A connected, compassionate response: Distress Brief Intervention (DBI) in Scotland

In this episode, we're thrilled to welcome Kimberley Irwin and Ian Graham from Change Mental Health in Scotland to talk about the Distress Brief Intervention (DBI) Programme, which was developed and first piloted in 2016 in parts of Scotland to respond to the needs of people experiencing distress.

DBI is now an established part of mental health support in Scotland.  The program was highlighted as a model for a similiar service in Victoria in recommendation 27 of the Royal Commission into Victoria’s Mental Health system.

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

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Find out more about Change Mental Health's origins and journey to where the organisation is today.

More about the DBI Programme in Scotland

Helplines (Australia):
Lifeline  13 11 14
QLIFE 1800 184 527
13 YARN 13 92 76
Suicide Callback Service 1300 659 467

Helplines in the UK
Samaritans  116 123 

ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.

We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

ermha365 provides mental health and disability support for people in Victoria and the Northern Territory. Find out more about our services at our website.

Helplines (Australia):
Lifeline 13 11 14
QLIFE 1800 184 527
13 YARN 13 92 76
Suicide Callback Service 1300 659 467

ermha365 acknowledges that our work in the community takes place on the Traditional Lands of many Aboriginal and Torres Strait Islander Peoples and therefore respectfully recognise their Elders, past and present, and the ongoing Custodianship of the Land and Water by all Members of these Communities.

We recognise people with lived experience who contribute to GET REAL podcast, and those who love, support and care for them. We recognise their strength, courage and unique perspective as a vital contribution so that we can learn, grow and achieve better outcomes together.

Transcript

Team at ermha365: 0:01

Get Real is recorded on the unceded lands of the Boon wurrung and Wurundjeri peoples of the Kulin Nation. We acknowledge and pay our respects to their elders, past and present. We also acknowledge that the First Peoples of Australia are the first storytellers, the first artists and the first creators of culture, and we celebrate their enduring connections to country, knowledge and stories.

Team at ermha365: 0:29

Welcome to Get Real talking mental health and disability brought to you by the team at erma 365.

Team at ermha365: 0:35

Join our hosts, Emily Webb and Karenza Louis-Smith, as we have frank and fearless conversations with special guests about all things mental health and complexity.

Team at ermha365: 0:49

We recognise people with lived experience of mental ill health and disability, as well as their families and carers. We recognise their strength, courage and unique perspective as a vital contribution to this podcast so we can learn, grow and achieve better outcomes together.

Ian Graham : 1:12

When someone's in distress, the fact that we will speak to them we guarantee we will speak to you within 24 hours makes a massive difference. You know their clients. When we speak to them, they're thinking they're going to refer to a GP or a community mental health team. They don't know how long they're going to wait. Wait, but they're getting someone to speak within 24 hours seeing the difference within individuals within those 14 days.

Kimberley Irwin: 1:34

You're making a difference. You're giving them hope, you're making them feel empowered, they're taking back control and you know you could speak to a client on the first day and on the last day it is literally like speaking to a completely different individual.

Emily Webb: 1:59

Welcome to Get Real Talking Mental Health and Disability. I'm Emily Webb. My co-host for this episode is Robyn Haydon, erma365's Chief Marketing Officer. When I first started at erma back in 2021, Robyn was the host of this podcast, so it's great to be co-hosting with her today.

Robyn Haydon: 2:19

Hey Em, it's great to be back and to see you and all of our guests today.

Emily Webb: 2:23

And we're particularly thrilled to have international guests for this episode Kimberley Irwin and Ian Graham from Change Mental Health in Scotland. We're talking with Kimberley and Ian to find out more about the Distress Brief Intervention Program, which was developed and piloted in 2016 in parts of Scotland to respond to the needs of people experiencing distress. This program is now established across Scotland and here in Victoria in Australia, where we are. The program will be piloted next year in response to the final advice of the National Suicide Prevention Advisor and the recommendations of the Royal Commission into Victoria's mental health system. So welcome to Get Real podcast, kimberley and Ian.

Ian Graham : 3:13

Hello Emily. Thank you for the invitation, hello Robyn.

Kimberley Irwin: 3:16

Hi to you both. It's lovely to be here.

Robyn Haydon: 3:18

We're so very glad to have you. And some background for listeners. Change Mental Health actually shares similar origins with ermha365, so we were both started decades ago as advocacy and support networks by groups of people caring for loved ones with mental ill health. Change Mental Health has been around for more than 50 years and its foundation was inspired when Scottish journalist John Pringle wrote an article in the Times about caring for his son experiencing schizophrenia. Hundreds of carers contacted John after reading this article and some of them were the founders in 1972 of the Schizophrenia Fellowship, which evolved into Change Mental Health. So Change provides services across Scotland for people living with mental ill health and the people who care for them. There's a great timeline of milestones for the organisation on its website, which we'll link to in the show notes for this episode. But look, we've spoken enough, we reckon, so let's get into the conversation with Kimberley and Ian.

