Lay summary
The New Zealand Government Inquiry into Mental Health and Addiction (He Ara Oranga) identified two important issues. First, a gap in mental health care provision, “the missing middle” of people with moderate to severe mental health difficulties whose needs are beyond the scope of primary healthcare services, but do not meet the threshold for specialist services. Second, mental health services provide treatment ‘through too narrow a lens’: people are offered medication, but not evidence-based psychological therapies to promote recovery. Many of the people in the “missing middle” are suffering from a major depressive episode. We have developed Intensive Activation Therapy (IAT) (Behavioral Activation and Cognitive Remediation) for people with moderate to severe depression in primary care with the aim of addressing functional impairment with short-term intensive therapy. This study aims to assess the feasibility of delivering a full study.