12 Distress Brief Intervention Update
North Ayrshire Council · 16 June 2022
Back to Integration Joint Board — 16 June 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Integration Joint Board 16th June 2022 Subject: Distress Brief Intervention Update Purpose: To update on the progress of implementation of the Distress Brief Intervention Service Recommendation: IJB to endorse the implementation of the plan to support DBI across Ayrshire Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership DBI Distress Brief Intervention SG Scottish Government 1. EXECUTIVE SUMMARY 1.1 Distress Brief Interventions (DBIs) are an innovative way of supporting people in distress. In support of the expansion of the DBI programme, the Scottish Government have established a DBI Associate Programme with partners and/or regions of Scotland who wish to become part of the DBI programme and embed the principles of DBI within their services. With support from the National DBI team, Ayrshire and Arran became an associate to the National programme. The initial commissioning contract was due to conclude on March 2023 but agreement was reached at the Pan- Ayrshire Mental Health Resource Allocation group to extend this for a further year. 1.2 This report seeks to provide an update to the implementation of a local Ayrshire wide service. It will also provides an update on the national DBI response currently open to citizens of Ayrshire and Arran. 2. BACKGROUND 2.1 For the purpose of the DBI programme distress is defined as “An emotional pain which led the person to seek help and which does not require further emergency service involvement”, This includes people who may not directly seek help themselves, but who are referred for assistance by others because of their perceived distress. The DBI ‘ask once get help fast’ approach has two levels: DBI Level 1 is provided by front line staff (NHS24, Emergency Departments (ED), Police Scotland (PS), Primary Care and Scottish Ambulance Services (SAS)), who have received the DBI Level 1 training, produced by University of Glasgow, who ease
Page 2
the person’s distress, provide a compassionate response and involves an offer of a seamless referral, with confidence and clarity to a DBI Level 2 service. DBI Level 2 is provided by commissioned and trained third sector staff who contact the person within 24-hours of referral and provide compassionate, problem-solving support, wellness and distress management planning, supported connections and signposting for a period of up to 14 days – reducing both immediate distress and empowering ability to manage future distress. The person’s GP will be notified of the outcome of referral by the DBI service. 2.2 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 improving experience and outcomes for those experiencing distress and those providing support. 2.3 The Scottish Government (SG) is focused on improving responses to people in distress. The DBI programme emerged through direct engagement with citizens who have experienced distress, front-line service providers and literature review. The SG established the DBI programme, which is hosted and led by South and North Lanarkshire HSCP’s, via a DBI Central Team and has been tested, developed and continuously improved in Aberdeen, Inverness, North and South Lanarkshire, Scottish Borders and more recently Moray. Many other parts of Scotland are engaged with DBI through the associate programme, benefiting from the knowledge, infrastructure and tools developed. The vision, collaborative culture and programme infrastructure has been harnessed in support of the effective delivery of the DBI COVID 19 response programme, at pace and scale which now sees national access to DBI for anyone over 16 who contacts NHS24 and where a DBI referral is appropriate. The local provider for Ayrshire and Arran residents is Penumbra. National pathways have also been opened up to Police Scotland and Scottish Ambulance Service to make direct referrals to local DBI service providers. Work is also underway through a few pilot sites for young people to access the service through schools. 2.4 Through the national COVID 19 response accessed through NHS 24, the referrals are as follows: National Covid Response: Ayrshire and Arran total referrals as at 21/04/2022 = 595 East Ayrshire = 198 North Ayrshire =242 South Ayrshire = 155 There have been approx. 26,400 referrals across Scotland from all pathways. DBI Ayrshire & Arran Associate Programme: Up to 21/04/2022 total number of referrals = 301 Geographic breakdown: East = 142; North = 54; South = 105 Primary Care referrals = 300 referrals; 8 GP Practices are actively referring and a further 4 practices are in the process of scheduling their training with the team.
Page 3
3. The roll out of DBI across Ayrshire 3.1 Penumbra have now successfully been commissioned through North Ayrshire HSCP to deliver DBI to all residents of Ayrshire and Arran through two remaining pathways. It has been agreed that the focus will be to incrementally upscale a direct referral pathway from Primary Care and NHS Emergency Departments. Penumbra currently employ a dedicated service manager as well as practitioners and peer workers. In addition, the local service receives support from Penumbra’s national DBI service manager. Training for Level 1 providers is progressing well but unfortunately North Ayrshire only have one of the three GP practices identified as being a priority for access fully engaged with training allowing them to refer. Progress has also been slow with engaging possible referrers through the emergency departments. Pressure on the system has made it difficult for would be referrers to make time in their schedule for the training sessions. Ongoing discussions are taking place to increase capacity for referrals to be made through all routes and Penumbra have offered a flexible schedule to deliver training. It was agreed at the outset that practices would be brought on board based on priority agreed through the GP subcommittee. Initially, East Ayrshire struggled to find the opportunities to engage the relevant practices but some work with the Stakeholder GP and MHP manager has resulted in a large increase in referrals. In North Ayrshire work is underway to capitalise on the success of MHPs in advocating the service and it is anticipated that with this targeted approach North Ayrshire referral numbers will increase. 3.2 Anticipated Outcomes By offering this service at the earliest opportunity and within 24 hours of referral it is anticipated based on delivery of this programme in other areas that crisis can be resolved without the intervention of secondary care services. Individuals can be supported through this period of uncertainty with practical support without medicalising a normal response to stress. 3.3 Measuring Impact A robust set of measures have been agreed with Penumbra through the commissioning process. In addition, the national programme provides a regular update on progress of the programme. See attached infographic included as Appendix 1 for the latest update. 4. IMPLICATIONS Financial: The service has been funded in part from the Mental Health Action 15 funding allocation and in part directly from the Scottish Government through the national DBI Programme. Funds are committed until March 2023. This includes £200k from SG and £300k from Action 15 Funding allocation. Human Resources: No implications for NAHSCP staff. Penumbra have been commissioned to deliver the service and are engaged in a recruitment programme to facilitate the service locally. Legal: N/A.
Page 4
Equality: People affected by mental health are an equalities groups and require appropriate levels of support. This programme improves access to support for vulnerable people. An Equalities impact assessment has been completed. Children and Young People DBI is currently open to individuals 16 and over. Glasgow University are currently researching the benefits of the programme for under 16’s and a report is due in the next six months having been delayed due to COVID 19. Environmental & Sustainability: The implementation plan will explore sustainability issues. Key Priorities: This programme links to the national and local priority around suicide prevention and is a key action in Every Life Matter action plan. Risk Implications: The contract with Penumbra runs until March 2023 and funding has been identified to allow a one-year extension. It is anticipated that this might be highlighted as a priority as part of the ongoing development work looking at mental health in primary care and as such may be allocated long term funding. Community Benefits: Increased range of choice, opportunities and access to services at a locality level Direction Required to Council, Health Board or Both (where Directions are required please complete Directions Template) Direction to :- 1. No Direction Required x 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran 5. CONSULTATION 5.1 There have been considerable consultations with teams from North, South and East Ayrshire with the Scottish government to take forward an appropriate Brief Intervention service. A DBI Steering group has been established with wide representation across Ayrshire 6. CONCLUSION 6.1 The Implementation of the DBI closes a gap in the support available for people who are experiencing mental health distress, and this is welcomed across Ayrshire and Arran. For more information please contact Thelma Bowers on 01294 317849 or thelmabowers@north-ayrshire.gov.uk
Page 5
Management Information Not for Onward Release On average 19 DBI referrals per month