the security consultant to fully understand the site-specific risk context of the health facility and internal departments based on organisational structure. While an outsider may have a ‘best guess’ at security challenges faced by a particular site that can be partially addressed using CCTV, the SRA process will identify unique security
risks applicable to the facility, department, ward or wing.

Some of these unique internal security risks that CCTV may help mitigate include monitoring patients decamping, wandering or entering staff only areas; assault (patient on patient, patient on staff and patient on visitor); unauthorised access into sensitive areas such as drug stores; external threats such as intruders and vandals; increasing perception of safety and responding proactively to duress events and post incident review.

An in-depth understanding of the internal and external operational context and risks associated with health facilities enables the comprehensive design and implementation of a CCTV system that maximises risk mitigation. Communication and consultation with operational staff and with managers is important when attempting to gain a broad understanding of the nature of risks; staff on the ground typically provide information in relation to day-to-day issues and managers will provide the big picture context.

Conducting a risk assessment early during concept design may not identify all risks as the design scope is not yet fully defined. The security consultant may, therefore, benefit from facilitating a second security risk assessment during detailed design where there is a more clear understanding by the client and consultant of the functional relationships between wards, areas and departments. Stakeholder consultation is an excellent catalyst for understanding and agreeing on how the health facility will actually operate and how CCTV will meet their daily operational needs.

Stakeholder Consultation

In addition to the SRA, stakeholder consultation plays a significant part in the security design process to obtain an understanding of the functions of each department, area and room from the end users’ point of view. The end users will have limited knowledge in the technical aspects of CCTV and how it can be implemented. Users that work in different departments and roles can have different opinions regarding the CCTV design ‘best fit’ for their department. It can be difficult to manage the expectations of each stakeholder and end user, and get them to agree on the type, location and purpose of CCTV cameras. The security professional needs to be mindful of budget blowouts in reaching an outcome that satisfies stakeholders’ and end users’ requirements.

Due to the unique nature of the mental health ward and level of care required for patients, specifying camera housings can be challenging without understanding the function of each room. This level of detail needs to be highlighted in the stakeholder consultation meetings – stakeholders can provide details regarding the severity of the patients’ mental state within each area of the mental health ward which can influence the type of camera housings. For example, standard camera housings may be broken and used by patients as a weapon to cause harm to others or themselves.

Balancing Privacy And Surveillance

A significant challenge faced in the design of a CCTV system in the health sector is maintaining an acceptable level of privacy for patients, staff and visitors. Patients within health institutions understandably require a high level of privacy and CCTV poses a significant threat to a person’s perception of privacy. Seclusion rooms within health institutions are locations where cameras and CCTV signage are likely to be present. These rooms are typically used for a patient who may be in an unstable condition requiring constant staff supervision and isolation from other patients. Nurses have a duty of care to monitor the patient to ensure they do not cause harm to themselves. In mental health wards particularly, the presence of CCTV can create a very uncomfortable environment, instead of the safe and relaxed environment in which a patient’s recovery should be encouraged.

A balance between privacy and surveillance can be achieved in several ways. If a CCTV camera is present in a seclusion room, stakeholders may perceive the installation of a covert camera, in accordance with (for example) the Western Australian Surveillance Devices Act 1998, to be the best option, as persons may be more accepting of being under surveillance if the camera is not overt which may make people feel self conscious. If overt cameras are used, they can be made less conspicuous by choosing models of cameras and housings that are small, flat and able to be recessed into walls and ceilings. Housings may also be modified and painted to match the interior design of the room to attract less attention to cameras.

A CCTV policy and/or code of conduct should be made known to users of the health facility as part of an overall security awareness strategy. This understanding by patients and users of the facility will help decrease their sense of privacy being threatened, increase levels of acceptance and create a higher perception of safety.

Housing, Mounting And Anti-ligature

In many health facilities, standard camera housings and mounting configurations are not acceptable and pose a high risk of patient aggravation and self harm. To overcome this challenge, the designer should be aware of BS EN 62262:2002, a classification system for the degrees of protection provided by enclosures for electrical equipment against external mechanical impacts, otherwise known as the impact resistant rating (IK rating), this system classifies the level of protection against a mechanical impact from the outside (for example, an IK rating of 10 translates to a 5 kg impact from a distance of 40 cm). Another consideration regarding camera housing is the reflections, which can cause patients to become unstable and potentially aggressive if they see a disfigured reflection of themselves. In this case, tinted domes should provide a minimum of external reflection.

