Time Space Compassion - supporting people experiencing suicidal crisis: stories in practice - volume 1

2. Practice deep dive

Distress Brief Intervention (DBI) Scotland

For a quick introduction to DBI, check out this short animation on YouTube. You can also view a hypothetical but realistic story of one person's experience of distress and DBI support, through Helen's story on YouTube.

DBI provides immediate, connected and compassionate support to people experiencing distress. DBI Level 1 is provided by trained frontline staff, working in a range of health and emergency settings and trained to listen without judgement, to understand and help ease the person's distress and know when to refer someone onto Level 2 support. DBI practitioners provide Level 2 support, which includes follow up, usually within 24 hours of referral, and the offer of support for around two weeks.

"We get the key people already working in a community together, working with them to set a shared goal of providing a compassionate and effective response to people in distress."

2.1 Our challenge

The Scottish Government undertook research that showed the response to people in distress in Scotland needed to improve. It highlighted a significant gap in support for those who present in distress or present with multiple contributing factors, but do not meet the criteria for clinical support. This gap was also impacting negatively for people providing support - contributing to frustration and the risk of compassion fatigue in busy front line practitioners.

2.2 Our response

DBI was established in 2016 by the Scottish Government and key partners. DBI is hosted and led by NHS Lanarkshire and the DBI Central Team, and shaped by stakeholders and a network of delivery partners. The two most important characteristics of DBI are the relationships and processes we use to connect people from Level 1 to Level 2 DBI support, and the local partnerships that enable us to offer community-based problem solving support, wellness and distress management planning, as well as the ability to connect people with other service and sources of support.

"People are referred to the DBI Service by specially trained practitioners working mainly in primary care, NHS emergency departments, NHS 24, Police Scotland and the Scottish Ambulance Service. These relationships are key to what we do."

2.3 Learning from practice

Making connections - focusing on building and maintaining networks through the DBI national and regional distress collaboration has supported this way of working to spread faster and farther than we anticipated. We learned that working in close connection needs supporting structures to flourish and last over time. That means paying close attention to the details – referral forms, information leaflets, standard operating procedures, shared systems and ways of working that support referral and data sharing, and distress management plans. They all have to really work for people.

"This means simplifying processes and giving staff the tools, confidence and trust to 'do the right things, the right way for that person."

Being clear and consistent - putting a clear shared commitment to connected compassionate support in our vision and evaluation has supported a culture of open learning and collaboration. We put a lot of energy into being as clear as possible on who we are and what we are here to do. This includes tailored training for anyone referring into our services on when to refer to us, and helping the person they're working with understand what to expect from us and the work we can do with them.

Building relationships - We've learned that when you really listen to what's going on for people, you can help them move beyond that initial sense of being overwhelmed and find a pace that works for them. We take time to ask what matters to them and how we can work together to create positive conditions for change and remove barriers. This empowers frontline staff to deliver connected compassionate support and creates space for people to make sense of what that means for them. A great deal can be achieved through the provision of assertive support over a two-week period, avoiding problems escalating and addressing issues quickly. The majority of people benefiting from DBI have a number of presenting problems and contributing factors, but services are often designed to work on one thing at a time. We see connection as the antidote to all of this, so we work an 'ask once get help fast' approach.

"A combination of compassionate response and practical support helps to validate people's distress and break down barriers to seeking help, thereby reducing self-stigma"

We talk a lot about tenacious support. Everyone referred to us receives a contact attempt within 24 hours of their referral to the Level 2 service. Each person receives up to 5 contact attempts over the first three days. We phone then write in case that works better for them. These things are written into our standard operating procedures. We see this assertive approach as a critical part in tackling inequalities including poverty – we don't assume people feel safe to talk to us the first time we call or that they have enough money on their phones to return a call.

2.4 Impact

At the point of writing this practice story, over 30,000 people in distress have been supported through this approach, with an average of 1,050 referrals received per month. DBI partners offer services in twenty Health & Social Care Partnerships, and plans are in place to cover the whole of Scotland. You can contact the team and read more about DBI and their evaluation reports on their website