* EC: Protecting Patients from Self-Harm: Reducing the risks of suicide in a behavioral health care unit or facility requires careful planning and diligence  (PDF/QV) [REF: EOC, SFT] EC News, July 2015, Vol 18, #7, Pg 1 JCe1507_B3

The American Psychiatric Association estimates that approximately 1500 suicides will occur in inpatient settings every year.  “Seventy-five percent of inpatient suicides involve hanging (typically in the patient’s room), and another 20% involve patients jumping from a roof or window”. The Joint Commission lists suicide among the top four most frequent categories of reported several events.  As such, “suicide in inpatient settings is an increasingly serious concern” and presents an increasing need to more effectively identify environmental safety risks (EC.02.01.01, EPs 1/3) and maintain safe interior spaces (EC.02.06.01, EP 1).  This article highlights the value of using a patient-centric perspective that uses understanding of your current patient population’s risks.  It emphasizes the need for conducting a rigorous safety risk assessment that includes a proactive or predictive risk management process.  Such a tool (illustrated on page 3 of this article and page 14 of the Design Guide referenced below), lays out a 4-box grid of risk levels that would result as Risk/Intent for Self Harm/Suicide (Y Axis) progresses along a continuum of more to less patient observation/Privacy/Opportunity for Self Harm (X Axis). The article also lists a number of things that increase the risk for hanging such as:

• Projecting hardware, overhangs, pinch points and hinges associates with interior doors, cabinets and windows
• Exposed plumbing under and/or on top of toilets, sinks and showers. 

A sample Risk Assessment Checklist is included in a sidebar on page 4. Another resource specifically referenced is the National Association of Psychiatric Health Systems’s Design Guide for the Built Environment of Behavioral Health Facilities by James M. Hunt, AIA, NCARB, president of Behavioral Health Facility Consulting, and David M. Sine, ARM, CSP, CPHRM, president of SafetyLogic Systems. Its authors provide their experience and perspective on best environmental design practices for behavioral health facilities and lists of products that have been found to be more safe.
Tip: Every Director of Engineering should download Edition 7.0 of the Design Guide for the Built Environment of Behavioral Health Facilities, distributed by The Facility Guidelines Institute.
Tip: Be sure to utilize a Risk Assessment Checklist when conducting safety risk assessment/environmental safety rounds (EC.04.01.01, EPs 12/14). Compare your checklist for completeness with the items highlighted in this article and/or the Mental Health Environment of Care Checklist also found in our SPHCC Resources: Suicide & Self-Harm/Injury (Assessment, Treatment & Prevention)