Special Needs of Specialty Facilities

March 2, 2024
In addition to general safety and security, the goal of ligature-resistant hardware is to protect patients from self-harm.

Ligature-resistant hardware is aimed at life safety, specifically the prevention of self-harm in behavioral facilities and correctional institutions. A ligature is something used for tying or binding, and a knob or handle naturally provides a strong ligature point by protruding out from a door. Creating a safe behavioral health environment requires selection of door hardware that is free from sharp edges or potential catch points.

Ligature-resistant door hardware features rounded surfaces and low profiles that are designed to secure rooms without presenting potential safety hazards. The hardware uses sloped escutcheon and handle designs, so anything attached will slide off. Levers aren’t fixed but spin freely when locked or rotate enough to further resist having something tied to them, staying on when enough weight is applied. Tolerances on the hardware itself have to be tight, so a person can’t jam something as small as a paper clip into a crack to create a ligature.

These environments can also be equipped with ligature-resistant doors and frames that enable staff to gain rapid access to a room and hinges that cannot be accessed from inside.

Ligature-resistant door hardware is a relatively new phenomenon in the security industry; so new, in fact, that an ANSI/BHMA standard for such hardware didn’t even exist 10 years ago.

This is a primary consideration at behavioral-health facilities as well as prisons and other correctional institutions, where attempted suicides are a big risk.

The latest handle designs typically are a solid D shape, so nothing can be looped through it. These products are deemed five-point ligature-resistant, because they resist having something tied to them in five directions: up, down, left, right and straight out, says Bill Sporre, senior vice president of sales for Marks USA.

“That’s brand new,” he says of five-point ligature resistance. “When I say ‘brand new,’ it’s been out for a couple of years, but it’s the direction that a lot of hospitals are going.”

Allegion’s extensive 2022 Healthcare Trends report noted that accommodating behavioral health patients is becoming more of a focus for healthcare facilities. “Many facilities (nearly 60%) are experiencing an increase in patients requiring rooms with ligature resistant hardware, which is specifically designed to reduce the risk of strangulation. This is a 7% increase from five years ago and could be affected by the impact of the COVID-19 pandemic, which was cited among the drivers of the increased need for this safety hardware,” the report found.


Code Considerations

Behavioral healthcare facilities and jails and prisons are the exception to the rule and understandably one of the few instances where free egress is not mandated. Instead, controlled egress locks are permitted on doors serving some types of healthcare units. 

According to Allegion and idighardware.com’s Lori Greene article, FAQs About Controlled Egress Locks in Health Care Facilities, the determining factor is that the patients within these units require containment for their safety or security.  Memory care units are a common location, as well as maternity, pediatrics, behavioral health, and in some cases, the emergency department. The types of units are not specifically called out in the model codes, so it is up to the Authority Having Jurisdiction (AHJ) to decide where controlled egress locks are acceptable.

There must be a method and plan for unlocking the doors for egress in an emergency like a fire; life safety must be protected. Clinical staff members must carry the keys or credentials to unlock the doors if evacuation is needed. Controlled egress doors must unlock automatically for egress upon activation of the fire alarm or sprinkler system, upon power failure, and in some cases via a remote release switch. Both sets of model codes allow some of the automatic release methods to be omitted on doors serving areas where specialized security measures are needed, including behavioral health units and maternity areas where listed child abduction systems are in use.

More information: https://idighardware.com/2022/03/faqs-about-controlled-egress-locks-in-health-care-facilities/

The Joint Commission (known colloquially as JHACO), which oversees and licenses hospitals, including behavioral-health hospitals, is migrating psychiatric hospitals to a five-point ligature-resistant lock. However, the Joint Commission makes no specific recommendation about ligature-resistant hardware, just that hospitals have it.

The Builders Hardware Manufacturers Association (BHMA) created a standard for bored and mortise locks that have ligature-resistant trim, A156.34-2019 being the most recent version, and manufacturers can test their locks against that.

NY-OMH certification from the New York State Office of Mental Health (OMH), which publishes a large volume of guidelines for a broad range of products aimed at ensuring patient safety, including door hardware but also closet bars, showerheads and even thermostats. Although meant only as recommendations for New York facilities, the guidelines are referred to nationwide. There’s more to OMH certification than just a seal of approval. In its guidelines, OMH notes three levels of risk: low, medium and high:

  • A low-risk area is one a patient won’t use or where patients are supervised constantly.
  • A medium-risk area is one where patient access is controlled or where patients are supervised without any solitary use.
  • A high-risk area is one where a patient will be unsupervised, such as their own room.

Proper selection of doors and hardware can help protect patients from harm and maintain a level of security for others, including professional and clinical staff.  Ultimately the product choice is up to the facility. Here are some of the options on the market.


Ceco and Curries

Solutions begin with the door and frame. The Patient Room Access Door from ASSA ABLOY brands Ceco Door Products and Curries is described as having the security and dependability required for healthcare facilities, plus being aesthetically pleasing to enhance a healing environment. It is intended to give caretakers or authorized personnel access to patient rooms in case of an emergency. The main door operates as an in-swinging patient room door while the inner door opens to the corridor, giving authorized personnel quick access to the patient room if main door is blocked or barricaded.

Additional features include eased edges for safety, standard top caps for security and the astragal applied to the face of the door for privacy.  More info: ww.cecodoorcontrols.com


Corbin Russwin and Sargent

Corbin Russwin and Sargent offer a wide variety of BHW/BHSS ligature resistant trim, including integrated low-profile trim, lever trim, push/pull paddle trim for use on mortise or bored locks and detention knob trim is designed for safety and security by eliminating catch points with a tapered knob recessed into the rose. Available as sectional trim, the anti-harm knob features recessed finger holes for a better grip and is ideal for psychiatric or detention facilities.

