1.Introduction

Distress Brief Interventions (DBIs) are an innovative way of supporting people in distress. The DBI approach emerged from the Scottish Government’s work on the Suicide Prevention and Mental Health strategies1. The need to improve the response to people presenting in distress has been strongly advocated by people who have experience of distress – and by front line service providers and is supported through a review of available literature2.

This led to the Scottish Government establishing a pilot DBI programme, which is hosted by Health and Social Care North Lanarkshire (H&SCNL) and South Lanarkshire Health & Social Care Partnership (SLH&SCP).

The DBI approach is initially being piloted over 53-months (November 2016 to March 2021) in four sites across Scotland: 1. Penumbra in Aberdeen, 2. Support in Mind in Inverness, 3. Scottish Borders Joint Mental Health Service 4. North & South Lanarkshire as above.

The new Mental Health Strategy for Scotland 2017 – 2027 reaffirms the commitment to DBI through the inclusion of action 11, “complete an evaluation of the Distress Brief Intervention Programme by 2021 and work to implement the findings from that evaluation 4”.

2. What is Distress Brief Intervention (DBI)?

The overarching aim of the DBI Programme is to provide a framework for improved inter-agency co-ordination, collaboration and co-operation across a wide range of care settings, interventions and community supports, towards the shared goal of providing a compassionate and effective response to people in distress, making it more likely that they will engage with and stay connected to services or support that may benefit them over time.

A Distress Brief Intervention is a time limited and supportive problem solving contact with an individual in distress. It is a two-level approach. DBI level 1 is provided by front line staff and involves a compassionate response, signposting and offer of referral to a DBI level 2 service. DBI level 2 is provided by commissioned and trained third sector staff who would contact the person within 24-hours of referral and provide compassionate community-based problem solving support, wellness and distress management planning, supported connections and signposting for a period of up to 14 days.

3. Who is the DBI for?

Distress is being defined as ‘An emotional pain for which the person sought, or was referred for, help and which does not require (further) emergency service response’. The initial test period will focus on people aged 18 and over. DBI does not replace existing arrangements for anyone in distress who requires further medical treatment, it is an additional option for frontline staff.

4. Who will provide the DBI and where?

For the purposes of the pilot, the DBI approach will be tested primarily in relation to people presenting in distress to A&E, Police Scotland, Scottish Ambulance Services and primary care, including out of hours, although each partnership site can include other services if the conditions facilitate this.
Provision of DBI level 1 will be by front line staff, in the above settings. Provision of level 2 will be by third sector services, providing a welcome additional option to which level 1 staff can refer people to.

5. How is the programme being co-ordinated?

5.1 Governance: A DBI central team has been established by the host organisation. The Scottish Government has established a national DBI Programme Board. Each of the four partnership sites has established DBI Implementation Boards. This structure will ensure that key stakeholders are involved and that local provision is embedded and connected with, and respectful of, related and complimentary programmes.

5.2 Evaluation: To evaluate the effectiveness of the approach the Scottish Government will be commissioning an independent evaluation, informed by an evaluablity assessment completed by NHS Health Scotland3.

5.3 Intervention, support & training: The University of Glasgow’s Institute of Health & Wellbeing is leading a systematic programme of developing the DBI and supportive training in preparation for the implementation phase commencing June 2017.

6. When will the programme be implemented?

The DBI package and training programme will be in place for a very controlled implementation in Lanarkshire beginning in June 2017, with incremental up scaling across all four partnership sites from October 2017 in preparation for full implementation in April 2018.

7. What is expected from colleagues in the partnership areas?

The DBI Implementation Boards in each of the four partnerships sites will work closely with those involved to ensure the programme is implemented respectful of competing demands and harnessing the opportunities that DBI brings. During the development phase the University of Glasgow’s Institute of Health & Wellbeing is leading the development of the DBI and training package. This will see interviews and/or focus groups with staff and some individuals with experience of distress. Staff are being asked to fully engage with the University team when opportunities present.

Planning for the implementation phase which will include the ‘roll out’ of training will be progressing over the coming year through dialogue with front-line services in the pilot areas. Local discussions will also be progressed to embed the DBI pathway within a local compassionate, connected and collaborative infrastructure.