‘Sleep psychologist’ directory to assist with de-prescribing

GPs can now streamline referral pathways for patients with insomnia via a new registry of healthcare providers specifically for cognitive behavioural therapy for insomnia (CBTi).
 
Insomnia is common, and despite general practice guidelines recommending non-drug interventions, such as CBTi as a first-line treatment, sleeping pills are still prescribed as a standalone therapy.
 
A key reason for this is a lack of psychologists available to provide CBTi, according to Dr Alexander Sweetman, Senior Program Manager at the Australasian Sleep Association (ASA).
 
‘GPs are generally aware that sleeping pills are not the recommended first-line treatment for insomnia but have often reported that it’s extremely difficult to find psychologists who can deliver CBTi,’ Dr Sweetman told newsGP.
 
The Psychologist Education Sub-Committee of the ASA recently audited the number of ‘sleep’ psychologists in Australia and found only 65, or around 30 full-time equivalent.
 
‘This is completely inadequate for the three million Australians with chronic insomnia and validates what GPs have been telling us,’ Dr Sweetman said.
 
Only an estimated 1% of Australian adults with insomnia currently access CBTi, and GPs have reported limited access to CBTi treatment and referral pathways.
 
Using these findings and in an effort to address access challenges to CBTi, the ASA has now developed an online CBTi provider registry that lists psychologists who have completed CBTi training, and specialist ‘sleep’ psychologist members of the ASA.
 
The new registry builds on the last three years of the ASA working with the Australian Psychological Society (APS) to develop CBTi training programs and activities for psychologists.
 
Earlier this year, the ASA and APS launched an interactive six-hour CBTi education module, with around 450 clinicians –  including GPs, psychologists, nurses, and psychiatrists – signing up since February to become an APS/ASA certified CBTi practitioner.
 
Hosted on the ASA’s primary care sleep health website, Sleep Central, the directory lists healthcare providers who are ASA members and those who have completed the education module and are seeing patients with sleep problems.
 
GPs can refer patients with insomnia to a psychologist or Level 2 Focused Psychological Strategies-trained GP for CBTi with a Mental Health Treatment Plan, and patients can claim a Medicare rebate for a portion of treatment costs. Insomnia is an eligible condition for treatment as a standalone mental health issue under a GP Mental Health Treatment Plan.
 
GPs can filter by state and territory, age group (children, adolescent, or adult), and whether psychologists provide treatment in-person or via telehealth.
 
Dr Sweetman said the registry is growing every month.
 
‘This has effectively doubled the number of psychologists with CBTi knowledge that GPs can refer patients to,’ he said.
 
‘We hope this online registry will help GPs throughout Australia, and in rural/remote locations, find psychologists that deliver CBTi.
 
‘Eventually, we’re hopeful it will reduce waiting lists for CBTi, assist with sleeping pill de-prescribing, and gradually increase the use and accessibility of CBTi in primary care.’
 
In 2021–22, PBS data indicates that around 4.9 million benzodiazepine scripts were dispensed to 1.4 million patients, a rate of 18,900 scripts and 5400 patients per 100,000 population.
 
Diazepam had the highest rates of dispensing among benzodiazepine drugs, at more than two million across 2021–22.
 
Other research suggests that while most benzodiazepine prescriptions declined over time, short-intermediate prescriptions remained higher among older women, and long-acting prescriptions were more frequent among younger men.
 
The end goal of reducing prescribing benzodiazepines for insomnia and increasing access and use of CBTi is in combination with other approaches, Dr Sweetman said, such as training primary care clinicians and developing digital CBTi programs.
 
‘It’s all been a long time coming and we’re hoping that GPs are enthusiastic about this,’ he said.
 
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benzodiazepines CBTi cognitive behavioural therapy de-prescribing insomnia non-drug interventions sleep health