Emily Webb: 4:16

Looking forward to it. Let's find out about you both, Kimberley and Ian. I'll start with you, Kimberley. What is your role at Change Mental Health and what's your background in working in mental health?

Kimberley Irwin: 4:27

Thanks, emily. Yes, so I am the project manager for the Distress Brief Intervention Service, which covers Inverness, the Highlands and, newly, the Western Isles. I came from a caring background. Before joining Change Mental Health, it was more on a personal level, for myself and my family, that drove me to want to help people within the mental health industry.

Emily Webb: 4:51

And what about you, Ian?

Ian Graham : 4:53

So my role is the National Distressed Brief Intervention Project Lead, so I manage and oversee the services for Highland, Western Isles, Ardell and Bute and Dumfries and Galloway. So we have project managers at Kimberley so I manage the entire service. My background is completely different to working in mental health. I was a police officer, retired just a couple of years ago, so I've worked all over the Highlands, was a firearms officer, child protection officer and also worked through management up to chief inspector. So I became involved in sort of the DBI through work in 2017 when I first came to Inverness. I've seen it set up and other mental health pilots in the area to see what can be done to lift the pressure off the frontline services and support people better at that point of impact. So I worked in road safety for a short period and then I seen the opportunity to come to change mental health and work through the stress-free intervention.

Emily Webb: 5:43

And Ian, you did mention the areas that your program covers and I have heard of these areas in Scotland, even though I haven't seen a lot of Scotland and you're the lead agency, as you said, in the Highlands, dumfries and Galloway, argyle and Bute and Western Isles, which all sound actually quite amazing. Can you tell us about these communities, especially for listeners in Australia, and we do have listeners all over the world?

Ian Graham : 6:09

We'll start with the Western Isles, which I'm from originally. It's a population of 26,000, but it's really geographically diverse. It's a huge string of islands also called the Outer Hebrides. We've got the main town of Stornoway, so we've just started going in there. They've got our big community around crofting fishing tourism's really starting to take off as well. But, like everywhere else, it's got rural challenges with trips to and from the mainland and I worked previously within the police, so a really good relationship with local health providers and our geographical awareness of the island. So it's really nice to be starting there.

Ian Graham : 6:40

Highlands it's got the capital of inverness, which is really well known, real big tourist hub. We've also got heavy of Inverness, which is a really well known, real big tourist hub with also a heavy industry. But it's for quite diverse communities from Fort William and Glencoe through to Aviemore and up to Caithness at the top of the Highland area. So the population is quite spread out. So that's quite a challenge for all the public services to support and also for the population, due to some of the rural areas are starting to the population's coming more into the centre, so finding staff to promote and support them. So we're quite, really useful with the DBI with the service, the way we can do it over the phone, and also we have staff within the areas Argyll and Bute, just attached to Highland, population of near 90,000, and it's along the west coast of Scotland.

Ian Graham : 7:19

Again, it's a massive geographical area. It's one of the largest in Scotland in terms of the length and the population is spread very diverse throughout the latest towns and villages. So again, we work really closely. With our knowledge of working in Highland and the Western Isles, it becomes really useful for how we work with staff. And then Dumfries and Galloway, which is a large farming and rural community. It's a large coastline and they've got a population approaching 150,000. They're down the bottom of Scotland, the border with England, a lot of little challenges within it. But we have staff based on all these areas so that we really do geographic knowledge. When they're dealing with clients they hear their voices to find out where they're from. So it works really well when we're providing the service locally.

Robyn Haydon: 8:00

Sounds like there's some really diverse areas, so that's really interesting in and of itself, but you're the lead agency for this program, so what does that mean? If you could explain for our listeners Ian or Kimberley either one of you can take this question how do you actually work as a lead agency to bring this program together?

Ian Graham : 8:19

When we're chosen to provide the service within an area, we link in with our NHS colleagues, our colleagues within the Scottish Ambulance Service, police Scotland, local GP surgeries, community mental health teams, and Kimberly would set up an implementation group meeting with them. So we discuss what the distress treatment intervention model will bring, how it will work. Then we would discuss what pathways to open and how we would open them, discuss what pathways to open and how we would open them, and then we sort of manage the services come through, advertising it locally, recruiting staff and showing the benefits to people of how we want to work with them. And then Cumberland and our team will do a lot of the work on the ground, meeting the staff locally, explaining to them it's providing a compassionate response at the first level and then the teams locally provide service. And you just work through a month-by-month schedule, introducing more pathways, starting to get more people on board, answering questions, and then just continue to drive the service.

