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There is no "safe zone" in which ligature attachment protection is not needed

July 16, 2012
by James M. Hunt, AIA
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Ligature attachment protection below 18 inches above the floor is necessary

I would like to get back to the earlier discussion in this blog regarding “Fallacies” that exist in the thought process of designing behavioral health facilities.  Another of these statements that may lead to less than desirable design and potentially hazardous conditions for the patients is the following:

"It is not necessary to protect against ligature attachment for items that are lower than 18" above the floor."

Many years ago the “standard of care” was that it was not necessary to protect against ligature attachment for items that were below waist level.  Then the “Conventional Wisdom” was that protection was needed for things only above 18 inches from the floor. 

As discussed previously, death by suicide can be accomplished in less than five minutes by tying something around the neck that is tight enough to restrict the blood flow to the brain.  The attachment point can be from items imbedded in the floor.  Therefore, there is no "safe zone".  Care must be taken to reduce the risk of ligature attachment from all items in the patient environment.  This concern is higher in areas where patients will be alone for periods of time such as the Patient Rooms and the Patient Toilet Rooms.  However, care should be exercised in other locations where the intent is that patients will never be alone.  Even though this is the intent of the staff, it is not unusual to find doors to these rooms unlocked (and patients in them) without staff being present.  Providing ligature resistant features for these rooms will reduce the possibility of a patient suicide in these areas in the event that they are inadvertently left unsecured.  This helps reduce the pressure on staff members to constantly guard against this possibility.  


Jim Hunt

Behavioral Healthcare Design Consultant

Jim Hunt

James M. Hunt, AIA, is a practicing architect and facility management professional with over 40...