The term “anti-ligature” refers to a design approach that minimizes the risk of self-harm and suicide, especially in environments where people may be vulnerable. The goal is to reduce the chance for individuals to create secure attachment points for ligatures (anything that can be used for strangulation or hanging).
Sadly, suicide using ligatures is all too common in healthcare and correctional facilities. In fact, around 70% of suicides in patient areas involve a ligature point.
It’s important to understand the nuances of “anti-ligature” versus “ligature-resistant” designs. While the terms are often used interchangeably, they don’t always mean the same thing.
This article will provide a comprehensive overview of anti-ligature design, its applications, and important factors to consider when implementing it.
Key Terms: Ligatures, Ligature Points, and Anti-Ligature
To understand what “anti-ligature” means, it helps to define a few key terms.
What is a Ligature?
A ligature is anything that could be used to tie or bind. This could be a cord, rope, bedsheet, clothing, or other type of fabric. In environments where there are vulnerable individuals, ligatures can present a safety risk.
Understanding Ligature Points
A ligature point is any kind of fixture or fitting to which a ligature could be attached. Common examples include door handles, hooks, showerheads, windows, and furniture. Eliminating or mitigating ligature points is an important part of keeping people safe in certain settings.
Data from the UK from 2009 to 2019 showed that almost half of deaths by hanging or strangulation in hospital wards involved the use of a door as a ligature point.
Defining Anti-Ligature
The term “anti-ligature” refers to designs or modifications that minimize the availability of ligature points. The goal of anti-ligature design is to prevent self-harm and suicide attempts in environments where people are at risk.
However, some experts point out that the term “anti-ligature” can be misleading because it’s often impossible to create a completely ligature-free environment. For this reason, some people think “ligature-resistant” is a more accurate term.
Anti-Ligature vs. Ligature-Resistant: What’s the Difference?
The terms “anti-ligature” and “ligature-resistant” often get used interchangeably, but there’s a subtle, important difference. “Anti-ligature” design aims to completely eliminate any and all points where someone could attach a cord or rope (a “ligature”). “Ligature-resistant,” on the other hand, focuses on minimizing the risk associated with potential attachment points. It acknowledges that completely eliminating every single possibility might not be feasible in every situation.
Ligature-resistant designs actively prevent points of attachment. They do this through features like sloped surfaces (so nothing can be tied around them), recessed hardware (so there’s nothing to hook onto), and smooth, seamless finishes (to avoid any gaps or crevices).
You might also hear terms like “load release anti-ligature” and “fixed anti-ligature,” which refer to how the device or structure behaves under pressure. Another important design consideration is “weapon deterrent,” meaning the design makes it difficult to convert the item into a weapon.
Why is anti-ligature design so important?
Anti-ligature design is key to safety in any setting where there’s a risk of self-harm, particularly in mental health facilities and correctional institutions.
Mental health facilities
In psychiatric wards and mental health units, anti-ligature design is essential to reducing the risk of self-harm and suicide. Creating a safe, therapeutic environment is critical for patients’ well-being.
In fact, a UK study of suicides in psychiatric wards in England and Wales between 1999 and 2007 found that 77% of suicides involved hanging.
Justice facilities
In prisons and detention centers, preventing inmate self-harm and violence is a major concern. Inadequate ligature resistance can have significant legal and financial consequences for correctional facilities.
Beyond the legal ramifications, improving inmate safety can help facilitate more effective management and mental health support for inmates.
Other healthcare settings
Anti-ligature measures can also be important in other healthcare settings, such as emergency rooms and substance abuse treatment centers.
Anti-Ligature Solutions and Design Strategies
Creating a safe environment requires careful consideration of every detail, from the door hardware to the furniture. Here’s a look at some of the solutions and design strategies that can enhance ligature resistance.
Anti-Ligature Fixtures and Fittings
There are a variety of anti-ligature solutions available for different areas of a room or building. For example:
- Doors: The SENTRY Complete Door System can help prevent ligature attachments.
- Washrooms: Ligature-resistant taps, mirrors, and dispensers are essential. The Porpoise tap is one example of a safer design.
- Furniture: Designs with smooth surfaces and rounded edges minimize attachment points.
It’s also important to select materials and finishes that are durable, tamper-resistant, and easy to clean. This helps maintain the integrity of the anti-ligature design over time.
Design Considerations
Thoughtful design plays a crucial role in enhancing ligature resistance. Some key elements include:
- Sloped surfaces, recessed hardware, and concealed fixings: These features minimize potential attachment points.
- Clear lines of sight: This allows staff to observe residents or patients more effectively.
- Bright, evenly distributed lighting: This improves visibility and reduces shadows.
- Colors and patterns that promote well-being: A calming and supportive environment can contribute to a sense of safety and security.
Ligature Monitors and Monitoring Systems
Technology is offering new ways to help prevent deaths by ligature. Ligature monitors are systems that can detect when someone is attempting self-harm, sending an alert to staff so they can intervene.
These systems often use sensors and cameras, sometimes incorporating sophisticated AI, to recognize behaviors that indicate a person is at risk. In environments where the risk of suicide is high, these systems can significantly improve safety.
One example of this technology is the KOSMOS Smart Monitoring System. It’s designed to provide constant, unobtrusive surveillance, helping to protect vulnerable individuals.
Frequently Asked Questions
What is an anti-ligature door?
An anti-ligature door is a specialized door designed to minimize potential ligature points. These doors typically feature smooth, sloping surfaces and concealed hardware to prevent the attachment of ropes, cords, or other materials that could be used for self-harm. They are commonly used in mental health facilities, correctional institutions, and other environments where suicide prevention is a priority.
What does it mean to be ligature-resistant?
Ligature-resistant means that a product or environment has been designed to reduce the risk of a person using a cord, rope, or other material (a ligature) to create a point of attachment for hanging or strangulation. Ligature-resistant features minimize or eliminate places where a ligature can be tied or secured. It’s a crucial safety consideration in environments where there’s a risk of suicide or self-harm.
What is an anti-ligature?
The term “anti-ligature” describes features or designs that are intended to minimize the possibility of a ligature being attached to a specific area or object. It’s a preventative measure to reduce the risk of self-harm or suicide. Anti-ligature designs eliminate or significantly reduce the potential for creating a secure attachment point for ligatures.
Closing Thoughts
Anti-ligature design plays a crucial role in reducing self-harm and suicide, especially in facilities where people are vulnerable. But it’s not a standalone solution. Effective prevention requires a comprehensive strategy that incorporates thoughtful design, technology, and thorough staff training.
Regular risk assessments and proactive action are essential to creating a safer environment. We have an ethical and, in many cases, a legal responsibility to do everything we can to protect the people in our care. That includes taking anti-ligature measures seriously.