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Patient safety supplement

Reducing ligature risks from plastic bags

Published on: 23/04/2026

This Patient Safety Supplement aims to raise staff awareness of the risk of self‑harm with people using plastic bags as ligatures in HSE and HSE‑funded services, including emergency care. A ligature is an item used for tying or binding something tightly.

To help prevent the risk of self-harm from bin bags or liners, this supplement will share alternative product options, including for sanitary bins. These options are based on learning from a number of our mental health services across the country.

All services should continue to risk assess their own area, particularly high-risk areas such as unsupervised and/or areas with low footfall. It is essential to identify any potential risk from any plastic bag, including all bin bags and liners and any rolls of plastic bags not in use.

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This Patient Safety Supplement aims to raise staff awareness of the risk of self‑harm with people using plastic bags as ligatures in HSE and HSE‑funded services, including emergency care. A ligature is an item used for tying or binding something tightly.

To help prevent the risk of self-harm from bin bags or liners, this supplement will share alternative product options, including for sanitary bins. These options are based on learning from a number of our mental health services across the country.

All services should continue to risk assess their own area, particularly high-risk areas such as unsupervised and/or areas with low footfall. It is essential to identify any potential risk from any plastic bag, including all bin bags and liners and any rolls of plastic bags not in use.

What is incident data telling us?

Data from the National Incident Management System (NIMS) on deliberate self-harm incidents and near misses from 2019-2024 in HSE and HSE funded services reported use of plastic bags as ligature points in more than (>) 130 Incidents/Near Misses, including two deaths.

  • Incidents/Near Misses occurred across acute mental health units, acute hospitals and community settings.
    • In > 74% of cases the person experienced harm or attempted to harm themselves, two people died as a result while in-patients
    • In > 22% of cases the person reported an intention to self-harm with a plastic bag
    • In almost 4% of cases the person was observed to be in possession of a plastic bag.
  • Findings included:
    • Types of bags used were bin bags, sanitary bin liners, linen bags, property bags and shopping bags
    • Incidents/Near Misses often occurred in typically unobserved areas such as bedrooms or bathrooms
    • Bags were also taken at opportunistic moments such as from cleaners’ trolleys or from rolls of plastic bags left unattended.

Prevention/Be prepared

Staff Preparation and Training

Have all relevant staff been:

  • brought up to date on the person’s history and preferences for care
  • trained in risk assessment and prevention of self-harm. See https://traininghub.nosp.ie/
  • informed of their obligations to access and adhere to relevant policies and guidelines. See section ‘Where can I get more information?’
  • Informed of their responsibility to report all incidents and near-misses involving ligatures or ligature anchor points on NIMS

Risk Assessment

  • Are staff up to date on the person’s current risk assessment and collaborative risk management plan?
  • Have alternatives to all plastic bag use been sought where possible, especially in unsupervised areas and low footfall areas? See Appendix 1
  • Is the local area regularly checked to determine if plastic bags have been safely stored away from service users, and for the potential access to these bags?
  • Are measures in place to reduce this risk, have these measures been communicated to staff, including clinical and non-clinical staff (e.g. household services staff) and visitors?

Ligature Risk Reduction Audit

Prevention Awareness

  • Staff within an approved centre and throughout all mental health services should remain alert to ligatures and ligature anchor points. It is impossible to eliminate all potential ligatures and ligature anchor points. It is therefore necessary for structured judgement based on documented risk assessment to identify the likelihood of an item being utilised as a ligature point, and to identify the potential opportunity for a service user to utilise it in that manner
  • Involve family/significant others where appropriate in prevention awareness, if consented to by the service user. Family/significant others will know; to be vigilant for risks, not bring items in plastic bags when visiting, or of the availability of paper bags at entry to units to put items into etc.

Sharing Learning

  • Learning from audits, near misses and incidents should be shared (locally, regionally, nationally) to support continuous improvement. Link with your local Quality and Patient Safety (QPS) staff to determine the most effective way to develop and communicate the learning to all relevant staff

Consider Alternatives

See Appendix 1

Compassion and Kindness

Preventative risk assessments and taking steps to remove potential sources for self-harm for service users are essential. While safety planning is vital, it should be collaborative, empowering the person rather than imposing control. Additionally, as important, is showing compassion and kindness and spending time with people in crisis to listen and talk to them, to help understand their situation. A therapeutic relationship, built on trust and mutual respect will help create a safe environment for people.

