PRODUCT TESTING
A service-user determined to create a ligature might use anything from the underwire of a bra, to a broken CD, a paper clip, or dental floss. They might alternatively smuggle a credit card in to create heat friction to cut a section of rubber. Right: Some service-users will co-ordinate barricade scenarios to learn how the anti-barricade system operates.
example, one of the key things we looked at was ensuring that what we were doing was evidence-led. We thus looked at design guides in America, such as one co-created by US architectural practice, Architecture+ and the New York State Office of Mental Health. The Office has a product testing guide, Patient Safety Standards, Materials and Systems Guidelines, created with Architecture+ and one of the practice’s Partners, Francis Pitts, who led the development. The document is an online guide to products that are tested, and how they are rated.” This guide proved ‘one of the really significant inspiration points’ for the DiMHN and the BRE, because it set out desk-based exercises to assess the performance of various products. Philip Ross said: “There were other influential bodies we took a steer from – such as Veterans Affairs, one of the US’s largest mental healthcare providers, which looks after the mental health needs of military veterans. We also looked closely at the Behavioral Health Design Guide, authored by Jim Hunt, a US architect with significant experience in this field.”
What the product testing group really liked about much of the US guidance was the ability to carry out desk-based test evaluations when assessing the suitability of products. “One of the things we learned about ligature performance,” Philip Ross said, “was the need to consider the service-user’s planning. We thus looked at some examples in the US, and at a number of studies from Vladislav D Khokhlov, focusing on all the potential weight loadings you can create using various body and ligature positions. We thus considered some of the existing US testing frameworks, and the medical science on how you can and cannot create a ligature,
and then overlaid all of this with the input from our clinical and estates workshops in the UK.”
Four key anti-ligature criteria Having ‘considered the evidence’, the DiMHN/BRE concluded there were basically four key criteria when considering enacting ligature from a service-user perspective. Philip Ross elaborated: “Firstly, the more time somebody has by themselves, the more likely they are to be able to enact ligature successfully. There are varying levels of determination, potentially impacted by the different patient groups, the tools the service-user might have, and the degree of ingenuity they might employ. So, for example, they might have a toothbrush, but can they use that to tamper with another product to create a ligature?” Another criterion was not just the load, but the loading patterns, i.e. the considerations around ligatures at different heights and points. It was not, Philip Ross stressed, ‘as simple as connecting a cord; how someone creates a ligature connection will depend on the height of the anchor and the form of ligation pursued’. He explained: “We were trying to create categorisations around this, so, for example, with the ligature grading, we might look at the amount of time a service-user devotes to the task – it might be an impulse move with minimal planning, or the service-user may be ‘semi- determined’, or very determined, which might apply in the highest risk room in the mental healthcare unit. There is a time consideration to all these things; for instance with ‘impulse’, they have three minutes to consider and apply the ligature, with ‘semi-determined’, 20 minutes, and ‘determined’, 40 minutes. One of our test engineers would have set time limits as to
What the product testing group really liked about much of the US guidance was the ability to carry out desk-based test evaluations when assessing the suitability of products
14
how quickly they could try and create a ligature, and if the attempt fell into one category or the next, this identified how challenging and resistant the particular product is to ligature attempts.”
The tools people have access to Other elements within the anti-ligature categorisations would, Philip Ross explained, include the tools being used. He said: “One of the really significant aspects of the design workshops was actually understanding what ‘tools’ service-users in mental healthcare facilities have access to. For example, typical such tools might be tights or headphones, bedsheets or bath towels – things almost always present in every single room in a mental health facility. You then start getting into consideration of somebody ‘semi- determined’, who might use a shoelace, or sections of clothing; the tools start taking an ever broader form. They might smuggle a credit card in to create heat friction to cut a section of rubber. The ultimate level of determination might entail a service-user getting a bra and disconnecting the underwire, using a broken CD, a paper clip, or dental floss.” While some of these are restricted items, it was acknowledged at the design workshops that sometimes – even after being searched – service-users may get hold of items they shouldn’t. Philip Ross said: “That is why we have created these various categories and criteria.”
Simplified and summarised He added: “In the guidance, which has four main sections, we discuss all the different types of testing, but ultimately we simplify it and summarise it, so with the ligature grading, a grade from 1-5 is awarded – with ‘5’ the highest-performing. A product graded ‘5’ might typically go into a seclusion room, whereas for a typical Medium Secure bedroom, a Ligature 4 rated product may suffice. There will then be other areas – such as a communal lounge – where Ligature 2 products will be appropriate. We’re not stipulating that, for
JULY 2020 | THE NETWORK
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38
