title: Ligature points and ligature types used by psychiatric inpatients who die by hanging: a national study.
abstract: BACKGROUND
  Approximately three-quarters of patients who die by suicide on psychiatric wards do so by hanging/strangulation. Increased awareness of the methods used by these patients may benefit prevention strategies in mental health services.
  
  
  OBJECTIVE
  To describe the ligature points and ligatures used in ward hangings; to identify any trends over time in ligature points and ligatures used; and to compare these patient characteristics with other inpatient suicides.
  
  
  METHODS
  A national clinical survey of suicide cases in recent (<1 year) contact with mental health services in England and Wales (1999-2007).
  
  
  RESULTS
  Of the 448 suicides that occured on psychiatric wards, 77% were by hanging. The number of hanging cases, however, has fallen by 74% since 1999. The most common ligature points and ligatures were doors, hooks/handles, windows, and belts or sheets/towels, respectively. Use of shoelaces, doors, and windows increased over time. These patient suicides had had high rates of self-harm, alcohol/drug misuse, and were more likely than other cases to have died early in admission and been formally detained for treatment.
  
  
  CONCLUSIONS
  Despite the decrease in inpatient suicides by hanging, regular reviews of ward structures are needed, particularly as ligatures and ligature points change over time. Improving the ward environment to engage patients, especially early in admission, may also contribute to reducing risk.
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Risk, University of Manchester, Manchester, UK. Isabelle.m.hunt@manchester.ac.uk
authors.forename: Isabelle M
authors.initials: IM
authors.lastname: Hunt
authors.forename: Kirsten
authors.initials: K
authors.lastname: Windfuhr
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
mesh_terms: D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D011567:Psychiatric Department, Hospital; D013405:Suicide / Q000706:statistics & numerical data; D014852:Wales / Q000453:epidemiology