Ligature risk management in mental health settings is often well understood in principle, but harder to implement consistently across an organisation. This case study from an acute mental health inpatient unit in Ireland shows how a structured ligature and environmental safety audit led to measurable changes in awareness, governance, and the physical environment. Background The service operates within a Community Healthcare Organisation (CHO) and is regulated as an Approved Centre under the Mental Health Act. Before the audit, ligature risk assessments were primarily carried out by a senior nursing lead. While risks were identified and communicated, involvement from other departments was limited. As described in the case study: “Prior to this audit I operated as though I was the owner of the risks identified… The global awareness at all levels of the management structure simply was not there.” The Audit Approach The audit went beyond a standard checklist and introduced a broader way of working. A key concept was collective capability, meaning that responsibility for identifying and managing risk is shared across multiple disciplines. The process resulted in: A detailed review of environmental risks, including fixtures and fittings A post-audit report A Quality Improvement Plan (QIP) with actions assigned to relevant departments The audit also highlighted that risk is not limited to obvious ligature points: “The attention to detail beyond the obvious was eye-opening… fixtures and fittings… can contribute to risk.” What Changed Governance and Leadership Involvement Following the audit, senior stakeholders including the Maintenance Manager, General Manager, and Registered Proprietor met specifically to address ligature risk. Responsibility moved beyond the nursing team and became a wider organisational issue. This aligned with national guidance published in December 2024, which requires Approved Centres to establish multidisciplinary Ligature Reduction Groups. 2. Environmental Improvements The audit informed investment decisions and led to specific changes within the unit, including: Replacement of en-suite and bathroom doors with alarmed anti-barricade doors Installation of ligature-reduced windows in the High Observation Unit Introduction of ligature-reduced beds Installation of ligature-resistant dispensers and waste bins Replacement of screw-fixed items with safer alternatives These changes were also standardised across multiple centres within the CHO. Maintenance and Accountability Including Maintenance in the audit process and assigning QIP actions to relevant teams changed how risks were managed. Maintenance staff became more aware of ligature risks and more proactive in responding to infrastructure-related issues, such as doors, windows, and fixtures. Multi-Disciplinary Working Future audits are planned with representatives from: Risk Health & Safety Maintenance Clinical teams Capital planning is also now discussed across all four Approved Centres in the CHO, allowing for more coordinated decision-making. Staff Awareness and Training Ligature risk is now a standing item in management meetings, and staff have received training on new systems such as alarmed anti-barricade doors and windows. Awareness of shared responsibility is regularly reinforced across different governance groups. Key Takeaways The service identified several practical lessons for other organisations: Involve Estates, Maintenance, Risk, and Health & Safety teams from the outset Ensure stakeholders understand their role before the audit begins Use a QIP to assign clear responsibility for actions Develop a standardised, approved range of ligature-resistant products Engage with sector forums to stay informed on design and product developments Anticipate alignment with national requirements for ligature-reduced environments Conclusion This case study shows that a ligature and environmental safety audit can do more than identify risks. In this instance, it led to: Greater organisational awareness Wider stakeholder involvement Defined accountability through a QIP Targeted environmental improvements For services reviewing their current approach, the main shift demonstrated here is from individual ownership of risk to a shared, structured, and organisation-wide response. If you're interested in finding out what we can do for your organisation, feel free to get in touch.

