A new distress support and management mental health programme is set to be implemented across Scotland, following an evaluation of the four local pilot programmes that researchers from the University of Stirling found to be successful.

Across Scotland, a pilot of a Distress Brief Intervention (DBI) ran from November 2016 to March of 2021 in four areas: Scottish Borders, Aberdeen, Inverness and Lanarkshire, with services initially targeting people over 18 then expanding to include younger people in 2019.

Conducting their evaluation alongside The Mental Health Foundation, Glasgow Caledonian University and ScotCen, the Stirling University researchers concluded:

“DBI has proved to be successful in offering support to those in distress, with most individuals receiving a compassionate and practical response that contributed to their ability to manage and reduce their distress in the short terms, and for some in the longer term.”

The pilot scheme was devised by the University of Glasgow and the Scottish government and delivered in partnership with the Joint Mental Health Service in NHS Borders, Penumbra in Aberdeen, Support in Mind in Inverness, and Health and Social Care Partnerships in North and South Lanarkshire.

Level 1 of the two key stages of delivery offers a direct, compassionate response to individuals in distress, signposting, and referrals to DBI Level 2.

Level 2 staff offer community-based problem-solving interventions within 24 hours of referral, again focused on compassionate care, and help for individuals to create distress management action plans.

Professor Edward Duncan, Nursing, Midwifery and Allied Health Professions Research Unit (NMAHP-RU) at Stirling, led the evaluation. He said they found it had been successful in supporting a wide range of people in distress:

“This evaluation is the result of several years' work and collaboration with a wide range of evaluation partners, services, practitioners, and people who received DBI.

“The DBI programme's facilitation of effective and efficient working within, and between, various agencies is particularly commendable and was a key component of its overall success.”

One in ten participants revealed they may have attempted suicide or continued with suicidal thoughts if DBI had not been offered to them.

Welcoming the news from the evaluation, DBI programme manager, Kevin O’Neill said the success recognised in the evaluation is a significant landmark. He added that the findings and recommendations within the evaluation report validates the “tremendous work” of everyone involved in development and delivery the programme.

Mr O’Neill said:

“The key independent recommendation that DBI should be further implemented across Scotland offers significant weight in support of the Scottish Government’s existing commitment to embed DBI in all NHS Board areas by March 2024.

“The combination of compassionate response and practical support, which is at the heart of DBI, was found to be central in helping people understand their distress and reduce it.”

At DBI Level 1, the programme had “direct, immediate benefits for the individual”, as most participants reported their Level 1 provider helped them cope with immediate distress.

For Level 2, researchers reported that “DBI is working well for most individuals” and cited that 9 in 10 people receiving this care show a continuing decrease in distress over the period of Level 2 intervention. The evaluation highlighted that a key strength of DBI found during the pilot was its flexibility to be tailored to individuals at this stage.

They recommend that the national rollout of the Distress Brief Intervention programme continues across Scotland, maintain the standards achieved in the pilot and improving upon the areas of feedback. The evaluation underlined that when DBI practitioners helped people improve their understanding of why they feel distressed, this had an important influence on reducing distress levels.

Despite 9 in 10 reporting improvements, 1 in 10 responded to have increased distress at the end of Level 2 intervention and they found that people referred via A&E, younger people and people with higher levels of distress were more likely to rate the compassion of Level 1 practitioners lower.

The authors of the evaluation said more work is needed here but that for A&E especially, this may reflect that people attending A&E were likely to be in “greater or more acute distress” and good engagement and communication of DBI services will be helpful in the future rollout.

According to Kevin Stewart, Minister for Mental Wellbeing & Social Care, £12m has been invested in the programme since 2016 and it has support 27,000 people. He added:

“I am pleased that this independent evaluation is confirming the hugely successful role the Distress Brief Intervention programme plays in providing timely, compassionate support to people in emotional distress.

“I would like to thank all our partners involved in developing and providing this service and I look forward to working together to achieve our target of national coverage by March 2024.”

The evaluation placed DBI in the wider healthcare service, stating its impact appears largely positive and practitioners agree it provides a more effective way to support people in distress and “DBI improved integrated working across frontline services.”

For rollout, the evaluation also stated that the DBI Central team communicating and coordinating services across Level 1 and 2 practitioners and wider healthcare services was an “essential component” of the programme’s success. Beyond wider implementation, further research to understand long-term impact is recommended in the evaluation.

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