The ‘No Force First’ initiative aims to change ward cultures from a focus on containment to one of recovery. The ultimate aim is to create coercion-free environments. This approach, which began in th United States, is being adopted by some UK based mental health trusts (Submission 27). The underlying idea is that ‘there is no such thing as a forced recovery’.

The ‘No Force First’ policy aims to create coercion-free environments through the following initiatives:

• promoting collaboration between users and staff members to make wards more recovery focused;
• developing training programmes in collaboration with users and promoting training in deescalation techniques;
• developing a cooperative culture, rather than a restrictive culture, to reduce incidents of aggression, selfharm and physical intervention;
• developing a deeper understanding of users in order to see their experiences in a traumainformed, empathetic manner, and working together to build resilience;
• including the experiences of service users and engaging in coproduction work;
• awarenessraising among users and relatives;
• recording of data on the use of coercion and immediate analysis after an incident (Submission 27).

The UK Mersey Care NHS Foundation Trust used the ‘No Force First’ policy along with other initiatives and recorded a reduction of approximately 60% in the use of physical interventions during the first two years of implementation (Submission 27). The approach was then implemented across all wards of the trust and, between April 2016 and August 2017, there was a 37% reduction in the use of restraint, as well as a reduction in staff sick leave (which led to financial savings as a result of less sickness-related absence). The Trust now has a strong culture of collaborative empowerment where staff and service users work together to reduce conflict and promote safety and recovery. Looking to the future, members of staff are encouraged to openly share learning from events that do not go as planned, and develop creative solutions. The focus is not around blaming individuals, but instead looking at the system and how it contributed to the event and could be improved (Submission 27).

According to the Mersey Care Trust website, there are three levels on which change must take place to promote No Force First care:

• Organisational – the Board must have the serious ambition to make change and turn ideas into reality despite opposition or conflicting views from peers
• Professional – clinicians and GPs must confront their own practices and practices of others, a difficult challenge to change day to day methods and gently change the system without confrontation
• Experts by experience – they have given so much to help co-produce practice, having the courage to tell their stories and, in some cases, having the courage to stand up and address and influence large groups of people. (See https://www.merseycare.nhs.uk/about-us/striving-for-perfect-care/no-force-first/ [accessed 12/04/2021]).

The website reports that ‘[b]oth staff and patients have shown great courage in accepting No Force First and making Mersey Care a better caring environment’. (See on Mersey Care Trust website, [accessed 12/04/2021]).