More info: www.corbinrusswin.com and www.sargentlock.com


Marks USA LifeSaver Series

The latest addition to Marks’ venerable LifeSaver Series of ligature-resistant hardware, the D-Lig Slide, features a five-point ligature-resistant slide trim handle. Sporre says the handle was a natural evolution of the company’s ligature-resistance hardware.

“There’s all these other little things that you have to think about besides being ligature-resistant,” Sporresays. “You have to be able to grab the door and close it and open it.”

Both versions meet BHMA 156.34 for ligature resistance and are rated Grade 1 for cylindrical (195BH) and mortise (5BH) locking versions, respectively. The mortise version has several options, including a ligature-resistant thumbturn for privacy applications that adhere to Americans with Disabilities Act (ADA) guidelines. An antimicrobial coating is available.

Keying: 6-pin Marks “C” keyway, interchangeable core and all OEM cylinder preps, Marks Hi-Security Cylinder available

The full LifeSaver line includes cylindrical, mortise styles, models and functions available, including electrified units, ideal for buzz-in and man-trap applications, plus antimicrobial finishes. With easy installation, they retrofit all popular preps and door constructions. 

More info: marksusa.com


Securitech SOLIS

The first thing anyone notices about the SOLIS, Securitech’s latest piece of ligature-resistant hardware, is that the white handle made of antimicrobial polycarbonate doesn’t look as though it belongs in an institutional setting. The SOLIS has a profile of only 2-1/4 inches off the door.

The SOLIS also has life safety firmly in mind by providing five-point ligature resistance in what Securitech calls a levered lockset. It’s available keyed or keyless in cylinder and mortise versions. The mortise version has a ligature-resistant thumbturn available for privacy applications as well as a deadbolt option. The handle requires less than 5 pounds of force to depress, which makes it comply with ADA regulations and ANSI 117.1. The SOLIS is available as a retrofit option to existing mortise locks. Keying: 6- or 7-pin small-format interchangeable core

Securitech has long been offering products for the behavioral health market. Other product lines include a4L ligature-resistant locksets, Daisy top-of-door alarm sensors used in conjunction with a smooth full-length anti-ligature continuous hinge and seclusion room locks.

More info: securitech.com



The SPSL Series by dormakaba brand BEST comes in a variety of options for maximum applications, including privacy functionality for patient rooms.

The lever has only a 1-3/4-inch profile off the face of the door, and it’s free moving in both directions for additional safety. Also, the locksets comply with the spirit of ADA by eliminating “pinch and grasp” motions. The result provides patients and staff with easy-to-operate hardware.

The SPSL comes in cylindrical or mortise versions, although the cylindrical version comes keyless only. However, the mortise version includes electrified options (SPSE) for fail-safe or fail-secure egress on one or both sides of a door, as well as request-to-exit, door-position monitoring and latch-position monitoring if connected to an access control system.

Keying: 7-pin small-format interchangeable core

More info: www.bestaccess.com


Markar DSH1000

The hinge presents a prime location for a ligature, particularly when a door is open. To protect against that possibility, ASSA ABLOY brand Markar offers the DSH1000. The DSH1000 not only provides ligature resistance as a continuous hinge, but it also can be employed as part of an anti-barricade strategy, because it allows a door to swing in either direction up to 100 degrees.

As for the DSH1000, its pin-and-barrel design supports door weights of up to 600 pounds, and it has a hinge frame and door leaf offset of three-thirty-seconds of an inch, which helps to reduce ligature points at the top of the opening. It’s available in lengths of 84, 96 and 120 inches.

In addition, the DSH1000 has an optional electrified module that allows for easy access to wires without having to remove a door from the frame.

More info: www.assaabloydooraccessories.us


Schlage HSLR Series

The HSLR Series from Allegion brand Schlage, which features a D-shaped sliding handle in cylindrical and mortise versions, is a good example of OMH’s influence on the industry. The HSLR carries OMH’s newer paper clip rating, which indicates that it resists attempts to create a ligature through the use of a paper clip.

A variety of options are available for either lockset, including electrification. Schlage notes that the handle complies with ADA for no pinching or grabbing, and both locks are Grade 1 certified for their respective BHMA standards.

Keying: 6-pin patented Schlage Everest 29, additional options available

More info: us.allegion.com


TownSteel MXR-A, CXR-A series

TownSteel was the first company in the industry to provide a ligature-resistant levered cylindrical lock — a significant breakthrough. The company has advanced to five-point ligature-resistant hardware, in mortise (MXR-A) and cylinder (CXR-A) versions. That the locksets and handles achieve the highest standard for ligature resistance — OMH’s paper-clip standard — is because of two things: design and manufacturing, Ma says.

Both versions are BHMA Grade 1 certified and come with multiple optional variations, including electrification (XMXR-A) and an auxiliary deadlatch for the mortise version. The mortise version also has through-bolt mounting in addition to the temper-resistant mounting screws that come with the cylinder version. Both versions meet ADA standards.

Keying: 6-pin Schlage C keyway, other OEM interchangeable cores, 6-pin TownSteel L high-security keyway available

More info: townsteel.com


ABH Manufacturing

Architectural Builders Hardware Mfg. Inc.’s (ABH) line of ligature-resistant hardware includes two specialty hinges – the A507 Double Swing Ligature Resistant Barricade Hinge and the A507-AT Double Swing Alarm Top Ligature Resistant Barricade Hinge – Both approved by the New York Office of Mental Health for Behavioral Health Facilities.

Other products include the ligature-resistant wall bumper and wall stop, two models of ligature-resistant pulls and a ligature-resistant, flush-mount electromagnetic door holder.

More info: www.abhmfg.com


For More Information

Here are some recommended resources.