In certain areas within hospitals and particularly in mental health wards, stakeholders will request exposed security hardware to be anti-ligature, that is, not serve as a hanging point. To comply with anti-ligature requirements, stakeholders will typically request all exposed hardware to be flush mounted, concealed or have a breaking strain of 15 kilograms to prevent patients from causing harm to themselves.

Specifying cameras and mounting structures can be challenging to meet this requirement given that cameras are typically dome or full body which present a number of ligature points. As much as practically possible, the security professional can specify cameras that are recessed into the wall; however this can compromise the field of view. 360-degree cameras may be considered as they are mounted on the ceiling and present no hanging points. Similarly, external cameras that are mounted in courtyards on poles, perimeter fences and external walls need to be mounted in such a way to reduce any protruding edges being a hanging point.

Recording And Monitoring

Recording video images at a health facility is not always required. Monitoring may be utilised for proactively launching responses to incidents, subsequently negating the need for post incident review. However, this approach to CCTV is heavily reliant on cameras acting as deterrence and also the operator’s focus, ability and efficiency in initiating a response.

in hospitals that have security personnel available to monitor and proactively initiate responses, preventing harmful events should be a key objective. Control rooms should facilitate the installation of several monitors to allow viewing of video images. However, depending on the size of the security control room, personnel available and budget constraints, this may not always be possible. In some cases, CCTV monitoring is undertaken at nurse stations in which case the client must include this as part of the nurse’s responsibilities.

Personnel may not be available to monitor video images and consequently CCTV can be used only for deterrence and post incident review as opposed to preventing potentially harmful events from occurring.

Recorded video images are useful for post incident review, where the effectiveness of procedures can be assessed in an attempt to improve them for the future. However, when only certain authorised personnel, such as psychologists, and not security personnel, are permitted access to view recorded video images, there may questions around the effectiveness of the surveillance.

Standards And Guidelines

There are several standards and guidelines available to help overcome some of the challenges faced in the design and implementation of CCTV systems. Security professionals designing CCTV systems need to be aware of these documents to ensure fundamental design principles are applied to all health institution projects.

Australian Standards do not provide many guidelines specific to the design of CCTV for health institutions. However, they provide a solid foundation for general design applicable to most projects. In addition to the well known Australian Standard AS4806:2008 CCTV Set, AS4485:1997 Security for health care facilities provides specific guidelines applicable to operations within health institutions.

Redundancy and Disaster Planning in Health’s Capital Works Program, updated in 2011 by the Disaster Preparedness & Management Unit of the Health Department of Western Australia categorises health institutions into six levels based on the number of acute inpatients per year, presence of critical infrastructure at risk to terrorism and range and complexity of clinical services offered. The level assigned to an institution corresponds to a level of CCTV required in the many departments for the purpose of disaster preparedness. The lower level institutions, specifically Level 1 to 3 have been deemed to not require CCTV for the purpose of disaster preparedness. Each Sate or Territory’s Health Department will have an equivalent document in place.

The Australasian Health Facility Guidelines (AusHFG) is an initiative of Australasian Health Infrastructure Alliance (AHIA) aimed at providing common guidelines for the design of health facilities. Part C of this document – Design for Access, Mobility, OHS and Security – provides more detailed advice for the design of CCTV systems than the other guidelines previously discussed. It discusses lighting for CCTV and general areas that should be covered by CCTV surveillance. This assists in providing direction for the designers and planners of health facilities.

This article has provided fundamental technical and strategic considerations when incorporating CCTV into health facilities. Video surveillance needs to be considered as part of a holistic security scope that involves other electronic security components working in conjunction with security management,
policies and procedures to achieve the optimum balance between patient comfort, security
and safety.


Robert van der Watt and Kevin Groves are security and risk consultants in the Perth office of AECOM. They have provided CCTV advisory and design consulting across various market sectors, including health facilities such as general hospitals, mental health units and mixed use facilities providing patient care and community outreach services. They can be contacted on +61 8 6208 0000, or