Despite COVID-19 and associated restrictions, the extended DBI service adapted successfully and provided telehealth support to individuals presenting with mild-moderate distress. The provision of Level 1 by the NHS24 Mental Health Hub was successful. NHS24 appropriately integrated Level 1 into its existing provision and provided a compassionate response, making appropriate and adequately detailed referrals to Level 2. The success of this integration may have been facilitated by Level 1 practitioners having a higher baseline of people being referred to their service who met the criteria for DBI and additionally having experienced qualified mental health practitioners available where they had any questions.
Within the limitations of the data collected, it appears that the DBI service evaluated in this report has successfully supported many of those individuals who were referred in distress. Delivery of Level 2 as a telehealth intervention was feasible and felt by many to have advantages and disadvantages over face-to-face contact.
In general, the direction of improvement for individuals in the DBI extended evaluation mirrored that found in the more in-depth pilot evaluation. As in the main DBI pilot evaluation, DBI does not appear to work equally well for everyone. Feedback from Level 1 and 2 providers and individuals who received DBI suggest that DBI is less appropriate for the needs of those with severe and/or enduring mental health problems and/or other complex needs.
The evaluation findings have several implications for the ongoing roll-out and improvement of the DBI programme. Key recommendations based on the findings are set out below.
- 1.Overall, Level 2 provider participants felt both face-to-face and virtual/telephone interaction with individuals receiving DBI had advantages and disadvantages. When it is possible, even when COVID related restrictions are no longer in place, providing both options to individuals receiving DBI may be advantageous and enable the preferences of both individuals and DBI service providers to be met.
- 2.NHS24 processes meant that each call they received could only result in a choice of referring an individual to DBI Level 2 or another signposted service. Enabling NHS24 Level 1 practitioners to refer individuals to DBI in addition to another signposted service would be helpful for practitioners and valuable for individuals receiving the service.
- 3.The evaluation findings should be incorporated in the roll-out programme and disseminated to share learning, encourage debate and promote further uptake of the DBI model.
DBI practitioner preparedness, training and development
- 4.Level 1 training with staff in the NHS24 Mental Health Hub should be explicitly and respectfully cognisant of practitioners' previous experience and training, acknowledging practitioners' potential existing awareness and understanding of identifying distress and the importance of compassion when individuals present to them in distress.
- 5.Level 1 practitioners in the NHS24 Mental Health Hub would value receiving a more detailed checklist as to what is and is not appropriate to refer to Level 2.
- 6.Level 1 practitioners in the NHS24 Mental Health Hub would value further information regarding the role of Level 2 providers.
- 7.Increased usage of anonymised case studies in Level 1 training in the NHS24 Mental Health Hub would help trainees' understanding of what was appropriate and the overall DBI journey individuals commonly take.
The NHS24 Mental Health Hub should consider how to maintain the capacity for Level 1 service provision and reduce the general challenge of waiting time for NHS24 calls to be answered.
- 8.Further research is recommended about the longer-term impact of DBI on individuals and the wider service system, particularly when the DBI intervention is conducted via telephone and other digital media when compared with face-to-face interactions.
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