Imagine being incarcerated, under compulsory care, for an undefined period of time. Some people have that experience, most don't. What does it mean to not have access to your personal belongings, your bed, walk-in closet, and all everyday artifacts that manifest and present the "self" ? Therefore, how you dress in a setting which is far from "home" is an important factor of presenting and maintaining your identity. However, if you can't take care of your favorite dress, or t-shirt, and must shove them into a shelf, or throw them in a pile on the floor, they will not keep well and a sense of "violation" of your personal belongings may occur. Many patients and clients in compulsory care express strongly that they feel belittled and restricted when they can't store their clothes well. Therefore, we have designed a safe clothes hanger system that can be used in institutions where there is risk of self-harm, weaponizing, and suicide by ordinary clothes hangers.

We apply a user centered design method with the individual in focus, clinical tests, and co-development with clients. We do academic research which involves fieldwork, which has given us a deeper understanding and respect for the people's lived experience inside an institution. We challenge the perception of "the dichotomy" between security or a well-designed "normalized" interior, and we advocate that it is possible to unite both when designing a healing environment.

Healsafe Interiör/HealSafe Interior Inc is a Swedish design company with focus on evidence-based design as a method to develop risk reducing and suicide resistant interiors. Our products are used for challenging environments such as psychiatric hospitals for adults or children, forensic psychiatric hospitals, behavioral health, correctional services and other public environments where safety- and self-harm prevention is crucial for both patients/clients, and not least, staff.

The J-trac hanger system consists of a rail which is secured safely to the inner top of the wardrobe. The rail's end caps are angled and hinder to fasten a ligature between the side and the endcap. A snug fit and open angles that don't create a cavity will stop e.g. a string or a sheet to be fastened. The hanger consists of two parts: the disc, which clips to the rail, is designed to offer an interchangeable system of hangers. The disc can is to be opened to replace or change material of the hanger; either card board or a robust but soft polyurethane foam.

• One hanger releases at 4 kg. However, due to the design with the cross on the disc, 5 hangers gathered together by tying a string around them, release from the rail at a load of 8 kg (!) (RISE, Research Institute of Sweden). This is different to all other hangers on the market. The risk load for strangling is often set to 15-20 kg, but differs from institution to institution. There are no standards set in any country to our knowledge and no global standard.

There is a false perception and myth that an interrupted suicide attempt is of no use since the person is determined to take his or her life, and will pursue attempts until a suicide is completed. Research shows that suicide attempts are committed in an "acute" situation of extreme anxiety, if the attempt is stopped, the person will with time return to a "non-acute" situation and many times never perform a suicide attempt again (1-3). Completed suicides can unfortunately be accidents where the person's action was a desperate act to get help but lost control.

HealSafe Interiör/HealSafe Interior Inc is a Swedish company in a scale-up phase and run as a project with 11 internal self-employed collaborators dealing with product development, 3rd party manufacturing (all in Sweden) and marketing & sales. We have in the past decade developed products such as anti-ligature curtain systems, safety furniture, beds, anti-ligature hooks, storage details and self-harm reducing utensils. We currently sell directly or via distributors in Sweden, Denmark, Norway, UK, Holland, United States, Canada and Australia. The amazing feedback we get from our customers and users is a great support to us to continue our quest. We are grateful to be seen rather as problem solvers than an ordinary "sales company".