Ian Graham : 9:12

And one of the key points Kimberly does is doing buzz sessions. She does this face-to-face meetings with staff in the other agencies, answers any questions and brings them up to speed and showing how the service is going to work and getting it on the ground and advertising it, showing the benefits of it and how. We're quite unique in the 24-hour call and the quick 14-day package. So I think that's one of the key things for us. Delivering, I mean the lead agency. We take all the questions, come in. We're expected to push it the whole time but also work with other agencies in the public sector to expand it and constantly meet the demand that's out there.

Robyn Haydon: 9:49

Sounds like there's always something to do with this program and a lot to coordinate and bring together. Kimberley, what's that like for you on the ground?

Kimberley Irwin: 9:53

and as part of the lead agency delivering this. There's a lot that goes on in the background for the program and really the most important component of being the lead agency is relationships, partnership working, supporting each other. And the idea of me going out about in the communities with the frontline, with the buzz sessions, is essentially, you know, going through referrals, going through how they looked, going through you know what their numbers were, really keeping them up to speed with how their DBI kind of looks. What's also really important is being there for support. You know, refreshing them with the distress brief intervention model, how it works, what happens on our end when we receive a referral, so they get a full picture. I also very much promote you know, if you are on the front line and you're not really too sure, pick up the phone, give me a call, we'll have a chat. It's important to have really good, strong relationships and that's something that I've been working really hard within the background so that we're all working collaboratively together.

Robyn Haydon: 10:58

Sounds like it's a very relationship driven program and a lot of sort of real time learning too. That's going on on the ground and there's a lot of partners of real-time learning too that's going on on the ground and there's a lot of partners, I think, to coordinate. It might be worth, just for the sake of our listeners who are not familiar with this, the DBI programs come to our attention in Australia because, after the Royal Commission into Victoria's mental health system which happened a few years ago now it was in 2019 and 2020, the introduction of this kind of program, a distress brief intervention program, was actually one of the recommendations of the Royal Commission's final report and it was specifically to improve our suicide prevention services here in Victoria. So we actually have representatives from our state government travel to Scotland to find out more about this program. So can you explain how DBI works in terms of what you do at Change Mental Health? So how does it work as a program within itself and then how does it fit with your other suite of services?

Kimberley Irwin: 11:57

The premise is pretty simple with distress brief intervention. It's connected, compassionate, immediate response within 24 hours and it's provided 365 days of the year. It's a two-level approach, so we have level one and we have level two. So level one would be all our frontline workers and level two are all our DBI practitioners. We have a DBI model. So the DBI model is the 14-day brief intervention. It it's person-centred, so it's dependent on the individual's situation and what's going on with them and what their needs are.

Kimberley Irwin: 12:32

What we would do during that support whereby it goes into their background. What's going on for them right now, what's causing the distress? Where do we need to look to see what we can help you with. That is a main component of the distress management plan, but the most important part of the distress management plan is how to improve. So with that, we will look at working with distress brief intervention tools.

Kimberley Irwin: 13:04

So there's an array of different tools, from looking at distress triggers, if then coping skills, confidence rulers, smart goals. There's a lot of planning and we will also use decider skills. So you know, looking at breathing exercises as well, like looking at what's going to help them right in that moment of that time, that when they can feel their distress occurring. We very much also look at triggers and behaviours so then we can identify what tools would be best for an individual. We'll look at practical side of things as well, you know. So a lot of signposting happens and everything that we give support on with an individual will go on their distress management plan and that distress management plan is theirs for the future, so they get to take that away with them at the end of support. Ian, do you want to chip in with anything else?

Ian Graham : 13:56

I think the key thing for us is a couple of things the 24-hour response when someone's in distress, the fact that we will speak to them. We guarantee we will speak to you within 24 hours. There's a massive difference. You know the clients when we speak to them, they're thinking they're getting referred to a GP or a community mental health team. They don't know how long they're going to wait, but they're getting someone to speak within 24 hours.

Ian Graham : 14:15

The way our staff are just really good listeners, really good communicators, so they're able to immediately recognize the person's distress levels, discuss with them, explain what we do. We had a really good example of one of our staff. They had a very distressed individual on the phone like what can I do, what do I need to do? What do you want me to do? And the member of staff just said just answer the phone. All you have to do is answer the phone to me and I'll talk to you. And they just talk through right, right, what's your distress, what's causing it? And just about turning that person around within that period of a couple of phone calls or face-to-face meeting or virtual. It's about listening to them and saying, right, what's causing the distress, what can we do to alleviate it and what can we do in the short-term period to do so? And I think the fact that we're guaranteeing phone calls within not just the 24, but the next couple of days and four, maybe five phone calls over a two-week period, do you know it really works for them and I've only been in the service a few months.

Ian Graham : 15:05

I've seen clients coming in really in a state of distress and after a few discussions with our staff you see them going out to a different person. They're saying hello to you on the way past. They're recognizing there's someone out there to listen to and they're recognizing what's causing the distress. And the dbi model allows the staff to do that in a structured way, but it's their personal skills following the structure that makes a big difference and we see that in the reviews and feedback that we get. I would always say to people that initial 24-hour call followed by a couple of phone calls that's the key of the distress brief intervention model and when we really sell that to clients and to the other agencies that we provide that, you can see the demand growing. But I think that's one of the key things, as long as we're able to maintain that and to be able to sell it to staff and get the clients on board and get the feedback. I think the model works really well. Every evaluation that's done has shown it really works.

