Is anti-ligature an automatic requirement for suicide prevention?: Assessing legal obligations in alternative mental health crisis services

Around the world, peer-run, bed-based services that offer voluntary support to people experiencing mental health crisis are emerging as alternatives to hospital-based mental healthcare. In Victoria, Australia, where these 'alternative crisis services' are expanding, a key legal question has arisen: must non-coercive settings adopt the suicide prevention architectural design (or 'anti-ligature design') mandated in psychiatric wards under negligence and occupational health and safety laws? This article answers that question through a three-stage study: (1) a doctrinal analysis of Victorian case law and statutes that shape duties to prevent suicide; (2) a narrative review of evidence on anti-ligature measures in hospital environments; and (3) thematic analysis of interviews with clinicians, designers, peer leaders and legal experts (n = 12). The findings indicate that empirical evidence only associates anti-ligature design with reduced suicide rates when paired with search, detention and close observation powers, which are absent from alternative crisis services. There was no evidence identified that anti-ligature design will reduce suicide in settings which do not also implement these practices. This absence of data does not justify retreat to institutional templates, especially considering key differences in the care models that differentiate alternative crisis services from traditional hospital-based offerings. Interviewees warned that conspicuous anti-ligature hardware can undermine the therapeutic value of alternative crisis services, and merely displace, rather than prevent, suicidal behaviour. Wholesale transplantation of hospital anti-ligature standards into alternative crisis services is therefore unlikely to satisfy the 'reasonableness' test and may contravene the therapeutic mandate of services. Instead, this study calls for regulators to endorse context-specific standards for mental health service design, some of which may require further empirical research on rights-based, peer-led safety strategies.