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What is ligature?

Many healthcare professionals are not familiar with the term ligature and the many associated
terms. My name is Lee deLoache, and I am a mechanical engineer and founder of Behavioral Safety
Products. For seventeen years, I was the Senior Executive Director of Design and Construction for
Charter Behavioral Health Systems and had direct responsibility for design and construction of over
100 psychiatric hospitals in the US, Puerto Rico, and Europe.
During those seventeen years, I was copied on any incident report in the hospitals we operated.
Obviously, a lot can go on in a psychiatric hospital and many of the incidents were not my concern.
However, any incident involving the relationship between a patient and the physical plant was of great
concern to me. These mostly involved patients attempting to harm themselves in some way. Many
times this involved a style of hanging. Ligature, on the other hand, can be distinguished from hanging
by the strangling force being something other than the person’s full body weight. This type of
strangulation cuts off blood flow to the brain and can be done in many ways besides vertical hanging.
Much of the time, this leaves the patient with permanent brain damage, if not death.
Ligature is usually performed by tying something around the neck, and applying pressure by a
“tie off “ point. In the early days, this was usually a showerhead, which has been rectified in most
facilities now. If a high “tie off” point is not available, the patient may tie off to something lower –
even near floor level – and then lean away from the ligature point to achieve the suffocation/loss of
blood flow to the brain.
Behavioral Safety Products was conceived to design and produce hospital components that are
ligature resistant. We now offer a broad line of products, which will dramatically reduce the occurrence
of such an event. The Joint Commission refers to these events as a “sentinel event.” Our line of 77
products now appears in over 1,133 facilities. Although originally focused on the psychiatric/
behavioral industry, we now sell to many general, medical-surgical facilities as they see the need to
convert some or all areas to behavioral standards. We have visited hundreds of psychiatric/behavioral
and medical-surgical facilities over the past 31 years, and believe our first hand experience and
technical expertise is second to none.
Thank you for considering Behavioral Safety Products for your needs.