Suicide Prevention Today
Mental health challenges and suicide have been lurking in the shadows of many cultures far back in recorded history. Unfortunately, the shadow still exists, and valuable lives are lost every year, some possibly preventable. In 2020, suicide was among the top 9 leading causes of death for people ages 10-64. Suicide was the second leading cause of death for people ages 10-14 and 25-34. These are depressing statistics to add to an already tricky topic: ligature-resistant door hardware.
However, the good news is that today, multiple educational, prevention, rehabilitation, and support organizations are available to help bring light to this shadow side of modern society. Also, the American Hospital Association (AHA) follows guidelines set by the American Society for Health Care Engineering (ASHE) and the Joint Commission. These guidelines include making patient rooms, bathrooms, corridors, and common patient care areas “ligature-resistant.”
These guidelines are for the psychiatric unit of a hospital but not the entire building. This protocol makes sense except when the behavioral beds are all filled. When this happens, the patient is placed in a “general population room.” These rooms are not ligature-resistant and leave open the possibility of a person self-harming.
Let’s add a new focus to Mental Health Awareness Month this May. What if there was one hardware application that could save lives? Implementing ligature-resistant door hardware to all hospital doors in healthcare centers that accept psychiatric patients could make a difference.
4 Good Reasons Why
- Lives Saved: Hospitals save lives daily and are an inherently valuable part of every community. However, an average of 1,500 suicides a year occur in hospitals nationwide. 75% of the time, these occur at a patient’s room door. Patients in mental distress will scan their space and assess ligature resistance. If they see a room with ligature-resistant products, they are often discouraged from self-harming.
- Safety: When talking about safety, we refer to taking measures in a hospital’s physical environment to prevent possible harm. Webster’s first definition of safety is “the condition of being safe; freedom from danger, risk, or injury.” So, if a patient is placed in a “general population room,” they scan the physical environment and realize the doors are ligature-resistant, then safety has occurred. All the work that went into installing ligature-resistant hardware resulted in success.
- Fewer Lawsuits: Although finding the exact number is challenging, lawsuits occur yearly against medical centers where someone felt a suicide could have been prevented. Recently, a 22-year-old woman was in a behavioral health unit. She left her room and was free to move about her floor. She went into the laundry room, tied off a bed sheet to a door lock, and fashioned a noose. She threw the bedsheet over the top of the door and died from suffocation. The hospital was found at fault for not having ligature-resistant door locks in the laundry room. As a result, they had to pay out $2.2 million.
- Best Practices: If medical centers chose the best practice of installing ligature-resistant hardware throughout their medical facility, they would know they are safe. Also, other facilities might adopt similar measures if they installed ligature-resistant hardware in general population rooms and had positive results. In the long run, this best practice could also lead to implementing more extensive architectural requirements for new build medical centers.
Why don’t hospitals have ligature-resistant door locks facility-wide?
A recent article written by the AHA called “Ligature Risk Requirements: Separating Fact From Fiction in Suicide Prevention” begins: “Few events in health care facilities are as catastrophic — and preventable — as a patient suicide. Yet data indicates that suicide incidents are a serious problem, which suggests that hospitals must do a better job identifying and monitoring patients at risk and removing the means to accomplish suicide in the physical environment.”
Not much information is available that directly explains why ligature-resistant doors have not been installed in medical centers facility-wide. However, here are some factors that we can consider.
- Cost and Efficiency: Even though ligature-resistant locks are still less expensive than many locks on the market today, the cost of purchasing and replacing all of the current door locks in a facility is still costly, extensive, and time-consuming.
- Regulations: Today, ligature-resistant environments are only required for behavioral health beds. These regulations come from the Joint Commission in alignment with SAMHSA, CMS, and ASHE, which are responsible for different aspects of the ligature-resistant environment in psychiatric inpatient care today.
- Social Change: Sociologists define social change as “Changes in human interactions and relationships that transform cultural and social institutions. These changes occur over time and often have profound and long-term consequences for society.” Suicide prevention today receives more media coverage than at any time historically. Maybe the attitude of “let’s not talk about it and pretend it doesn’t exist” is fading out due to the sheer increase in suicides today. A recent study found that up to 135 people are affected by every person lost to suicide.
In conclusion, there is no definitive reason why medical centers have not added ligature-resistant door hardware to all medical rooms. There is also no single solution we can implement to end suicide as a collective, but we can contribute through our voices, eyes, compassion, and community. By continuing to have a conversation about this topic with our local hospitals, community leaders, and each other, we can help save lives.
If you know of someone who needs help, please refer them to the National Suicide Prevention Hotline. Starting July 16, 2022, dialing 988 will connect you to the National Suicide Prevention network, which will provide you with access to the closest crisis center.