Infectious disease outbreaks have occurred sporadically over the centuries. The most significant ones of this century, as reported by the WHO, include the EVD epidemic, SARS pandemic, Swine Flu pandemic and MERS pandemic. The long-term mental health consequences of outbreaks are as profound as physical ones and can last for years post-outbreak. This highlights the need for enhancing the preparedness of pragmatic mental health service provision. Due to its magnitude, the novel COVID-19 pandemic has proven to be the most impactful. Compared to previous outbreaks, COVID-19 has also occurred at higher rates in frontline staff in addition to patients. Since COVID-19 is more contagious than earlier outbreaks, there is a need to identify infected people quickly and isolate them and their contacts. This is the current context in which mental health services including IAPT have had to operate. Evidently, IAPT services are a major mental health service provider in the UK which have demonstrated variability in their response to COVID-19. While some IAPT services quickly adapted their existing strengths and resources (e.g. remote working) other services were less prepared. To date there are no clear unitary guidelines on how IAPT services can use their pre-existing resources to respond to the long-term effects of outbreaks. In light of this, the current paper aims to reflect on the lessons learned from past outbreaks in order to consider how an enhanced remit of IAPT might integrate with other services to meet the long-term needs of patients and staff affected by COVID-19.

Britain has increasingly become a multi-cultural society. In order to improve access to primary care psychological therapy including cognitive behavioural therapy (CBT), there has been an increase in focus on cultural adaptation and cultural responsiveness. To date, these adaptations have focused on domains such as language, beliefs and values. In this case, familism was the focus for adaptation. The client was a 22-year-old female from a black African-British background. She presented with severe symptoms of chronic depression as measured on routine standard questionnaires and the interview. She had minimal success from previous interventions and was struggling to make progress. Therapy was guided by the client’s views on what issues had a bearing on her difficulties. The client hypothesised that familism factors with themes around ‘my parents’ culture’ and ‘family comes first’ were interacting with her cognitive behavioural factors to maintain her problem. She requested the involvement of her family in her treatment plan. In line with the Improving Access to Psychological Therapies–Black, Asian and Minority Ethnic service user Positive Practice Guide, this was integrated as part of her formulation. Upon involvement of her father in a single session, the client attained reliable improvement. She attributed her improvement to this involvement. By the end of therapy, she reached recovery, which was maintained at 3-month follow-up. This study was responsive to the client’s own perceived cultural needs through the integration of familism into her CBT formulation. It illustrates a client-led cultural adaptation of CBT to treat chronic depression. Key learning aims It is hoped that the reader will increase their understanding of the following from reading this case study: (1) Creating an environment where clients can freely discuss their perceived cultural factors from the outset. (2) Client-led cultural responsiveness to their expressed cultural needs. (3) Familism as a domain for adapting CBT.

Perinatal depression is prevalent in primary care in the United Kingdom. The recent NHS agenda implemented specialist perinatal mental health services to improve women’s access to evidence-based care. Although there is ample research on maternal perinatal depression, paternal perinatal depression remains overlooked. Fatherhood can have a positive long-term protective impact on men’s health. However, a proportion of fathers also experience perinatal depression which often correlates with maternal depression. Research reports that paternal perinatal depression is a highly prevalent public health concern. As there are no current specific guidelines for screening for paternal perinatal depression, it is often unrecognized, misdiagnosed, or untreated in primary care. This is concerning as research reports a positive correlation between paternal perinatal depression with maternal perinatal depression and overall family well-being. This study illustrates the successful recognition and treatment of a paternal perinatal depression case in a primary care service. The client was a 22-year-old White male living with a partner who was 6 months pregnant. He attended primary care with symptoms consistent with paternal perinatal depression as indicated by his interview and specified clinical measures. The client attended 12 sessions of cognitive behavioral therapy, conducted weekly over a period of 4 months. At the end of treatment, he no longer portrayed symptoms of depression. This was maintained at 3-month follow-up. This study highlights the importance of screening for paternal perinatal depression in primary care. It could benefit clinicians and researchers who may wish to better recognize and treat this clinical presentation.

Behavioural experiments (BEs) are a major cognitive ingredient in the cognitive behavioural therapy (CBT) model which can be applied in-session or between-sessions. In-session BEs are particularly effective and widely demonstrated in anxiety disorders, yet they remain under-utilised in depression. Clients presenting with persistent depression are often difficult to engage due to the chronicity of their symptoms and their learnt self-perpetuating demoralised states. Research to date demonstrates the effectiveness of in-session BEs in engagement and treatment in depression. This case study details the treatment of a client presenting with persistent major depressive disorder (MDD) with hopelessness and how in-session BEs effected engagement and treatment. This case study is discussed with reference to strengths, limitations, clinical implications and recommendations for practice and development. Key learning aims It is hoped that the reader of this case study will increase their understanding of the following: (1) Using BEs to help engagement and treatment in persistent MDD. (2) Instilling hope by starting in-session BEs during the assessment stage. (3) When to plan or seize opportunities for off-the-cuffin-session BEs. (4) Setting no-lose BEs to enable clients to widen their perceptual field. (5) The importance of repeated BEs to consolidate experiential learning.

Individual Trauma-focused CBT has been shown to be effective for treating posttraumatic stress disorder in military veterans. Treatment challenges are common including the presence of dissociation and comorbidities including depression, traumatic brain injury symptoms, substance misuse, and social transition difficulties. There are currently no standard psychological therapy guidelines for veterans with comorbid presentations. However, as recommended by the National Institute for Health and Care Excellence treatment guidelines, adapting existing treatments can improve the chances of successfully treating trauma cases. In line with these recommendations, the current case study describes how the existing individual trauma-focused CBT model was integrated to treat posttraumatic stress disorder with comorbid depression, persistent mild-traumatic brain injury migraine, and social transition difficulties in a 38-year-old male combat veteran. The client attended 16-sessions of trauma-focused CBT. This model integrated his comorbidities and involved his spouse and multidisciplinary discussions with his general practitioner, and neurorehabilitation team and the Veterans’ Transition Service. At the end of treatment, the client no longer met the diagnostic criteria for posttraumatic stress disorder. This case illustrates how trauma-focused CBT can be integrated to treat comorbid posttraumatic stress disorder in veterans.