What does ‘anti-ligature’ mean?
The term ‘anti-ligature’ describes any object that is designed to prevent the ability of securing a ligature to it.
As such, anti-ligature design plays a crucial role in protecting those who are most vulnerable in mental health and challenging environments by reducing the risk of self-harm or suicide by use of a ligature.
Best practices within design for mental health facilities have greatly improved in recent years through collaborative efforts to create safer environments. Anti-ligature design is one of the factors that has played a key role in this.
What is a 'ligature'?
A ‘ligature’ is any item that can be used to tie or bind something tightly, such as a rope, cord, or items of clothing or bedding. Such items pose a significant risk in mental health settings and challenging environments for their potential to be used in self-harm or suicide attempts. This risk is increased by the presence of ‘ligature points’ – a point on furniture, architecture, or any other physical object that allows a ligature to be affixed.
Anti-ligature design reduces the presence of these ligature points and therefore plays an essential role in mitigating the risk of a ligature being used to self-harm.
Why is 'anti-ligature' design important?
A study carried out in 2012 into cases of suicide within psychiatric wards in England and Wales found that of the 448 suicides that occurred between 1999-2007, 77% were by hanging. The study highlighted the most common ligature points as doors, hooks, handles, and windows. The most common ligatures used were belts, sheets, and towels.
The National Confidential Inquiry into Suicide and Safety in Mental Health Annual Report 2022 investigated data on UK suicides between 2009-2019. The report found that 49% of deaths by hanging or strangulation on wards used a door as a ligature point.
Anti-ligature guidance in the UK
The Department of Health’s Environmental Design Guide offers best practice guidance for the design of adult medium secure services. It states that for the prevention of self-harm and suicide:
“Spaces where patients may not be continually supervised or observed by staff (for example bedrooms and toilets) should be considered high-risk areas and designed, constructed and furnished to minimise the opportunity for self-harm. Lines of sight and access for staff responding to high-risk incidents and emergencies should be carefully considered when planning design, layout and furnishing.
All fixtures and fittings in the service such as window and door furniture, door closers and hinges, taps, showerheads, and coat hooks should be anti-ligature and meet national safety requirements.”
The Royal College of Psychiatrists’ CCQI Standards for Inpatient Mental Health Services (Fourth Edition) outlines essential, expected, and desirable standards that should be followed to deliver accessible, compassionate, and safe mental health care environments. The standards address ligature risk, highlighting it as an essential standard to be followed:
“A risk assessment of all ligature points on the ward is conducted at least annually. An action plan and mitigations are put in place where risks are identified, and staff are aware of the risk points and their management.”
What anti-ligature solutions are available?
Kingsway offer an extensive range of anti-ligature internal door sets to ensure the ligature risk can be reduced in any given area of a mental health facility, including; service user bedrooms, staff areas, communal spaces, washroom facilities and more.
Our anti-ligature Complete Door Systems are designed in collaboration with healthcare professionals and Experts by Experience to help prevent service user self-harm or suicide within challenging environments. Through our expertise gained in delivering anti-ligature solutions for over 2,300 UK projects, we ensure the best-suited materials are selected to deliver the robustness and reliability demanded by mental health environments.
Aesthetically pleasing without sacrificing safety or security, our products improve patient and staff safety within challenging environments while contributing to creating therapeutic, de-institutionalised spaces. And as your partner in patient safety, all our Complete Door Systems come with a 5-year guarantee at no extra cost.
In addition to anti-ligature door systems, we offer a number of anti-ligature solutions to reduce risk within challenging mental health settings, including washroom dispensers, shatter-resistant mirrors, coat & towel hooks, handrails and more.
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What are 'ligature monitors'?
A ligature monitor is a device that can detect ligature attempts and will alert staff to allow swift clinical intervention. Their use can dramatically improve staff responsiveness to life-threatening incidents. Our SENTRY Complete Door System features anti-ligature design along with ligature monitoring technology that spans the full length of all exposed edges on the doorset. The ligature monitors will alert staff if a service user attempts to anchor or wedge a ligature.
To maximise the benefits of ligature monitors and to support staff further, we have developed our KOSMOS Smart Monitoring System – the next-generation ligature monitoring software. KOSMOS provides live ligature monitoring across wards with early warning indicators to enable proactive clinical intervention. KOSMOS also aids management teams by providing invaluable data for future review. By recording a complete audit trail of patient activity, staff observations and alarm activations, KOSMOS can help management teams review patient care quality and highlight key trends on wards.
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Pre-tendered Anti-Ligature Doors on NHS Commercial Solutions Framework Agreement
Following a rigorous tender process, Kingsway Group have been selected as a pre-approved provider of Anti-Ligature, Specialist and Bespoke Doors on the NHS Commercial Solutions Framework Agreement. The in-depth vetting process covers every aspect of the Kingsway service, from our production process and products through to our net zero commitments.
Our inclusion on the Framework Agreement gives assurance that our products and processes have been independently pre-approved for quality and provides all NHS Organisations and public sector entities with a streamlined route to pre-tendered specialist solutions.
Pre-approved Specialist Anti-Ligature Doors for the NHSBrowse our anti-ligature solutions
Anti-Ligature Vision Panels
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Anti-Ligature Washroom Accessories
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Anti-Ligature Door Systems
Browse productsPast Projects
Dorset HealthCare University NHS Foundation Trust: Kimmeridge Court
Eating Disorder UnitKingsway Group worked with Dorset HealthCare University NHS Foundation Trust to provide bespoke anti-ligature and anti-barricade solutions to the new build Eating Disorder Unit, Kimmeridge Court.
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South Eastern Health and Social Care Trust: Downshire Hospital
Psychiatric Intensive Care UnitA state-of-the-art new build Psychiatric Intensive Care Unit (PICU) at Downshire Hospital in Downpatrick, Northern Ireland.
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Barnet, Enfield & Haringey Mental Health NHS Trust: St Ann’s Hospital
InpatientThe new 74-bed Blossom Court at St Ann’s Hospital is using the SWITCH Anti-Barricade System and the STOW en-suite door system – Kingsway Group used their Define, Design & Deliver process to complete this project for IHP Projects.
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