Robyn Haydon: 15:51

Yeah, absolutely, and obviously a very successful program, which is why we're looking to emulate it here and well-established now. And I'm wondering if you think back to when the program was first introduced and I think probably you've alluded to this already, in the sense that you know there was a gap in that being able to provide a brief intervention quickly to people who might have kind of fallen through the cracks because they weren't able to get to a GP. They weren't actually able to get the support quickly enough. Was that the reason why the program was developed in the first place, or what was the need that was originally identified that then became the distress brief intervention program?

Ian Graham : 16:32

Yeah, the Scottish government, you know, from the 1990s onwards, were looking at the distress brief to see what was happening, what was causing distress in the communities, what pressure was within the frontline providers, getting the feedback from clients, getting the feedback from the providers. And they looked all around the globe. They looked at various studies, various researchers, they looked at the international literature that was out there, trying to decide what model will work best in Scotland. A timely, compassionate response was key. Also, maintaining longer-term contact with the clients by what we do, by putting the plans back to the GPs to show them we've met with the client. This is what we've done with them Giving them signposting to show them what's available out there if they're not already aware. What will work for the frontline and will also work for the client in coming back and supporting the frontline services. So the gap was identified. This was the main one the number of people that were approaching GPs emergency services in a state of distress. So they thought, right, this could be a good model to bring in. So, 2016, they come up with a pilot. We have members of staff, our manager. She's been on the DBI since it first started. So she started the small model as it rolled out and immediately they could see it was starting to work.

Ian Graham : 17:40

Somebody was showing me newsletters today from a couple of years ago which showed how the numbers have started to grow to what we are now. We're up to approaching 2,400 a year now within our bit of DBI, and that's just over a number of little areas Nationally. I think it's over 62,000 referrals since 2017. So it's growing year on year. So I think that was it. It's been brought in to meet the demand. But the good thing with the DBI they're always looking to improve. So they're always keen for feedback working with Glasgow University to get more tools to work with the staff, listen to the staff on the ground and the staff come up always some excellent suggestions. So they're always looking to improve. So I think from that start, as long ago as the 1990s to the model in 2016, one One of the key points has been it's not a set model. It works under a structure, but they're always looking to improve it and how to develop it better.

Robyn Haydon: 18:27

Kimberly, do you have anything to add to that? Just in terms of the origins and where the need first evolved for this programme.

Kimberley Irwin: 18:34

Ian gave a really good explanation there, and it's all in aid of trying to get as much support for individuals as possible, as well as as helping frontline, because we know, especially through times over four years ago, everything went a bit crazy and they need support now more than ever, and I think that's really the crucial thing as well, that this DBI program is here to support them too, and it works beautifully. As Ian said, you know the model. The model works and if it didn't work then it wouldn't have succeeded to the extent that it has to date and it's been wonderful to have been part of it and its growth. Dbi is a fantastic model.

Emily Webb: 19:15

You mentioned, gps are a really crucial part of this program and your frontline workers? Gps are a really crucial part of this program and your frontline workers? Emergency services like police, fire, ambulance. So I'm guessing when you talk about support for them, it's because they're interacting with people in extreme distress, so it's helping to take, I guess, some pressure off those services. So community partners are really important for this program, from everything that I've read and I'm listening to you. So who are the the main referrers or partners and how does it work?

Kimberley Irwin: 19:49

We have different pathways, so with Inverness and Highland in particular. Yes, gps, they are sort of our our main referrers. You know we will have some GPs within a year that are reaching sort of the 150 for referrals for that year, which is great. On averaging of 10 to 12 a month. We also work very closely with mental health teams so they can also refer custody link workers within the police station and we also have relationships with the police and the ambulance. Last year we also have relationships with the police and the ambulance. Last year we also have a children and young persons pathway. So we are within Inverness High Schools whereby those partners for me are the wonderful guidance teachers and that's been really successful so far. We also work alongside CAMHS as well With our national programme which came about in the COVID response because you know the world sort of shut down in a sense.

Kimberley Irwin: 20:50

We took on the NHS 24 mental health hub so that actually covers a wider area of all of the four areas of Inverness outside Inverness, within the Highlands, dumfries and Galloway, argyll and Bute and Western Isles, so it's really a larger area. There are so it;s really a larger area there and we also get from the police and that's open to ambulance as well. Argyle and Bute, dumfries and Galloway and Western Isles they have their own individual local pathways. So they work again with an array of different partners. Every front line service has to be DBI level one, trained, before they can make a referral into the service whereby maybe you know we see a lot, especially with GPs. They're sort of moving around from practice to practice or they're moving on elsewhere or we're getting quite a lot of new GPs.

