Background: Mental health problems, self-harm and suicide are major public health concerns. National mental health and suicide prevention strategies in Scotland have emphasised the need to improve the response and follow-up support for adults presenting to frontline services in distress. This study describes the development of the 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 (including contemporary suicide and self-harm frameworks); delivery partner and stakeholder consultations (n=19); semi-structured interviews and/or focus-groups with frontline services staff (n=8); interviews and/or focus groups with adults with experience of distress (n=9); feedback from test training for staff (n=16) and self-assessed confidence ratings provided by staff immediately before and after 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 informed by the integrated motivational-volitional model of suicidal behaviour, information protocols and guidance for providers, personalised distress management planning and behaviour change tools including safety planning and volitional help sheets for self-harm. During development, 525 intervention providers (n=472 frontline statutory service staff; n=53 third-sector community organisation staff) completed training in four pilot areas. Training evaluations from 388 providers (74%) indicated significantly greater confidence following training on key competencies.
Conclusions: A multi-agency Distress Brief Intervention was systematically developed and implemented in a range of non-specialist frontline and community settings in Scotland. As of 2024 more than 60,000 people in distress have received a referral for Distress Brief Intervention, a significant proportion of whom present with suicidal risk. Further evaluation is underway to understand the possible suicide-protective effects of Distress Brief Intervention.