Showing genuine human connection can often ease tension, strengthen relationships, and improve morale, contributing to a positive and resilient healthcare culture. Without fully appreciating a person’s reason for, and motivation to self-harm reduces the chance to prevent it recurring. It is important to identify potential ligature risk points but also know what might trigger the person as an individual, and look out for the signs that the person is struggling.

A user of our mental health services explained that if a person is in crisis and one potential ligature risk is removed but the problem isn’t fully addressed, then the person will likely look for another option to harm themselves. Compassion means recognising the person behind the illness, understanding their distress, and responding with genuine concern rather than focusing solely on risk management. Kindness is demonstrated through tone, body language, and patience.

Using simple gestures such as listening, maintaining eye contact, speaking calmly, not rushing and allowing time for responses can help reduce a person’s anxiety and therefore encourage them to talk about what they are struggling with. Healthcare providers who use active listening and show empathy and understanding help people feel understood and valued, enhancing their therapeutic engagement. This engagement empowers people to set realistic goals, make informed decisions, and actively participate in their own care and recovery.

It is essential that mental health services engage in ongoing anti-ligature processes that are used to actively reduce environmental risks, such as anchor points and other potential ligatures that are accessible to individuals. However, simultaneously promoting therapeutic interventions aimed at alleviating any immediate risk and supporting the service user on their journey of recovery is important. Training in mindfulness and compassion in a professional capacity could be explored to support this further.

What to consider when ordering new products

  • Manage the required stock to maintain supplies. Local services must:
    • Work with local procurement teams to plan for local stock requirements and organisational readiness. Agree a timeline for transition to new lower risk products. See Appendix 1 for options
    • Consider existing contracts
  • Communicate with and prepare all relevant staff
    • Clearly communicate any agreed changes to relevant staff
    • Ensure all relevant policies, procedures and training resources/material are updated with reference to the use of new products. Consider staff training needs
  • Ensure National Financial Regulations, B1 Procurement are followed

Where can I get more information?

Refer to and follow any local guidance or policies on ligature risk reduction. For additional information, please see below:

This Patient Safety Supplement was co-developed by:

  • A Service User with lived experience
  • Health Service Executive:
    • Estates
    • Mental Health Services
    • National Quality and Patient Safety - Incident Management & Patient Safety Together
    • Quality, Patient Safety & Service Improvement
  • Office of Government Procurement

Approved by the HSE National Patient Safety Alerts Committee and the National Clinical Lead, NQPS

For further information on Patient Safety Supplements, see www.hse.ie/pst

All feedback on content or format of this supplement is welcome and can be sent to patientsafetytogether@hse.ie

Appendix 1 - Alternative options to plastic bin bags and/or liners (this list is not exhaustive)

Prior to use, all options should be risk assessed before use within local/service context.

Single Patient Product

Eclipse Extra Disposable Event Unit

  • An easily constructed cardboard sanitary disposal unit designed for one-off use.
  • Will require assembly by local services before use
  • Available from PHS Washrooms - 01 643 4680 / productinfo@phswashrooms.ie / www.phswashrooms.ie

No Plastic Bag Bins

Eclipse Xtra Bin

Sanitary bin with soft cardboard liner – not visible when lid is attached. Plastic ties can be used to secure the lid (if preferred). However, their use should be considered within the local risk assessment framework, as they may present a potential ligature anchor if incorrectly fitted or used. Where plastic ties are correctly secured and the bin is not fixed, the assessed ligature risk is low.

  • Smaller capacity
  • The company provides the disposal service
  • Available from PHS Washrooms - 01 643 4680 / productinfo@phswashrooms.ie / www.phswashrooms.ie

Tamper Proof Bins

Securabin - manufactured by Ovogard

42 Litre Mental Health Bin

  • The Mental Health Bin with 42 litre capacity is a purpose-designed waste unit for use in hospitals and clinical settings where added safety and security is required.
  • Currently being used in an approved centre
  • Available from Wybone

Bin Cleaning Service – no bag or liner required

Individual services can come to local arrangement with their service providers.

Other products and options

Are available (list is not exhaustive) at:

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