Coercive practices such as mechanical restraint, seclusion (detention in a locked room) and rapid tranquilisation are still widely used in mental health in-patient services around the world to manage crisis situations. Their implementation has a serious impact on psychological and physical wellbeing of both patients and staff and certain procedures have been classified as a form of torture by some agencies and patient groups. Reduction and elimination of coercive practice has become a policy priority in all European countries in the past decade and various interventions have been developed to give staff alternative approaches for preventing and managing crisis situations. Six Core Strategies (6CS) is an American model of organisational change which has been tested in the USA, Finland, Australia and the UK with evidence of effectiveness in reducing coercive practice across health systems. These preliminary studies have so far only taken place in high-income countries, mostly at relatively small scale in single centres. No attempt has been made previously to implement 6CS in a low- or middle-income country where there is potential for its adoption at scale across multiple centres and services.
1 translation of 6CS for the relevant countries
2 sign-up for implementation at the outset by mental health service leaders and managers
3 sustained adoption of 6CS at scale in the selected services
4 baseline and post-implementation collection of quantitative and qualitative data for evaluation of outcomes
5 process data on acceptability/feasibility
6 consultation with stakeholders in India about the feasibility of adaptation
7 effective dissemination of findings on feasibility (RO, ME and IN), implementation and effectiveness (RO and ME).
evidence of improvements in services for people in acute states of mental crisis: These may include improvements for patients (e.g. less exposure to restraint), staff (e.g. less injury) and services (e.g reduced costs).