Kimberley Irwin: 21:34

So my role is to keep on top of that to make sure all the GPs within surgeries you know they are up to date with the DBI training and they're fully refreshed constantly. Usually I go into GPs quarterly where I'll go in with a little bit of a newsletter, give them a rundown of the referrals of that quarter top referrer, champion kind of thing. Just to make it a little bit interesting. We all work with the frontline really quite closely and it's also making sure that they're aware of the DBI programme in the sense of how it's helping individuals. That's genuinely how it works with the frontline and obviously with Western Isles. We've started with the police, which has gone really well with training. We've done some buzz sessions already. So it's just about keeping on top of that and constantly expanding and building those relationships up and ian, did you want to add anything there?

Ian Graham : 22:29

yeah, I think, as kimberly said, the relationships are key, but it's also getting the buy-in from the frontline services. You're wanting them to understand just that compassionate response. I was frontline you line with the police. We would go to someone who was in a state of distress and we'd say how can we best help them? The police is not best suited. They don't require to go to the hospital, it's out of hours so we can't get maybe the right community psychiatric services available for them. So we would just sit down with the person and say that we could suggest you go forward to this program where someone will phone you. It's called the stress brief intervention model. They get a wee handout given to them and just doing that five to ten minute time to sit down with a person gives them some hope that someone's going to call them the next day and the frontline provider can go away and think right, I've done something really positive with that person, you know, and they may not be phoning back two or three times during the night to other services.

Ian Graham : 23:17

As Kimberly said, once you get the frontline provider on board and they start to see the benefits and they get the feedback from the clients themselves when they come into the GP practice or something. The referral starts to come from that particular practice or from that particular officer or from the Scottish Ambulance Service NHS24. And word soon spreads that there's more of this available and I think the work with Kimberly and the staff here and throughout the other areas that we cover and meeting with the frontline it really gets the buy-in from them and it's the chance for them to understand what we hear and why we're here and that we provide that quick response. It's not just a case of something's going to phone you in a few weeks. It's a quick response. It's the key thing for the frontline provider and we do see the practitioners and more and more people referring.

Ian Graham : 24:07

As a result of that. We also have more people wanting to become a referrer. Up here we've had the local prisons asking can they get in touch. It's word of mouth that spreads and they start to pick up quickly how the DBI model works and all the evaluation has shown that it works and the key is in the frontline buy-in to get that started and then get them over to us for the discussion. So it really works well and the relationship with the providers works really well, especially in our areas. We're quite rural and diverse. So the fact that staff live there, they know the staff, they know the people, we can go face to face with them in whatever they're based, that's a key selling point for us.

Emily Webb: 24:32

Yeah, it sounds like the word of mouth element of this program and the community partnerships and training to equip people to actually refer in is really fascinating. And from the research around this program and Robin's been doing some as well it's my understanding that some people who are accessing DBI and being supported by it actually maybe haven't had much interaction with a mental health program or service or maybe have never identified in themselves that they are having, I guess, a mental health crisis or service, or maybe have never identified in themselves that they are having, I guess, a mental health crisis or a distress or something like that. Can you explain a bit more about this and, I guess, the stresses and the general reasons broadly that you're seeing people referred for this program, and whether or not what I said is correct or not?

Kimberley Irwin: 25:18

So, yeah, what you're saying is is correct, but we also see it on the flip side, that there can be quite a generous amount of time on waiting lists within the highlands for different programs and we will be approached with an individual who is, you know, distressed because of having to wait X amount of time to be able to get some support With a team on the ground. When we first initially speak with an individual, you know we're listening, we're being compassionate, we're giving them that time and space to enable them to, you know, go through that frustrations, because we understand. But what we do on our end of things is provide expectations Okay, tell them exactly what DBI is, what it's not, how it's going to work throughout their support, but also giving them the hope that we can do so much within 14 days to enable to equip you to wait to go on for your next support service. And we see that a lot coming through with the referrals and it's just about the team being able to handle and manage when individuals are coming through with distress, of frustration. Essentially, we see an array of different reasons why individuals would be distressed low mood, depression, relationships, financial family bereavement. You know that list is really quite endless when it comes to the stressors, because everybody's distress is different and everybody's distress is relevant to that individual. So you and I might be going through the same situation but react completely differently, and it's really important to remember that everybody's distress is valid and it's just about us taking the time and listening to what it is that their needs are.

Kimberley Irwin: 27:08

Two of the most common, unfortunately, factors within referrals is self-harm and suicidal ideation.

