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Use of plastic bags for self harm | Signal

Reference number
Issue date25 March 2011

This Signal relates to the use of plastic bags for self-harm on inpatient mental health units. 
A sample incident reads:

“Patient engaged in 1:1 session, was tearful and expressing thoughts of self harm. At 20:00 she had barricaded herself in family room, lying on floor with cable wrapped around neck and plastic bag on head. Both removed and ambulance called - transferred to ED, returned to ward.”

Following the suicide of three patients using black plastic bags, a search of the National Learning and Reporting System (NRLS) was undertaken. Between January 2008 and May 2010 there were 131 reports describing self-harm incidents using plastic bags. It was identified that patients use these in two different ways:

• over the head in an attempt to suffocate;
• around the neck in an attempt to self strangulate or to use as a ligature.

Analysis of NRLS data was also undertaken by Len Bowers et al (2010, p.3). All incidents of attempted suicides occurring during 2009 on inpatient psychiatric wards (including some of the reports highlighted above) were reviewed to identify risk factors and the interventions that prevented self-harm or suicide. A total of 602 incidents were analysed and it was found that:


• the majority of attempts occurred in the bedroom;
• the majority of patients attempted to take their own life by strangulation;
• suicide attempts were more likely to occur in the evening;
• more women than men attempted to take their own life; and
• the majority of attempts were stopped by the actions of ward staff such as intermittent observations and medication rounds.


Len Bowers et al (2010, p.3) recommended units and staff to:

1. Increase checks (continue intermittent observations, i.e. in the evening and during handover, target bedrooms, bathrooms and toilets).
2. Be awake, be aware, trust your instincts (attend to obvious and subtle cues, check without hesitation).

In addition, ward areas should review their use of plastic bags. 

We would like to hear from you - please contact us with your initiatives to reduce risks in these areas.

Signals are notifications of key risks emerging from review of serious incidents reported to the NRLS and shared by the NPSA.