We always develop products based on unmet needs in close collaboration with stakeholders and customers. It's common for us to be consultants to architects, facilities and governmental agencies. For the hanger development the need was identified together with customers in the UK and Sweden during an iterative process. The J-trac hanger system has been developed under a long period through testing a number of different materials and a range of technical solutions. We mainly make prototypes by hand in our workshop which we combine with 3D printing, molding, and sometimes simplified plastic injection tooling. Together with material specialists we use materials that have a long-life span, are impact resistant, and follow strict hygiene standards. Unfortunately, bio-plastics are not there yet, but we are involved in material development projects to increase the use of renewable polymers. The process from the dialogue with facilities regarding their problem with patient's and staff's unmet needs to clinical testing has resulted in understanding that the needs are different depending on patient/client group, hence the design of the clothes hanger that offers different materials the hanger can be fitted with. Cardboard is common in high-risk environments and can be printed on to give a "non-institutional" design. Polyurethane foam is extremely robust, resistant to alcohol- and other detergents which must be used in many hospitals, polyurethane foam is made to last (almost forever) which is important for sustainability and to the strict budgets most facilities strive with.

Clothes hangers are often avoided since hangers and rails are identified as potential ligature points with the risk for the clients committing suicide by attaching a string or similar, strangling themselves. Standard wooden or plastic hangers can be weaponized or used for self-harm. Injuries to staff unfortunately occur fairly often, this leaves fewer staff to care for patients and clients, creates an unattractive workplace which is negative for recruiting, and is a personal physical and psychological disaster for many staff members.

Patient/client autonomy, to be able to control your physical environment, is one of the mostimportant factors of Evidence Based Design, EBD. Patient/client autonomy is therefore essential when designing healing environments. Home-like characteristics is an effective design contribution when it comes to design of patient rooms or cells. Autonomy and environmental features contribute to well-being by reducing stress levels which foster decreased levels of aggression, fewer reported bed restraints, less use of medicine, and thereby increase the potential for healing (4). Patient rooms and cells that offer space for storage that contribute to the normality of caring for your personal belongings is many times lacking in psychiatric hospitals, forensic psychiatric hospitals, youth homes and prisons. Clutter is also a challenge to handle for people e.g. within the autism spectrum, a diagnosis overly represented in forensic psychiatric hospitals, youth homes and prisons. Due to the risk of self-harm and suicide attempts there is commonly a lack of normal storage which gives combined with a hard and harsh interior design. This design failure is often expressed by patients since it unfortunately strengthens their lack of well-being (5). In these settings it is difficult to obtain the "self" -your personal identity.

An institution's routines and physical environment is known to make an ordinary everyday life difficult, through incarceration or compulsory care as well as illness and ill-being, the "self" tends to slowly deteriorate (6). In these scarce settings, with very few personal items, one of the few ways to keep the "self" is through your appearance, how you dress is important as a means to express your identity (7,8). It is therefore vital to be able to store and keep garments in good shape, to present yourself as the person you are.

The J-trac hanger system offers the function of hanging clothes in the best way by a well-designed hanger that can hold several garments for both men and women. The good news is that the hanger's normalized design holds the function to reduce ligature risk, prevent (as far as possible) the risk of self-harm behavior and diminish the risk of violence (DSH) such as cutting. Hence, the "self" can at least be supported by a dignified function of giving your "second skin", your clothes, a little love and caring.

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2. O'Connor RC. Suicidal Behavior as a Cry of Pain: Test of a Psychological Model. Archives of Suicide Research. 2003;7(4):297-308.

3. Ramsay R. Cry of Pain: Understanding Suicide and Self-harm. Journal of the Royal Society of Medicine. 1998;91(3):171-2.

4. Ulrich RS, Bogren L, Gardiner SK, Lundin S. Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology. 2018;57:53-66.

5. Olausson S, Danielson E, Berglund Johansson I, Wijk H. The meanings of place and space in forensic psychiatric care – A qualitative study reflecting patients' point of view. International Journal Of Mental Health Nursing, 2018. 2018.

6. Goffman E. Asylums: essays on the social situation of mental patients and other inmates. New York Penguin books; 1961.

7. Moran D, Pallot J, Piacentini L. Lipstick, lace, and longing: Constructions of femininity inside a Russian prison. Environment and Planning D: Society and Space.2009;27(4):700-20

8. Miller D. Stuff. Cambridge ; Malden: Cambridge ; Malden : Polity Press; 2010.