In 2018 there were 6,507 deaths in the UK due to suicide and 80 to 90% of people who die by suicide are experiencing mental distress. People with mental ill health are far more likely to harm themselves than anyone else.
Sadly, many people undergoing treatment for mental health issues are inclined to commit self harm and a high proportion of recorded suicides are due to hanging. This means that organisations and personnel involved in dealing with vulnerable people need to be highly aware of ligature risks and opportunities that may exist for people to harm themselves.
Ligature Risk Assessment
Those employed in mental healthcare have a statutory duty to promote the welfare of those in their care. An important aspect of this responsibility is being able to recognise ligature risks and then take appropriate steps to mitigate identified risks.
The term ‘ligature’ refers to an item (or combination of items) that can be used to cause asphyxiation and death by compressing the airways and preventing breathing. Ligatures can be attached to ligature points such as door hinges or other protuberances in a room. Examples of ligatures include shoe-laces, belts, socks, cables or anything that can be tied together to create a dangerous ligature. A ligature point is formed by any feature or element in a space which can potentially be used to attach a strangulation device (ligature).
A thorough ligature risk assessment should systematically examine relevant environments intended to be used by vulnerable people. All potential ligature points need to be identified and steps taken to remove risks. Ligature points to look out for typically include: window frames and handles, door handles, door hinges, curtain rails, light switches, radiators, mirrors, sinks, furniture and more. Anywhere there is a gap due to furniture fixings or uneven wall surfaces there is the potential for a ligature to be attached so these must all be identified.
The term ‘anti-ligature products’ refers to items that have been specifically designed not to offer any potentially harmful ligature points. This means that they have been designed to make it impossible for someone to attach a strangulation device (ligature).
An example of a potential ligature points that are found in many institutions are the ventilation grilles. Standard ventilation grills offer a number of potential ligature points including the fixing points and the grille front panel. Anti-ligature ventilation grilles are designed not to offer any opportunities for even the thinnest of ligatures to be attached.
Another example of a potential ligature point are the observation mirrors commonly used in institutions. Generally these are convex ceiling or wall mounted mirrors that provide improved, all-round observational capability. But these installations can present some ligature points so it’s a good idea to install appropriate anti-ligature mirrors specifically designed for institutional use.
Check and Double Check
When assessing a space for ligature point risks it’s important to be thorough. It’s often beneficial to have two risk assessors independently evaluate a room for ligature point risks as double checking helps ensure that no risk is unidentified. It’s also worth keeping in mind that not all ligature points are immediately obvious so thorough assessment by multiple inspectors can save lives.