DESIGN IN MENTAL HEALTH CONFERENCE 2019
where we use a standardised pendulum impactor to represent the different effects. We have also looked at the direction of force and its momentum – which is important to ensure that we capture whether the person is running at their ‘target’ from the other side of a bedroom, or the full length of the corridor. By contrast,” he added, “if you think about a punch, the force impacts a much smaller surface area, and the assailant can attack items both high and low in multiple directions.”
Testing ‘to failure’
With no product ‘indestructible’, the speaker said the DiMHN and BRE team had decided it was important to test all products to failure through prolonged attacks, and to make the data available to staff – to ensure that their risk assessments and management procedures are correctly informed. This would not only inform the time to failure, but also how failure occurred, and whether there are any early signs of failure that should be looked for following an attack. Philip Ross said: “One example of how this might play out would be in forming an intervention policy for a room. If a product being attacked is known to fail after two hours, risk management procedures could direct staff to intervene after one, allowing for a margin of safety.”
Stealth attacks
The speaker’s next focus was ‘stealth attacks’ where, say, a service-user makes a non-audible or invisible attack, for example, by simply using an item and picking away at it over time. Philip Ross said: “We’ve seen credit cards used on rubber to create heat friction, even with anti-pick arrangements, to expose ligature points.” The team had also created some category-specific tests for critical performance measures not captured in the ‘all product’ ligature and robustness tests. One example was the anti-barricade performance of doorsets, a topic that had come into sharp focus following the issue of a nationwide safety alert after a hostage incident. A cleaner’s life had been put at risk when excess pressure was applied on the inside of a door and rendered the anti-barricade device inoperable. “Like the test developed for ligature performance, we factored in the patient learning process, and the determination employed in an attempt to prevent the ‘staff override’ mechanism,” he explained. “We’ll allow a test engineer to observe the anti-barricade system being used 10 times, and then give them time to try and tamper with the system to prevent operation. We will then rate performance based upon ‘no planning’ (i.e. slam of a door only), ‘some planning’, and then a great deal of planning and manipulation. We will capture the timing against each of these scenarios too.”
Draft guidance released last month Bringing things up to date, Philip Ross explained that the project team would be releasing the draft test guidance in early
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The DiMHN/BRE workshops were attended by personnel including estates and facilities staff, architects, clinical teams, and product manufacturers, and generated valuable feedback.
June (this happened on 10 June), followed by a four-week consultation process, managed by BRE. He exhorted all present to ‘get involved’, either by joining the Design in Mental Health Network as a member – membership is free for NHS and non-commercial organisations – or by simply emailing him (
pross@dimhn.org), at which point he would add the individual or organisation to the register. Following the consultation’s close, BRE would then undertake a full review, and process some of the comment received into the testing guidance, or explain why particular feedback was not being adopted. He said: “Once we have the final version to hand, it will need assessing by the BRE Governing Body, to ensure the testing guidance’s independence and impartiality, and that it meets the organisation’s strict requirements.”
Preference for single test organisation
The Design in Mental Health Network had expressed a preference ‘relatively early on’ for a single organisation to test all products. Philip Ross elaborated: “This is partly due to the expertise and know-how involved with capturing the ingenuity and determination of service-users when one is testing products, but should also enable us to improve the repeatability of human- based testing procedures. Our preference is for BRE to be the testing body, but this has not yet been formally agreed.” In fact when the joint team initiated the work, it split the project into two phases – the first being to create the design guidance, and the second to then establish the test body and procedures for it. Philip Ross said: “We have already started the second process, and over coming months we will look to formalise it. We’re working towards the testing guidance being finalised, and BRE being ready to test and certify products’ performance, by the end of 2019.”
Philip Ross explained as his presentation neared its close that he really believed the enhanced clarity on the performance of products used in mental health environments would help ‘the experts’ – architects, clinical staff, and estates teams – make better decisions for their projects,
‘both in terms of reducing risk, and knowing what risks remain’, to ensure that ‘the clinical risk management reflects reality’. He said: “The ability to shortlist suitable manufacturers using desk-based research in a couple of hours with one supplier will not only lead to better value procurement, but will also allow more time for assessing the impact of each option on the patient’s wellbeing, and how this affects clinicians’ core role of providing therapeutic care – which should drive further improvements.”
Presenting claims with confidence It was not, however, just project teams that would benefit from the publication of uniform test standards. Philip Ross stressed: “Manufacturers will be able to present their claims with confidence, encouraging more innovation from both new and existing suppliers. The testing process will also help product designers and engineers create the next generation of solutions by using the framework of performance measures to research clients’ requirements and then develop tests against this. Ultimately,” he said, “the only way this will become a reality is if it is adopted by the people in this room. I think it’s is everybody’s job to make this happen – simply by asking for copies of certification when it is available in the future, and by the manufacturers getting their products tested.
A ‘long, hard journey’
“This has been a long, hard journey, but I’m incredibly proud of what the core and the wider team have achieved together. I believe this testing guidance can be a game changer in creating better recovery environments, and not just in the UK. I’d like to give a big ‘thank you’ to everybody involved to date, and also for the months and years ahead. In particular I’d like to thank Richard Hardy and Chris Hall from BRE, and also Tony Crumpton and Jeff Bartle – who are on the Design in Mental Health Network Board, and have been working with us on the internal working group.” This brought to a close a comprehensive update on the test standards’ development by the DiMHN’s Innovation and Testing workstream lead. n
JULY 2019 | THE NETWORK
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