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Does insomnia fall under mental health treatment plans?


Morgan Liotta


24/06/2021 3:11:20 PM

Research aims to address GPs’ ‘uncertainty or concern’ around the classification of sleep disorders as part of the plans.

Man in bed awake looking sad
Insomnia can be treated as a standalone mental health issue under a GP Mental Health Treatment Plan.

With mental health conditions among the most common presentations to general practice, GP Mental Health Treatment Plans (GP MHTPs) support the management of such presentations under the Better Access initiative.
 
But for patients with sleep issues, new research suggests there is some uncertainty among GPs about whether chronic insomnia – classified as ongoing sleep disturbance for more than three months and affecting sleep three nights a week – is eligible for treatment under a GP MHTP.
 
Bond University Professor Nick Zwar is part of the qualitative research team on common sleep problems, including chronic insomnia and obstructive sleep apnoea at the National Centre for Sleep Health Services Research, and believes this uncertainty can create barriers for providing care.
 
‘We asked GPs about some of the issues that they see in looking after patients with long-term insomnia, and one thing that came out of it was that [GPs see] this as core business for general practice,’ Professor Zwar told newsGP.
 
‘They see quite a few patients with difficulty sleeping that goes on for months or recurs over time.
 
‘But there was uncertainty or concern among GPs whether insomnia is classified as eligible in the way depression or anxiety are … It may have been eligible, but confirming that it is – that’s the issue.’
 
Professor Zwar also believes that GPs can sometimes struggle to know how to look after patients experiencing sleep issues.
 
‘GPs don’t want to be prescribing hypnotics if we can avoid the risks of dependency and adverse effects. [But] it’s not always easy to know what the alternatives are,’ he said.
 
‘The other uncertainty is if the GP wanted to deliver cognitive behavioural therapy for insomnia, could they do that under the MBS-funded focused psychological strategy service? And the answer is yes, as long as it met the time requirements, because those items are time-tiered.’
 
Taking this GP feedback on board, the research team then requested and received confirmation from Medicare that as per the ICD-10 classification of diagnostic criteria, insomnia is a mental disorder in its own right, not a symptom of another disorder, and therefore eligible under a GP MHTP.
 
And insomnia could be a ‘standalone’ issue forming the plan, according to Professor Zwar.
 
‘GPs can do a plan for someone with chronic insomnia with a referral to a psychologist for appropriate treatment, if that was the only problem that the GP wanted to treat,’ he said.
 
‘Often people have other things as well, so [the plan is] probably not going to often be for just insomnia, but it could be, in the same way it could be for just depression, or just anxiety.’
 
Given GPs’ central role in assessment and management of mental health issues, Professor Zwar also wants primary care to be positioned at the centre of sleep issues management.
 
‘We’re developing an online resource on chronic insomnia and obstructive sleep apnoea, aimed at primary care – particularly GPs, but also nurses and dentists, who may see people with snoring issues,’ he said.
 
‘There is lots of work going into the development from a range of GPs, including from the RACGP. Stay tuned.’
 
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Dr Duncan MacWalter   25/06/2021 7:57:42 AM

Does insomnia and sleep disorders appear in very specific: "World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD‑10 Chapter V Primary Care Version" as mandated by MBS.
The Primary Care Version is a cut down limited version with only a few diagnoses. But this is what the MBS specifies, not the full gamut of ICD-10 FX.XX diagnoses. It's also very hard to find.

Can RACGP clarify this with urgency, as the advice given could result in members falling foul of an audit.