Starting Conversations: Victoria on Distress and Early Intervention
Victoria
Operations Manager - NHS24 DBI Pathway
Q. Can you tell us a little about your journey with Penumbra and your current role?
A. I joined Penumbra in October 2017 as a Mental Health and Wellbeing Practitioner at the Edinburgh Crisis Centre, where I supported people experiencing a wide range of mental health crises and distress. In 2020, not long after the start of the COVID pandemic, I moved across to the DBI National team as a practitioner. I then became Operations Manager for the DBI National service in 2022.
Because I worked in DBI as a practitioner before moving into management, I think I have a good understanding of the service from both sides. I know what the day-to-day work is like for our practitioners, but I also now have responsibility for making sure the service is running well and that the team have the support they need to do their jobs.
Q. For those who may not be familiar with it, what is DBI and how does it support people?
A. DBI stands for Distress Brief Intervention. We support people aged 16 and over across Scotland who are experiencing distress and feeling emotionally overwhelmed. We receive our referrals in the DBI National service through NHS24 Mental Health Hub and the Scottish Ambulance Service National Contact Centre.
We are committed to attempting contact with all people within 24 hours of receiving their referral and, from this first contact, we can offer a number of phone or video support sessions over the following 14 days.
Q. What does support through DBI look like in practice?
A. The support we provide really depends on the person. We spend time talking about what has been happening for that person, what might be contributing to how they are feeling and what could help make things a bit more manageable now and in the future.
That might involve looking at ways of coping with distress, making a Distress Management Plan for the days ahead or helping someone connect with other services for longer-term ongoing support. We aren’t there to try and fix everything in 14 days. Often, it is about giving someone the time and space to talk, helping them make sense of what is going on and working out what the next steps might be, and we can support a person to take those next steps.
Q. What does a typical day look like for you as Operations Manager?
A. There isn’t really a typical day for me as Operations Manager. A big part of my role is managing and supporting the team. That includes things like supervision, staffing, managing capacity across the service and being there when practitioners need support after a particularly difficult or challenging session.
It can be emotionally demanding work, so supporting the staff who are having those conversations every day is a really important part of my role.
There is also quite a lot happening behind the scenes. I manage many of the systems and processes involved in keeping the service running, including referrals, case-management systems, data, reporting and service performance. A lot of my time is spent looking at how things are working day to day, dealing with problems when they come up and looking at ways we can improve how the service operates.
Q. What are you most proud of about the service?
A. The thing I am most proud of is definitely the team. Since DBI National went live, we have supported almost 15,000 people across Scotland, averaging around 213 referrals a month. We are actually quite a small team: 13 Mental Health and Wellbeing Practitioners, a Team Leader, an Operations Manager and an Administrator, so that is a huge amount of work.
But I think it is important not to lose sight of the fact that those aren’t just numbers. Every referral is a person who has reached a point where they are struggling and have reached out for support. They have very difficult conversations with supported people every day. They speak to people who may be overwhelmed, frightened, isolated, having thoughts of suicide or self-harm, or who are struggling to see a way forward.
They do that with a huge amount of compassion and without judgement, and I am really proud of the care and compassion they put into supporting every person who comes through the service.
Q. How does the work of DBI connect with the message behind World Suicide Prevention Day?
A. That links quite closely to the Scottish message around World Suicide Prevention Day and starting conversations. I think people can sometimes be frightened to talk about suicide because they are worried about saying the wrong thing, or they feel like they need to know what to say to make things better.
You don’t always need to have the right words or an answer. Sometimes the most important thing you can do is ask someone how they are, give them the space to be honest about what they are going through, and really listen to what they are telling you.
Q. Why is early intervention so important?
A. When someone is extremely distressed, it can be very difficult for them to see past how they are feeling at that moment. Having another person there who is calm, who listens and who takes them seriously can help them start thinking about what they need and what might help.
That is also why early support is so important. If someone can access help before things become even more overwhelming, there is an opportunity to look at what is happening, what could help right now and where they can get further support if they need it. With our 24-hour contact time, that is what makes DBI so special. People who are reaching out for support are getting the opportunity to speak with someone quickly.
Q. What continues to motivate you in this work?
A. I have spent most of my career with Penumbra working in crisis and distress support, and I think what keeps me in this area of work is knowing that support at the right time really can make a huge difference.
It doesn’t always mean someone’s circumstances suddenly change, but sometimes the difference is that the supported person feels heard and validated. Sometimes they feel a little less alone or a bit more able to cope with what is happening, and sometimes it is simply helping someone work out what they are going to do next.
Now that I am in a management role, a lot of my motivation also comes from the team. I see how much effort they put into their work every day and how much they genuinely care about the people they support. Being able to support them to do that work well, and helping the service continue to develop, is something I really value.
Q. Is there one thing you would like people to understand about DBI?
A. One thing I would like people to understand about DBI is that distress can affect anyone, and it doesn’t always look the way we might expect it to. Someone can appear to be coping on the outside while feeling completely overwhelmed underneath.
You don’t have to reach a particular point, or fit a particular description, for what you’re going through to matter and be significant.
DBI is a brief intervention, and we know that we can’t change every circumstance someone is facing within 14 days. But sometimes that isn’t what a person needs from us. Sometimes they need someone to really listen, to take their distress seriously and to help them find a way through the next few hours, days or weeks.
I think that’s what can be so powerful about this kind of support. We may only be part of someone’s life for a very short time, but we are meeting them at a point when things may feel incredibly difficult. If, during that time, we can help someone feel a little less alone, see that there are options they couldn’t see before, or begin to believe that things might not always feel the way they do in that moment, then that brief intervention can be incredibly meaningful.
