Opinion piece: service-user safety

eliminate ligature risks from doors within the bedroom. If we can push the ligature risk outside the bedroom into public space, can we help reduce the number of suicides? With sufficient funding, focus on the built environment, and better staff support, we believe it’s possible.

THE BUILT ENVIRONMENT Indeed, against a backdrop of budget cuts and lower staff numbers, the built environment needs to play a more significant role than ever in reducing the suicide risk – which is why our team at Safehinge Primera has adopted the ambitious goal of eliminating ligature risk from bedroom doors. With 91% of inpatient deaths occurring under intermittent observations,9 and doors representing the two last major ligature risks within the bedroom, we understand and recognise that we have a key role to play. Clinical staff told us that the en-suite door was the biggest risk because it’s unsupervised. Existing solutions either didn’t provide dignity, or still enabled ligatures. That is why we developed an award-winning door that removes all known ligature points from the en-suite door. However, this of course simply moves the risk to the next obvious point in the bedroom – the bedroom door itself. Taking this thought further, and one realises that doortop alarms would simply move the risk elsewhere on the door – either to the latch or the bottom of the door. We needed to ‘think bigger’, and that is why we developed our full door alarm – which notifies staff of any abnormal loads anywhere on the door. With Jeremy Hunt having identified

‘improved patient observation and safer psychiatric wards’ as priorities to achieving zero suicides,8 these recent innovations minimise the blind spot that currently exists between observations, enabling staff to respond more quickly to more suicide attempts, and to disrupt the ligature learning process of service-users.

The bright leaves bring a vibrancy to this en suite area, while the door ‘has no known ligature points’.

We also believe it can help facilitate earlier therapeutic interventions – by highlighting early stage attempts made by service-users.

THE ROLE OF GOOD DESIGN Research also shows that having a well-designed built environment not only helps to increase safety, but also improves the recovery process for service-users. Research from the Design in Mental Health Network guide, Design with People in Mind, published last year (see also pages ???),10 reveals that there is a 20% reduction in the average length of stay following ward refurbishment, and a 70% reduction in seclusion room rates within new inpatient facilities. Similarly, Papoulias and colleagues’ systematic review, referenced in the DIMHN report, found that the provision of private spaces and homely design was associated with increased well-being and social interaction.11 When discussing the relationship between the design of mental health wards and service-user outcomes, one service-user in Payne and May’s research (also cited in Design with People in Mind), claimed ‘It’s definitely a combination, it’s not just the environment, it’s also the staff’.12 However, it remains evident that the

products are only as effective as the staff who operate them – and that those staff need sufficient time and support to successfully perform their roles. Factors such as staff training thus have a significant role to play in achieving zero suicides.

Sussex Partnership NHS FT used electronic locksets on the Brunswick Ward at Mill View Hospital, allowing service-users to operate their own doors – ‘restoring dignity and independence’.


STAFF TRAINING’S IMPORTANCE With staff attrition in Mental Health at 14%,13 understaffing is a common challenge – resulting in agency workers being used, who may regularly be working in unfamiliar environments with products they’ve encountered infrequently. Equally, with various shifts, organising regular staff training can be challenging. So, while adequate funding is required to ease the pressure on frontline staff, convenient access to product training to help equip staff to use the products quickly and effectively in an emergency situation is equally important.

That is why we are working with clinicians and estates teams across the UK to develop a full set of online training videos for our products – meaning that refresher training on life-saving products is accessible to staff when it suits them. As frontline NHS staff work hard to meet

increasing clinical demand with limited resources, we’ve identified the ways we can support care providers – through safer built environments, and more accessible staff training – all helping to make zero suicides a more achievable goal. To find out more about our Target Zero campaign, please visit the Safehinge Primera stand at next month’s Design in Mental Health 2018 event, or simply get in touch with us. n

The concealed alarm senses ligature attempts across the whole door, and communicates wirelessly to an existing staff attack system, making it a simple retrofit.

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