Beyond the COVID-19 pandemic: ‘Learning the hard way’ – adapting long-term IAPT service provision using lessons from past outbreaks

Abstract

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.

Variations in the uptake of telemental health technologies in community and crisis mental health services during the early pandemic: a survey of mental health professionals in the UK

“…It should, however, be noted that other studies have concluded that, whilst promising, the current research on video psychotherapy is limited and lacking generalisability [42], and that there are likely to be differences in video compared with face-to-face psychotherapy, for example, that impact how the therapeutic relationship and alliance develops. However, during a crisis such as the COVID-19 pandemic, our finding that psychologists and peer support workers made more use of telemental health compared to other professionals likely reflects the greater feasibility of adopting remote appointments for these professions, compared to the activities of many other clinical roles such as performing assessments, safeguarding, and managing medications [43]. It may also reflect that telephone therapy already played a substantial part of IAPT practice before the pandemic.…”

Patient-led integrated cognitive behavioural therapy for management of long COVID with comorbid depression and anxiety in primary care - A case study

“…This is also in line with the pandemic preparedness recommendations for IAPT services. 16 There are currently no clear guidelines on integrated physio-psychological primary care management of long COVID symptoms. However, the NICE guidelines recommend that careful planning and adapting existing interventions can enhance the chances of successful treatment for long COVID cases.…”

IAPT CBT treatment for PTSD following COVID-19-related intensive care admission – a case study

“…Data have shown that some survivors of COVID-19 go on to develop PTSD (Einvik et al, 2021;Janiri et al, 2021). Using lessons from past pandemics, Skilbeck et al (2020) had mapped out a trajectory of a surge of COVID-19 ICU-PTSD. This Improving Access to Psychological Therapies (IAPT) service has seen an increase in the number of such cases.…”

“…Using lessons from past pandemics, Skilbeck et al . (2020) had mapped out a trajectory of a surge of COVID-19 ICU-PTSD. This Improving Access to Psychological Therapies (IAPT) service has seen an increase in the number of such cases.…”