For patients at risk for self-harm, ensuring safety can be difficult. Since the majority of suicide attempts involve using makeshift ligatures to hang from doors or door hardware, the entrance to any room is a key consideration for mental health facilities.
Fortunately, the industry has taken a much more proactive approach in recent years. This has led manufacturers to introduce a variety of new anti-ligature (or “ligature resistant”) locking solutions and door hardware, which are designed to make suicide attempts much less likely to be successful.
Even then, there is no “perfect solution,” according to Mark Berger, president and chief product officer at Securitech Group, Inc., which partners with Stanley Security Solutions in the behavioral healthcare market. “Every product is simply better than what existed before-and one more tool to assist the staff.”
Of course, conventional door hardware isn't designed with any considerations that would help prevent something like a suicide attempt. But in a mental health environment, it's important to take a slightly different approach-even when it comes to something as simple as a doorknob.
While anti-ligature hardware can be installed on brand new doors, many facilities still choose to retrofit to existing doors. But it can be a challenging process, according to Rodd Salvatore, sales engineer for Accurate Lock & Hardware Co., because once you really start looking, “you have to rethink everything.”
“Originally, existing [doors and hardware] weren't designed to prevent suicide attempts, so conventional wisdom just doesn't hold up,” says Salvatore. “Often you end up solving one problem only to create another, so the trick is to find the balance without giving up too much on either end.”
To find the balance, manufacturers work closely with facility personnel. Product development is guided by insight from patient safety coordinators, nurses, doctors, and facility engineers, many of whom provide step-by-step scenarios to illustrate the potential for self-harm.
Berger explains: “An administrator will tell us: ‘Okay, you've removed the lockset as a ligature point. The next thing the patient will do is take their bed sheet, tie a knot at one end, throw it over the door, close the door, and attempt to harm themselves that way.’”
In addition, aesthetics are playing an increasingly important role. To some extent, door hardware manufacturers are moving away from products that have the “foreboding” appearance of a detention center toward those that make patients feel they are in a therapeutic environment.
“It's actually quite remarkable how the industry has responded [to deinstitutionalizing different aspects of facility design],” notes Berger. “We have gone from sterile designs to code-compliant solutions that meet the needs of patients as well as safety professionals.”
For years, lock manufacturers made conical safety knobs for use in mental health facilities. However, with the rise of ADA regulations in recent years, it's no longer enough for products to provide sufficient safety controls. They also have to be ADA-
“With stricter enforcement and a number of sentinel events, the pendulum shifted,” says Salvatore. “When facilities felt pressure to comply, manufacturers started introducing conical safety levers and that solved the problem.”
Conical safety levers feature a conical section that comes off the door, rounding into a tapered lever. Because rigid levers become potential ligature points, it's important for levers to be “free moving” in a mental health environment.
According to Berger, Stanley's approach involves having a key that locks the door, but disconnects the lever from the lockset. “The lever can move, but it no longer retracts the latch on the lock,” he explains. “This provides the same effect of locking the door, but with a lever that's never rigid.”
Stanley also offers emergency door alarm sensors, which notify nurses when pressure is applied to top of the door, as well as “piano-type” hinge arrangements that cover the entire gap between door and frame. In addition, a “slip-clutch” feature prevents patients from jamming the turnpiece in order to keep staff from entering.
“We look at the whole door in our approach of how to prevent patients from harming themselves,” says Berger. “It's a holistic approach to the entire opening between the lock set, the sensor bar, and the hinge-and how they all work in concert.”
Accurate Lock & Hardware has introduced a dimpled safety knob and lever clutch safety mechanism, in addition to a crescent handle hybrid, which Salvatore says “offers all the attributes of anti-ligature hardware, but is still ADA compatible.”