Table 3 Summary of stakeholder (delivery partner, service and policy leads, Distress Brief Intervention National Programme Board member) views on the Distress Brief Intervention

Clear oversight and central planning

∙ A clear programme structure, with central coordinating body, would ensure consistency and communication across agencies and pilot sites.

∙ A board constituting expertise and representation of partners and stakeholders should provide oversight and be consulted on key decisions.

Two-level, frontline and community-based, response and support

∙ The Distress Brief Intervention specification described a two-level response, with frontline providers providing a ‘Level 1 response’ at point of presentation, which in turn could lead to an offer of referral to receive an additional ‘Level 2’ enhanced response based in the community.

∙ There was consensus among stakeholders that both frontline and community-based responses were needed to address the range of distress presentations and intensity and type of support needed.

∙ Some stakeholders emphasised that the Level 1 response, provided at point of presentation, would be constrained by time pressures and it would not be possible to provide a standalone intervention in the frontline setting.

∙ There was uncertainty about whether some staff providing a Level 1 response staff would feel competent to determine the need for an enhanced Level 2 response, which may become a barrier to staff engaging with the intervention.

Intervention duration and speed of response

∙ While a Level 1 response was anticipated to be relatively brief, stakeholders were unsure what the optimal duration should be for the enhanced Level 2 response provided in the community. In the absence of comparable interventions for distress, most stakeholders felt support lasting up to 14 consecutive days was appropriate for initial piloting and evaluation.

∙ For those referred to enhanced community-based Level 2 response, stakeholders felt a 24-hour target for initiating follow-up contact would offer quick and efficient transfer from statutory to community services for follow-up support. Notably, several organisational or service leads emphasised that this speed of follow-up contact would be a vital condition for Level 1 frontline staff engaging with the intervention.

Target population and eligibility

∙ Clear and simple eligibility criteria and operational definitions of distress were viewed as necessary for consistency and utility across different non-specialising frontline services and contexts.

∙ The operational definition of distress should seek to be inclusive of a wide range of presentations, as well as de-medicalise and normalise distress as a response to stressful social, relational, and economic events.

∙ The process of determining eligibility and need for the intervention should not amount to an assessment of risk.

Intervention delivery partners

∙ There was broad agreement among stakeholders that consistency across sectors and settings was needed to support people in distress, with consensus that a core set of frontline services should provide an initial Level 1 intervention response.

∙ There also broad support for the Level 2 community-based response to be met by established third sector community mental health support services. This should be the standard model of providers in each of the four pilot areas.

Critical role of compassion

∙ To address the needs of those in distress there was agreement that the intervention should be underpinned by a compassionate approach to responding to distress.

∙ Some stakeholders considered that a compassionate response required time and resources that already stretched frontline services were not well placed to provide. Other concerns raised by stakeholders included whether a compassionate approach would be readily adopted by those frontline services where compassion is not an established feature of practice.

Referral process

∙ The referral process linking the Level 1 frontline service response to the Level 2 community response was a key concern for frontline service leads. A process that is time-consuming, inefficient, or required non-standard systems or actions was felt to be a potential barrier to uptake and use of the intervention.

∙ The secure and timely transfer of information from the Level 1 referrer to the Level 2 community service, with confirmation of receipt, was also a concern of frontline services leads. This process was viewed as an important facilitator, with frontline service staff engagement with the intervention likely to depend on their confidence that immediate follow-up support would be available in-line with expectations.

∙ Of importance to third sector service leads was establishing a referral process that facilitated high quality, consistent and relevant information. Based on past experiences providing follow-on support for frontline services, poor quality referral information and systems were a barrier to the community support responding efficiently and appropriately to referrals.