Ligatures: The Risks You Should Be Aware Of

Suicide statistics in mental health settings demonstrate that three-quarters of patients who kill themselves on a psychiatric ward do so by hanging or strangulation, prompting regulators to focus heavily on ligature risks.

Architects, specifiers and ward managers should closely observe any ligature risk- no matter how big or small-when redesigning or upgrading their facility.

Ligature Risks: Key Examples

Even the smallest risk must be identified, and measures put in place to minimise. Some examples of risks are as follows:

• Power cords on medical equipment

• Call bell cords

• Handrails

• Doors

• Doorknobs

• Door hinges and hardware

• Showerheads and curtains

• Exposed plumbing or piping

• Paper towel and soap dispensers on walls

• Electrical switches

• Lighting fixtures

• Projections from ceilings

Managing Identified Risks

It’s extremely difficult, and in some cases impossible, to completely remove ligature risks. Doing so may serve as a hindrance for employees carrying out necessary tasks, and for service users by taking away their rights of independence.

In managing risks, it is recommended that you take a ‘remove, replace, protect, or manage’ approach, as highlighted by The Nottinghamshire Healthcare NHS Ligature Risk Reduction Policy (2019)

Remove, Replace, Protect, Manage

Remove: If the risk would leave the patients at risk, the ligature should be removed and there is no suitable alternative.

Replace: The ligature Is removed and replaced with a purposely designed similar anti-ligature piece of equipment.

Protect: Provide materials that hide the potential ligature.

Manage: There is a need to keep the risk because of the potential injury is greater than the potential of an attempted suicide, for example, grab rails within an elderly in-patient/dementia unit. 

Examples Of Ligatures and Ligature Point Risks To Consider

Before we head into the examples, it’s important to understand the distinction between ligatures and ligature points.

Ligature: Anything that binds or ties. Examples include: chains, linen, clothing, cords, tubing, etc

Ligature point: Anything that could be used to attach or secure a ligature. Examples include: shower rails, coat hooks, water pipes, door frames, etc.

Bedsteads : Should be appropriate to the environment

Brackets, picture rails, ventilation grilles, ducts : Brackets: remove, box in or chase into wall

                                                                                    Grilles: perforations should be a maximum of 3mm in diameter

Coat hooks: Remove all hooks behind doors, in wardrobes, etc

Curtain rails: Collapsible rails and safety track

Curtain tracking: Avoid gaps in fixed tracking

Curtain wires : Avoid use of curtain wires

Doors (closers, handles, frames): Careful consideration of design

Electrical wiring : Should be ‘chased’ into wall or fitted flush to wall

Exposed pipework: Consider height and accessibility

Hinges : Consider types of hinges and gaps between doors and frames

Light switch cords: Should not be nylon. Consider solid pull cords or infra-red automatic switches

                                 Consider anti-ligature light switch covers

Patient’s lockers/wardrobes: Remove hanging rails

Radiators: Consider boxing in with appropriate covers

Wardrobes: Consider design (handles, internal hooks, door closing etc)

Window and window openings: Consider handles, trickle vents, hinges

Window and door weatherproof seals: Consider ligature points

Sink taps, plugs : Consider ligature points

Smoke detectors: Consider ligature points or appropriate covering

When assessing ligature risks, consider the use of the outdoor environment too. Anchor points in the garden may include windows, drainpipes, fencing, and trees. 

Conclusion

We hope that this blog will enable you to identify and list all potential ligature points within your working environment that are accessible to Service Users.

Contour’s range of anti-ligature products are designed to help minimise the risk of self-harm and suicide in mental health settings, providing Service Users with a safe and secure environment.

If you’d like to learn more about how we work with mental health settings to reduce ligature risks, get in touch today.