Kimberley Irwin: 27:16

We have tools that can help us with those. We have a safety plan that we go through with individuals, whereby it talks about their mood, their feelings, emotions, how they're feeling right at that moment and time of you know being able to identify feeling that way in the moment. Then we'll look at coping strategies. I think it's also really valuable to to ask the individual you know what do you do at that moment? Because if it's something that they are automatically doing themselves, it's very much worth making sure that that is within a safety plan, because it's something they're already currently doing to enable them to sort of balance the triggering and the behaviors. Then we'll look at support options. So who can you call, whether that would be family, friends, places that provide you with a distraction, and then, obviously, other support services that would be available. So, with those particular types, there's training in place and there's tools in place to spend time with an individual, to go through all of those, so they are equipped for feeling that way.

Ian Graham : 28:19

I think one of the key things with DBI as well, we started to pick up trends. Rural isolation, that features for us. Gambling and debt are starting to feature with us. So we start looking at that and we look to see where can we go for advice for our staff. So we work with the Citizens Advice Bureau for that.

Ian Graham : 28:36

I think the question you had about people coming to us who haven't had much interaction with mental health services before. When we have clients coming in, we fill in forms to see who we've spoken to. Do they have a diagnosis? A significant amount of people do not have diagnosis for mental health. They are suffering purely from anxiety and distress and they're concerned then that they're coming to a mental health charity. But the staff are really good in speaking to them to explain it's distress. This is what some people do. You might just be a case of a coping method when they come to us. You know we're non-judgmental. We'll work with anyone.

Ian Graham : 29:09

We go from complex to people who haven't had dealings with mental health services before and they may never again. You know our hope is someone can go away and use the coping tools. The studies we've done show that people do keep the distress management plan with them for a number of months and they do work through with them. So we're always looking to see right that's really good work, what works for you or doesn't work. Staff are always identifying tools to deal with some of the stressors that come in. So it's always moving forward, it's always evaluating, it's always looking to see where the trends are. The stressors list seems to get larger and larger. It's different ages as well. We've got people in their 90s coming to us, down to people still in school.

Robyn Haydon: 29:44

And it sounds like from what you're saying, Ian, that sense of normalising the help-seeking behaviour, especially for people who are not normally in contact with mental health services, and reducing some of the stigma and normalising that so that people can feel better about what they're going through and getting that help, even if it is simply all they need, is something that's brief and really curious to know. Since you've been providing this programme at Change Mental Health. How has the DBI programme evolved and, as you said, it's changing? Is the need growing? In what areas are you seeing that happening?

Kimberley Irwin: 30:20

yeah. So I've been with dbi coming up three years this year and I came in as a coordinator and the growth, even within that time, has been immense and it's been an absolute honor to watch and be part of. We were looking at this yesterday myself, myself and Ian found about 100% growth since it went live in 2016. The DBI has an average of around 220 odd referrals a month and Inverness take around 105 of those. So when the front line are seeing DBI, seeing the immediate response, seeing the 24 hours, they're intrigued. And we do get people emailing. You know, outside can we refer?

Kimberley Irwin: 31:02

Not only that, we get a lot of when I go to do visits with GPs they'll say I had so-and-so come in, you know, and they were explaining how amazing the service was, what it did for them. They're providing feedback. That's not something that we get often from individuals who come to DBI, but when we do, it's really important to take that and feel empowered with it that we're making a difference in individuals' lives, the programme itself, even from referrals from when I was here as a coordinator. The amount of stressors that have grown since then have changed. Like Ian was saying, the list has always been added to with different things and we always take a look at that with the trends that are coming into the service. So overall the growth has been massive and I have absolutely no doubt that it will continue to grow.

Robyn Haydon: 31:55

Ian, anything you'd like to add to that?

Ian Graham : 31:58

Mental health distance and still Distress is always changing throughout the year. We see peaks and troughs throughout the year. So we're probably professionalising as we do along as well. We've done from the pilot project, but we also have other third sector providers. We meet regularly I think it's once every six months Distress-based practice. We discuss what's happening, what the trends are, who's doing things.

Ian Graham : 32:17

You're always looking for ideas for how to improve the service that you give to the clients. The staff are always coming up with ideas, so the need's definitely growing. We're looking at things like, I think, DBI Plus for the future. What will that meet? What else can we do? What can we provide Because it works? People look to us and say, right, right, what are you doing as a service that works and how are you providing that service and what do you think we can see to improve? And within the whole DBI community in Scotland it's always looking for right.

Ian Graham : 32:43

Where's the next best idea going to come from? Where's the next best provision going to be? What are you seeing that works? What are you seeing that doesn't work? Where can we go next? What can we do to support the front line? Who else should we be supporting when we go to our health and social care partnerships. With our data, with our numbers and with where we're going. You know they can see the positives of it. We have a plan to support their service going forward. So I think it's really good. I think we all see the positives of it and we just see it constantly starting to grow, and so I was really keen to see it going elsewhere. We always like to share work as we go around things as well and things you've identified that maybe we haven't thought of. So I think it's a really good service to work in and we're always selling the positives for it.

