Suicide using curtain or shower rails by an inpatient in an acute mental health setting.
Main care setting
Inpatients in mental health units are at high risk of suicide, and hanging or strangulation is the most common method of suicide for this group. In 2000, the report An organisation with a memory highlighted the issue of collapsible rails. The following advice is available for providers to reduce this risk:
NHSE SN (2002) 01: Cubicle rail suspension system with load release support systems
This NHS Estates Safety Notice states that any cubicle track, curtain track, shower track and wardrobe rails with load release support systems must be maintained in accordance with manufacturers' instructions and subject to an annual safety load test.
NHSE (2004) 10: Bed cubicle rails, shower curtain rails and curtain rails in psychiatric in-patients settings
This NHS Estates Alert requires all NHS organisations to identify and remove all non-collapsible rails, and replace them with collapsible rails, and to identify other potential ligature points, for example windows, coat hooks, door closures, suspended ceiling tracks etc, and remove or neutralise these risks.
Clinical Guideline 16 – Self-harm: the short term physical and psychological management and secondary prevention of self-harm in primary and secondary care
This evidence-based guidance from the National Institute for Clinical Excellence (NICE) covers the general management of those who have already self-harmed.
DH (2007)08: Cubicle curtain track rails (anti-ligature)
This alert from the Estates and Facilities Division of the Department of Health encourages correct installation of rails to ensure that they collapse as intended.