Distress Brief Interventions (DBIs) are an innovative approach to reducing emotional pain in people who present in distress. They equip individuals with a range of skills and capacities to cope with emotional pain, both in the immediate term and for the future.
Within DBI, distress is defined as:
"An emotional pain for which the person sought, or was referred for, help and which does not require (further) emergency service response (NHS Health Scotland 2017)."
The original DBI pilot programme had two Levels. Level 1 was provided by trained front-line staff from Police Scotland, the Scottish Ambulance Service, NHS Accident and Emergency (A&E) departments and Primary Care. Level 1 staff were trained to provide a compassionate response and offer individuals in distress the opportunity to be referred to Level 2, a brief (around 14 days), compassionate, community-based problem-solving intervention. The main DBI pilot programme (established in 2016) was delivered by third sector organisations in four sites across Scotland:
- The Richmond Fellowship Scotland (TRFS) and Lanarkshire Association for Mental Health (LAMH) in South Lanarkshire, and Lifelink in North Lanarkshire
- Penumbra in Aberdeen
- Support in Mind in Inverness
- Scottish Association for Mental Health (SAMH) in the Scottish Borders
With the arrival of COVID-19, there was concern that the pandemic would have a negative impact on people's mental health and that the number of people seeking support from DBI might significantly increase. On 14 April 2020, the Scottish Government announced funding of an extension to the DBI pilot programme, to support people across the whole of Scotland who were distressed during the period of the COVID-19 pandemic.
2.2 Overview of the extended DBI approach
The DBI extension programme built on the pilot, but the nature of interactions at Level 1 and 2 were different. A DBI Level 1 intervention was comprised of providing a compassionate response to those who present in distress and offering referral to a Level 2 service. The Level 1 component of DBI was provided by NHS24 staff through their Mental Health Hub. NHS24 staff in the Mental Health Hub comprised of both mental health nurses and psychological wellbeing practitioners (PWPs); PWPs are not registered healthcare professionals but are trained to assess and support people with common mental health problems – principally anxiety disorders and depression – in the self-management of their recovery. For the purposes of this evaluation, both groups of staff are hereafter referred to as Level 1 practitioners.
Level 2 was provided by trained practitioners from the original DBI third sector providers, but their geographical remit was extended to cover the whole of Scotland. While some Level 2 interventions had already been delivered, at least in part, using telephone/video communications, the extended programme saw all Level 2 interventions being delivered in this way. Practitioners received additional training to account for the context of COVID-19.
Level 2 practitioners attempted to contact all individuals who had been referred within 24 hours to offer their intervention. Level 2 interventions consisted of around 14 consecutive days of person-centred, tele-health support with a problem-solving focus. Individuals who took up support from Level 2 were helped to identify the source and triggers of their distress and to identify existing sources of support available to them. As with face-to-face delivery of DBI, Level 2 practitioners helped individuals to explore strategies to alleviate the issues causing them distress and supported them to develop a Distress Management Plan (D-MaP), which individuals could use to help manage any future instances of distress. A key aspect of the Level 2 intervention was to connect individuals with a wide variety of community and statutory services and support tools relevant to their needs. Level 2 practitioners signposted and/or supported individuals in distress to connect with relevant follow-up support.
The DBI extension programme evolved over two phases. Phase 1: from 13 May 2020, NHS24 could refer direct to Level 2 services in existing DBI regions across Scotland (Lanarkshire, Scottish Borders, Aberdeen City and Inverness); Phase 2: from 8 June 2020, NHS24 could refer to Level 2 from all 14 territorial Health Boards across Scotland. In addition, from 15 July 2020 NHS24's Mental Health Hub moved to 24 hour operation, so as part of this, NHS24 could refer to DBI Level 2 services 24 hours a day.
2.3 Purpose of the Extended DBI Evaluation
The aim of this evaluation was to investigate the implementation of the DBI extended programme across Scotland, during the first nine months of the COVID-19 pandemic, the experiences of those who deliver and received DBI, and the impact that the programme has on levels of distress. A separate evaluation of the main pilot programme is also available Distress Brief Intervention Pilot Programme evaluation: findings report - gov.scot (www.gov.scot). The specific objectives of this evaluation were as follows:
Objective 1. To investigate the modes of delivery (e.g., telephone or online support) that were introduced because of physical distancing, and what providers' and recipients' views about these modes were.
Objective 2. To explore the experiences of involving NHS24 as the key Level 1 provider of the expanded DBI service. This included Level 1 providers' experiences of training, assessing people's needs and risks, and the relationship between Level 1 and Level 2 service providers.
Objective 3. To identify the implementation challenges of delivering the expanded DBI programme in the current context of the COVID-19 pandemic.
Objective 4. To detail the demographic characteristics of those who accessed the DBI service at Level 1 and Level 2: including the geographical breakdown of referrals; and the number of referrals offered, made, accepted, and taken up.
Objective 5. To investigate the reasons for referral, including the relationship that the coronavirus pandemic had on the referral.
Objective 6. To investigate the experiences of people who accessed the DBI service (including the perception of responses received) and their outcomes (including impact on distress).
Objective 7. To investigate the effectiveness of telephone and online modes of service delivery.
Objective 8. To consider how comparable the findings are between the main DBI pilot evaluation and the expanded DBI programme.
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