Robyn Haydon: 33:22

Clearly a very, very successful program and one that you should be very, very proud of, and it's really exciting to hear, kimberley you've been working on this for, you know, three years and Ian for just a few months. You know, you're already, you're seeing the great demand that exists for the DBI program. I'm wondering very curious, if you could kind of wave a magic wand and do anything differently. What advice would you provide to us here in Australia Is there anything that you would change or do differently? What are the most important things that you think that we need to focus on to really make this program work for people who are experiencing distress?

Ian Graham : 34:09

A couple of things. One is the funding. You know, longer term funding model, not year to year, five to 10 year funding model, I think provides more service, provides more continuity, provides better assurance for the staff working within the team, provides the frontline providers with every assurance you're going to be there year on year, that you're going to grow with them. And the other one is getting into the frontline providers early doors, whether you make a compulsory that they are on board. Kimberly recently done a presentation to trainee adults, mental health nurses, at one of the local colleges here you know, and that's a room of about 100 people who are just about to qualify as nurses, listening to what we provide. You want to get them early. Once they start to hear the word DBI, you know going around in their head, they know it's a really good model and use what's worked elsewhere, use the branding, the name.

Ian Graham : 34:54

The DBI is really distinctive. The one thing I'm sure you've read all the evaluation reports. We're one of the third sector providers and it's all run through a thing called DBI Central. It's like the hub and spoke model and that's been really key. It's not been absorbed into one particular health board but having that one central office. But they're really open to thinking it's been really beneficial. They're looking to grow it but contain the growth so that everyone's sharing from the same thing, and I think all the evaluations are pointed to the same thing. That model works really well. That provides that level of control, stability, governance that's needed in the background behind this and that's been one of the positives. So if you set it up using that sort of model and the other points, I think you'll have loads of success for the future.

Emily Webb: 35:36

You've both got a lot of experience in community services. Really, your careers are dedicated to it, kimberly, in mental health. Ian, you've come from a policing background. It's a really dynamic, rewarding space, but also, you know it can be tough and it can be stressful. So I just want to know what is it that keeps both of you doing the work that you're doing with your communities? Kimberly, I'll start with you.

Kimberley Irwin: 36:03

You're right, it can be tough, but for me personally, it's seeing the difference within individuals. Within those 14 days. You're making a difference. You're giving them hope, you're making them feel empowered, they're taking back control and you know you could speak to a client on the first day and on the last day it is literally like speaking to a completely different individual. They are making the changes. They've done things within their plan and for me, you know, feedback is amazing to hear.

Kimberley Irwin: 36:39

I don't work directly so much with clients anymore, that is with my team, and the feedback that they get is so heartwarming to see as well. It's about, you know, I obviously I'm working with the team in the sense of making sure they're good, their welfare is good, making sure they're good, their welfare is good, making sure they're fully up to speed with training, making sure everybody's connected. I've kind of gone from the one that's providing, you know, the support to clients but now I'm providing the support to the team, seeing the team as well. You know, come back with. I've had this email. This is what it says. You know, they're so proud, they're so proud. It's just an amazing program to be a part of Change. Mental Health is an amazing organisation to be part of, and that really is why I'm still here, nearly three years on, and I'm very, very passionate about the service.

Emily Webb: 37:31

It sounds incredible and, yeah, like there's many similarities with Irma365 and Change Mental Health when I was looking at stuff. It's quite interesting, Ian, what about you? Because you've had a pretty intensive career dedicated to the community.

Ian Graham : 37:47

Yes, policing is especially in the Highlands. You're working with large communities like Inverness, or you're working in small communities with the only police officer on an island of 1,200 people and that's really intense. You need to build up that relationship with people. You just be there to help and support people. If someone's in distress, or even in the police, if someone needs help, they need to know someone's there for them. I think that's one of the key things of all the emergency service and frontline providers and the mental health community sector. I remember coming in for my interview and I had to. I got interviewed by, I think I had to go into the tea room and speak to all the staff as well and asking them what their background was, and it's all varied backgrounds. You know, there's not like 10 people there that have been through university and have done the degrees here. They've all got different backgrounds but they're really good speakers. They want to help people. You can't help everyone, unfortunately. You are going to find clients that will come back or will finish the period of support, but it's the rest of the staff. You know, when they come on at the end of the day for our meetings, it's the staff speaking to them to say, yeah, they're there to support them, they're there to listen to them. So supportive staff. But yeah, mental health is about purely helping people. We can do what we can. Dbi works.

Ian Graham : 38:53

Change. Mental health has come through a huge change period over the last few years. You, you know our branding, our logo, the way we do things with our chief exec is always pushing the service. Every time you listen to him, you feel more inspired each time and that's what you want in our organization. So we're always looking to see how we can help and working within change and working here.

