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

Action	Description/Definition
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.

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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.

Potential Ligatures and Ligature Points	Potential Risk Control
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

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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, fill out the form below.

About Us

Contour produces a range of innovative, safe surface temperature systems for healthcare, education, mental health, commercial and secure sectors, working in close partnership and collaborating with architects, M&E engineers, NHS Trusts, local authorities, design consultants and contractors to deliver outstanding safe heating solutions.

Contour is the exclusive partner of BioCote® anti-microbial technology for LST and anti-ligature radiators. BioCote® additives reduce bacteria by up to 99.9%. Contour combines an extensive range of colour-paints is with BioCote® for a durable, high-quality finish.

Contour’s heating solutions offer secure, single-person quick access to radiator guard interiors for regular deep cleaning and maintenance. Each year, Contour save the NHS millions of pounds in cleaning costs, therefore delivering.