Anti-ligature clothing is used to promote the safety of vulnerable and often segregated individuals, preventing incidents of self-harm and suicide, whether in psychiatric hospitals, mental health hospitals, secure care facilities, custodial settings, or any other setting where an individual might be legally placed in seclusion, writes Robert Kaiser, founder and CEO of the stab-resistant body armour and slash resistant, bite resistant or cut resistant clothing company PPSS Group.
Emma Pring, a young woman, tragically took her own life on April 20, 2021, while receiving treatment at a privately operated mental health care facility. She was wearing anti-ligature clothing that, in my personal opinion, was not suitable for its intended purpose. I believe the coroner must have been appalled at the absence of national standards regarding the production of anti-ligature clothing in the UK during his investigation of this tragic incident.
It is also worth acknowledging a study carried out in 2012 into cases of suicide within psychiatric wards in England and Wales. The study found that of the 448 suicides that occurred between 1999-2007, 77 per cent 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.
A further truly excellent read highlighting additional data is the 2022 National Confidential Inquiry Into Suicide and Safety in Mental Health.
The objective of this article is to explore and highlight the precise application and benefits of anti-ligature clothing.
While extensive mental health research in recent years has focused on components of quality of care, published research lacks focus on the science of patient safety, especially the safety of those placed in involuntary confinement.
At the early stage of drafting this article and when discussing this subject with some experts, it was Ross Ferguson, who highlighted to me the article: ‘Suicide and Language.’ Ross has spent almost 34 years as ‘Violence Reduction Lead’ at one of the UK’s high security hospitals.
This excellent article urged me to consider terms, such as “commit suicide,” “successful suicide,” or “failed suicide attempt.” According to the article, to “commit” suicide has criminal overtones which refer to a past time when it was illegal to kill oneself. “Committing suicide” was like committing murder or rape. The original negative reputation of the word may have decreased over time, but the underlying residue remains (Sommer – Rottenburg, p.239).
Then there are also phrases which paradoxically include positive terminologies when a suicide is carried through, and negative terminologies when a suicide is attempted but does not result in death. Based on that, we should consider replacing phrases, such as “completed suicide,” “successful suicide,” or “failed suicide attempt.” In this context I would welcome open discussions among healthcare professionals, to establish more suitable terminologies.
A view
It is of greatest importance to understand that it must be a last resort to seclude an individual. Any such restriction must be for the safest and shortest time possible. It must be no longer than necessary, and the person’s dignity and freedom of movement should remain a priority. All other methods must be tried, and great care should be taken when identifying if other options were more suitable to legally place an individual in seclusion.
Peter Turner, Principal Associate of SWC Expert Group, who spent over 31 years as violence reduction lead at another high security hospital in the UK, pointed out there are several benefits in ensuring an individual at risk of self-harm or suicide is wearing anti-ligature clothing: “Of course, it significantly reduces the patient’s opportunities to self-harm, but it will also keep the area and person sterile and make it less likely for a member of staff to have to re-enter a secure area to reengage if personal clothing has been damaged (increased likelihood of active violence, injuries and trauma etc). It can also provide comfort and reassurance to some patients knowing that they were unable to carry out their intended acts to harm themselves, often expressed with gratitude post the prescribed intervention.”
This statement really got to me when I read it the first time. As desperate as some might appear when aiming to harm themselves or take their lives, this statement highlighted to me once again that there really is a ‘light at the end of a tunnel,’ even if many seem to be unable to see that light in moments of ‘insufferable darkness.’
However, we also must acknowledge that some individuals are driven, or influenced by unique biological, psychological, socioeconomical and environmental factors. Due to these factors, their relentless pursue to harm themselves or take their lives can often be final.
When speaking about anti-ligature clothing, Pete Turner strongly emphasises the moral aspects, and concluded: “If used unlawfully, such clothing can be degrading, traumatic, unethical, and very damaging to the staff and patient therapeutic relationship and have no clinical function or recovery benefits. However, when such clothing is being used for the correct reasons, and with care and compassion to safely manage and reduce the observed levels of risk, they are extremely supportive of the therapeutic delivery and patients’ recovery.”
“We must always be aware of the danger that if this practice is not carefully monitored and regularly reviewed, it can become a cultural and habitual blanket approach. This has the potential of contributing to the vicious cycle of violence and the internal justification for their use of restrictive responses. We must aim to reduce practises whereby the patient can become unintentionally dehumanised to ensure the safety of themselves and others.”
Photo by Mark Rowe; PPSS exhibiting at the Carlisle Support Services Innovation Lab day at Liverpool in February.