Ian Graham : 39:09

It is the positive feedback. Having worked for years within the police, we didn't get a lot of positive feedback, even though we're there 24 7 for people. So, the little things here. There was a card received yesterday for a member of staff. It was really nice, you know. It was really touching. They also sent a packet of biscuits, so we're looking forward to that as well. Obviously, we'll share that among staff. But, yeah, I think the staff are really positive. You have your morning chat, the morning meeting. It's still very stressful, it's still very busy. They're still challenging as complex individuals, but the positiveness of the staff and the small difference we can make. It's just the little things to help the community, little things to help someone. You may not have been able to help them as much as you want, but they've had someone to speak to. I'm always speaking to colleagues who left the police to do other jobs just to say it's a brilliant organisation to work for because you can make a difference and that's you know. That's quite unique, this test.

Robyn Haydon: 39:56

Absolutely. It is unique and it's very rewarding work, very meaningful work and very necessary work. It can be challenging work at times, as we all know. So really interested in how you look after yourselves and we ask this question of all of our guests what do you do to take care of your own mental health and wellbeing? Ian, I might start with you. What do you do to look after yourself, your own?

Ian Graham : 40:21

mental health and well-being. Ian, I might start with you. What do you do to look after yourself? I do a lot of sport, so I go to the gym. We've done a cycle around Loch Ness on the weekend, so where they close the roads, 66-mile cycle challenge. I do a lot of running. I think, as I'm getting older, I'm doing more sport and more fitness because I realise the benefits that it brings to you and that'll be my main thing for keeping my mental health and wellbeing going.

Robyn Haydon: 40:39

Offsets all the biscuits too.

Ian Graham : 40:41

Well, we're looking forward to them still arriving, but yes, they will help.

Robyn Haydon: 40:45

What about you, Kimberly?

Kimberley Irwin: 40:47

I'm a busy mum of three, so I have three children at home. So I did say to Ian yesterday what is it I do? And he said your family holidays. I look forward. Every single year we book a nice family holiday to get away to spend some quality time together, because it's very busy, you know, by the time you get home with with three children. What I do think is really quite important, though and I've learned quite a lot myself since joining DBI with their tools and things is a lot of staff do it as well as we're using them. So I've learned quite a lot about my own triggers and my own behaviors where I need to take a little bit of a step back and input in my decider skill or a DBI tool. So essentially, I don't really do match, apart from making sure that I'm having good fun with with my children, because they're growing up and it's important to make sure that I capture that time before they flee the nest.

Robyn Haydon: 41:42

Yeah, absolutely Connecting with what's really important to you as well, as you know, doing the great work that you are both doing in this space. Really appreciate your time today and we're coming to the end of this chat it always goes so quickly Wondering if you have any final thoughts for listeners or anything that you'd like to to mention that we didn't cover today for me.

Ian Graham : 42:05

It's just you can tell from us we enjoy working with dbi. We really enjoy working with change mental health. It's exciting times we're really. You know, when we got the call from yourselves, your communications team can really wanted to go to Australia to do it but unfortunately I said no. So we're really excited to see the DPI model moving. It's you know it's going to parts of England, Obviously down with yourselves. It's been recommended elsewhere. There's a lot of international coverage for it. We've both got life experience. We've worked in various occupations, We've come here. We see the benefit it brings to people. So we're really delighted to see that it is spreading elsewhere and we look forward to seeing the results and listening to the reviews and the feedback and seeing how it goes elsewhere. So it's a really good chance to speak to yourselves today and just to follow how you stood on in the future as well.

Robyn Haydon: 42:50

Kimberly. Any final thoughts from you?

Kimberley Irwin: 42:52

Firstly, just to clarify Ian does keep saying no, but I keep saying yes, we are going to Australia, but no, it's been an absolute honour to be asked to come and speak with you today. You can tell that obviously I'm very passionate about DBI and how it works and you know I'm also here for any questions on how our day-to-day running works, always here to offer a hand. That relationship working again, and it's been fantastic to spend some time with you this morning.

Robyn Haydon: 43:18

That relationship working again and it's been fantastic to spend some time with you this morning, and absolutely with both of you. A big thank you to you both and we would love to welcome you to Melbourne and to Victoria Anytime you want to come over. You'll have a place with us and we'd love to show you some of the work that we are doing here. So thank you both. We've been talking to Ian and Kimberley from the Distress Brief Intervention Team at Change Mental Health in Scotland, so we will have details in the show notes for this episode so listeners can find out more about Change Mental Health and some of the things we've spoken about. Thanks for listening and if you're enjoying this podcast, please tell your friends, your family, your colleagues any and all of them and rate or review on your podcast listening platform.

Emily Webb: 44:16

If you've been affected by anything discussed in this podcast, you can phone lifeline on 13, 11, 14 or go to lifelineorgau you've been listening to get real talking mental health and disability, brought to you by the team at irma 365.

Team at ermha365: 44:36

Get Real is produced and presented by Emily Webb, with Corenza Louis-Smith and special guests. Thanks for listening and we'll see you next time.