Abstract
BACKGROUND: Mental health problems, self-harm and suicide are major public health concerns. Following national strategic commitments to improve the response and follow-up support for adults in Scotland presenting to frontline services in emotional distress, this study describes the development of the first national Distress Brief Intervention, a multi-agency service to provide connected, compassionate support for people in distress. METHODS: The six step Intervention Mapping protocol was used to account for the complexity of the intervention and to guide development, testing and implementation. Data/information sources comprised: literature and evidence review; delivery partner and stakeholder consultations (n = 19); semi-structured interviews and/or focus-groups with frontline services staff experienced in responding to distress (n = 8); interviews and/or focus groups with adults with experience of distress (n = 9); feedback from test training for staff (n = 16); self-assessed confidence ratings provided by staff immediately before and following training (n = 388). RESULTS: We developed a time-limited, two-level, complex intervention for adults experiencing emotional distress, provided by 'frontline' statutory services (primary and acute healthcare, police, ambulance) and third-sector community organisations in Scotland. Intervention components included competency-based training programmes for staff, information, protocols and guidance for providers, personalised distress management planning and behaviour change tools. During the development phase, 525 intervention providers (n = 472 frontline statutory service staff; n = 53 third-sector community organisation staff) completed training programmes in four pilot areas in Scotland. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies. CONCLUSIONS: A multi-agency national Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. Up-take of training and evaluations of training indicate it is highly acceptable to potential providers and improves key competencies. Following independent evaluation, the Distress Brief Intervention has been rolled out nationally across the whole of Scotland, and has significant potential as a model of care and prevention internationally, including countries with low statutory health resources.