Ligature Attachment Point Environmental Safety Audits The National Suicide Prevention Strategy for England (DoH 2002) set the standard that likely ligature anchor points in mental health service in-patient environments must be removed or covered. As a development all Mental health trusts and private care providers complete environmental suicide risk assessments & management plans to mitigate the risks across inpatient areas to ensure patient safety. Without specific knowledge and training many care providers find it difficult to understand whether the safety products they have fitted are installed correctly and working properly. We have found from auditing that poor or incorrect fitting of these products is often the norm with little or no post installation planned preventative maintenance. Over the last twenty years ligature resistant products have developed at pace and many early products fitted have been superseded or are now beyond their useful life. Our team of experts can provide a detailed safety audit which will: Identify the make and model of equipment fitted in inpatient areas Examine whether the items have been fitted correctly in accordance with manufacturers fitting instructions Comment on the age and condition of the products fitted within the environment Report on gaps between fitted products and the substrate they are attached to Provide a condition report on all items fitted within each area including loose furniture Identify fittings and products that are unsuitable for the patient group Examine the suitability of fixings used to mount products Examine patient garden areas for ligature issues and wider safety concerns Items included: Doors including mechanical locks, override systems, removable doorstops, hinges, closures, doorstops, and vision panels. Widows, blinds, curtain rails and curtains Radiator covers, heat panels, alarm systems Fitted furniture including bedroom furniture, TV protection cabinets, tables, and seating (Beds, wardrobes, etc) Lighting (surface mounted and flush fitted) En suite doors & frames Sanitary ware including WC, basin shower, drain covers, vents and extraction, shower rails, IPS panels, Grab rails and other Doc M equipment Washroom fittings: e.g. toilet roll holder, paper towel dispenser, soap dish, shelves, coat hooks etc Art installations Noticeboards Lines of sight / blind spots Audits can take place in any area on the ward, once communicated to the auditor. As well as auditing the environment the report will identify high risk areas of concern not just within the products, but procedures also. To assist in focusing resources towards creating a safe environment. In addition, we will also be happy to identify suitable products and remedial actions to address any issues found. Types of Survey Available Full Audit of Inpatient Areas: An examination of each room identified by the care provider. To identify the physical state of the care environment including the products fitted and how they are functioning. The audit will assist care providers in developing remedial work required to help create a safer environment and to in specifying products and work required for refurbishment or upgrade Health Safety Check: This report examines critical areas on each unit within a mental health hospital with terms of reference tailored to the clients needs. This could be to examine a hospital prior to commissioning or as a preventative measure where safety concerns have been raised. As well as auditing the physical environment we can co-develop bespoke terms of reference to triangulate our physical findings with, policy, procedures and staff training to identify any gaps in current practice. Get in touch with Lig-safe to discuss your requirements. Call: 03300 433226 Email: enquiries@lig-safe.co.uk

All ligature-resistant products should be operated and tested in accordance with manufacturer’s instructions to ensure optimum safety and performance. Commonly most manufacturers recommend a yearly inspection to ensure that products are operating appropriately and that the fittings and fixtures are free from damage. Testing validates the effectiveness of these designs, ensuring that they meet stringent safety standards and can with stand real-world usage. (Example of testing) The weight at which a curtain / curtain rail releases depends on: The correct installation Wear and tear during operation Misuse or damage Weight, length and drop of the curtains The weight at which the curtains / rail drops (NB: This will differ depending on the client group) Load release weight: One size doesn’t fit all. i.e. the static load at which a curtain / rail releases on an adult acute ward will be greater than that on a child and adolescent mental health services (CAMHS). Magnetic systems commonly release between 15-30kg depending on the proximity of the brackets but will not exceed 40kg. Specially developed magnetic fixings for CAMHS and eating disorder services have been developed to release at a lower weight threshold not exceeding 26kg. Report of the test findings: In order to provide you with proof of the efficiency of the installed ligature-resistant systems we can provide a certificate, annual audit and test for all of your rails and Ligature Resistant Equipment. In addition, we will supply you with a report providing. Visual inspection of whole system Load release data in Kgs Photographic evidence and summary of key faults Visual inspection of surrounding room for obstructions that might prevent the correct fall of the curtains Identification of any repair or replacement required

When planning the construction or refurbishment of a bedroom or bathroom for patients it is essential in the design process to eliminate points where ligatures can be looped or tied to a fixture in order to create a point of ligature. Here at Lig-Safe Ltd we can arrange the design, supply and installation of these specialist products through ourselves and our sister company Maintenance Solutions (GB) limited. Ligature-resistant hardware has become a term that covers a multitude of products, many of which go beyond the strict definition of ligature-resistant. The applications involved, and general product features required need to be considered and additionally reviews to ensure that the products are suited to the environment they are being fitted in. Most reputable suppliers spend a lot of time and effort exhorting specifiers about the need to consider complete doors sets, compatible hardware and whole life costs. This is particularly true in safe and secure installations where a simple generalisation of ‘anti-ligature hardware’ does us all a disservice and does not embrace all the hardware necessary including handles, hinges, door pulls, locks, latches, escutcheons and striking plates. Specifically this means products suitable for use in situations where a combination of safety and security is required coupled with the rights for privacy and dignity. Such places include: prisons, detention centres, young offender’s institutions, psychiatric hospitals and care homes. Lig-Safe have a sister company Maintenance Solutions who have been trained to install these particular products to ensure they are fitted and work correctly. Maintenance solutions will also train staff on site to correctly use, operate and maintain the products fitted.