DESIGN IN MENTAL HEALTH CONFERENCE 2019
Philip Ross’s update on the DiMHN and BRE’s joint development of test standards for products used in mental healthcare settings drew a sizeable audience.
one only has to refer back to the Estates and Facilities Alert (EFA/2017/002) issued in August 2017 by the four NHS Bodies across the UK, Anti-Barricade Devices: Risk of ineffectivity in certain circumstances. This relates to push-button stops and any other anti-barricade devices not working under active manipulation of pressure from within the room.” While NHS estates teams UK-wide had been alerted to the issue, the speaker said no guidance had been issued ‘on how to actually assess current products’, either in situ, or in new-build / refurbishment projects.
Work undertaken ‘in silos’ Testing of ligature and robustness was also ‘a major time sink’ on projects. Philip Ross elaborated: “We typically find that testing happens in silos, both at Trust or Health Board level, and project-by-project.” This not only restricted the time afforded to the consideration of potential products’ impact on service-user wellbeing, but also impacted on the ability of staff at the frontline of mental healthcare do their job. He added: “If there’s one area we are going to need to spend more time on to make better recovery spaces environments, it’s that wellbeing space.”
A key parallel
The DiMHN’s Testing and Innovation Workstream lead said he would use one key parallel in learning from other products used in construction throughout his presentation – fire doors – since he felt this would help the mental healthcare community ‘understand where we need to go’. He explained: “The first point we can take from fire doors is the benefits of repeatable, reliable, independent testing and certification. We test fire doors once, using an independent UKAS-accredited test lab, and there are third party accredited schemes to ensure that products are manufactured to consistent quality – assessing processes and systems.” This approach allowed specifiers to assess various products or suppliers ‘robustly and quickly’. Turning to the varying levels of fire door performance required in different
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parts of a building, Philip Ross’s next slide showed a fire strategy on architectural plans, highlighting a mix of predominantly FD30 and FD60 fire-rated doors. He said: “The key point here is the fact that, given varying risk levels to building occupants and users in different parts of a building, product specification and performance requirements will depend on location. Additionally, accurate product performance specifications help building owners to understand the risks and create risk management strategies based on them – the best example here being fire escape plans. They also help specifiers select the right product based on the risk management plan, which in turn helps manage budgets.”
Philip Ross was keen to emphasise that, in jointly developing the test standards, the DiMHN and BRE were not seeking, ‘realistically’, to be able to eliminate all the risks. “It’s more,” he explained, “about providing a platform for assessing and clearly identifying what risk reduction is achievable, and then identifying what risk remains, and how that can be picked up by clinical management procedures.”
Research session highlighted As part of the test development process, the speaker explained that DiMHN and BRE had hosted an early ‘research session’ in 2014 at a Mersey Care mental healthcare facility, where participants were asked which product categories they were particularly keen that the joint team focus on. The ‘feedback’ was that doors, door hardware, and windows, were ‘the most problematic areas’. However, after further review and discussion, Philip Ross explained that the project team had ‘reorganised the testing process’ to allow coverage of all products for the two most significant performance concerns – ligature and robustness. He said: “We also retained some specifics for doorsets, hardware, and windows. For example, with anti-barricade doors, we didn’t need to assess for coat hooks, but rather looked at overall door performance, and with windows you need to think about cleanability, especially with
sliding windows incorporating security mesh.”
‘Test and declare’ approach To enable the testing to ‘work’ for a range of care pathways, Philip Ross explained that DiMHN and BRE had decided to adopt a ‘test and declare’ approach; no product would thus receive a simple ‘pass’ or ‘fail’. Instead, performance against a number of testing criteria would be captured and shared. “This will help specifiers make informed choices, and set the ability for aspirational standards that no product is able to achieve today,” he told delegates.
Countrywide workshops Another key element of the testing and standards development process had been a number of workshops held countrywide, which secured feedback and input ‘from almost 150 experts actively involved with mental health’ – including estates and facilities managers, architects, clinical staff, and product manufacturers. Philip Ross elaborated: “We used the workshops to understand what types of failure commonly occur, and what problems we have to capture within our performance evaluation, getting input on clinical needs, and understanding how clinical personnel’s risk assessment and management policies are affected by product-based risks. We also undertook a literature review to ensure that ligature performance was based on medical research. A couple of Russian studies into how ligatures are often carried out – including the various angles and weights with different parts of the body, and how they are supported – were especially helpful.”
‘Superhuman strength’ For the ‘robustness aspects’ of the test development, the team had to consider the phenomenon of ‘superhuman strength’ when, for example, a service-user’s pain receptors are not as responsive as usual due to psychosis or the effects of strong medication. The team also looked into studies of the forces of the kicks and punches of elite fighters and Olympic
JULY 2019 | THE NETWORK
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