Suicide risks found in nearly half of A&E and mental health wards

The CQC has found that a number of A&E departments and mental health wards have ligature risks

11th June 2024 about a 3 minute read
"NHS leaders are keen for an incoming government to increase capital spending to at least £14.1bn annually. HSJ’s findings alongside broader concerns about ageing estate show why mental health needs to be a core focus of this.” Sean Duggan, chief executive, NHS Confederation’s mental health network

Nearly half of Care Quality Commission (CQC) inspection reports into A&E departments and mental health wards have raised concerns over ligature risks for vulnerable patients, according to an analysis by the publication HSJ.

HSJ’s analysis of reports carried out in the past six months found that concerns about ligature risks were mentioned in at least 11 out of 25 reports published since November last year.

The reports highlight a lack of adaptations to fixtures and equipment, or a lack of safeguards against these being used as anchor points for patients to harm themselves.

Mental health rooms in A&E departments identified in the reports as containing ligature risks include the Queen Elizabeth Hospital in Birmingham, the Countess of Chester Hospital, and the County Hospital in Hereford. At the County Hospital, which is run by Wye Valley Trust, inspectors also found that patients could lock the room from the inside.

Potential ligature points and out-of-date risk assessments were also identified at South West Yorkshire Partnership’s forensic wards. The trust said it had taken action to address the problem.

Trust fined for failing to manage ligature risks

The presence of ligature points and lack of assessments for them have been raised in high-profile cases of harm and deaths, such as the independent review into Greater Manchester Mental Health Trust, where concerns about ligatures have been raised repeatedly. Essex Partnership University Foundation Trust was fined £1.5m in 2021 for failing to manage risks from potential fixed ligature points relating to the deaths of 11 patients.

In a national confidential inquiry into suicide and safety in mental health in 2022, experts wrote that ligature points were directly linked to an increased likelihood of death. The report found 1,109 in-patient deaths by suicide in 2009-2019, and noted that the overwhelming majority (80%) of mental health inpatients who die on the ward do so by hanging or strangulation.

According to the report: “Between 2009 and 2014 there were on average 32 deaths per year by hanging/strangulation on the ward but since 2015 the number has fallen to an average of 20 deaths per year (Figure 13). Many (230, 95%) are from low-lying ligature points (i.e. strangulation) but also include deaths by strangulation with no ligature point (i.e. self-strangulation).” The report added that the most common ligature points were doors or windows, and the most common ligatures were a belt or sheets and towels.

The 11 trusts where the CQC found suicide risks were:

Countess of Chester

Doncaster and Bassetlaw Teaching Hospitals

Wye Valley Trust

University Hospitals Birmingham FT (Queen Elizabeth Hospital)

University Hospitals Birmingham FT (Good Hope Hospital)

South London and Maudsley FT

East Kent Hospitals University FT

South West Yorkshire Partnership

Lancashire Teaching Hospitals FT

Derbyshire Healthcare

Barking, Havering and Redbridge University Hospitals Trust

Saffron Cordery, NHS Providers deputy chief executive, said that insufficient capital funding and budget raids meant trusts were facing challenges over ligature risks.

Sean Duggan, chief executive of the NHS Confederation’s mental health network, commented: “NHS leaders are keen for an incoming government to increase capital spending to at least £14.1bn annually.

HSJ’s findings alongside broader concerns about ageing estate show why mental health needs to be a core focus of this.”

An NHS spokeswoman said that organisations are expected to implement guidance for mental health facilities which it has produced with the CQC alongside local risk assessments.

FCC Insight

Suicide is a known risk for patients in both A&E and psychiatric wards, with 1,109 in-patient deaths by suicide in the period 2009-2019. The majority of suicides are by hanging or strangulation, which means that managing the risk involves removing ligature points in hospitals. Although NHS trusts are short of money for infrastructure work, it is difficult to understand why removing ligature points would not be a priority, if it could save 100 lives a year. Hospitals, in particular mental health trusts, need to address this issue as a matter of urgency.