Sleep problems and referral intentions in mental health services: service user self-report and staff proxy report surveys

Abstract

Background Sleep problems are common in mental health service users, but few non-pharmacological therapies are offered. Therapies are being developed and tested, but there may be barriers to these therapies reaching those who need them. Methods Light-Dark and Activity Rhythm Therapy (L-DART), is a new sleep therapy delivered by an occupational therapist, which has been feasibility tested in people with schizophrenia spectrum diagnoses. This paper presents two surveys, conducted with mental health staff and service users, on sleep problems, treatment wishes; and barriers and facilitators to uptake of L-DART or similar therapies. Descriptive statistics, single-level and multi-level ordinal logistic regression were used to examine factors associated with sleep problems and referral intentions. Findings Sleep problems were commonly identified by staff and service users, there was demand for non-pharmacological intervention across diagnostic and demographic categories, but staff readiness to refer differed according to NHS Trust and service user diagnosis. Staff and service user reports differed in awareness of sleep disordered breathing and parasomnias, and wish for referral. Staff were more confident identifying sleep problems than addressing them, but more training was associated with greater confidence concerning both assessment and treatment. Conclusions A range of sleep problems are prevalent and recognised in mental health service users, and there is an unmet need for non-pharmacological sleep interventions. Improving suitable resources to support self-management in this group may help; Staff and service users also reported a high readiness to refer or be referred for sleep interventions. Staff training to improve identification of sleep problems, and differentiation between types of sleep problems, would support access to the most appropriate treatments.

Light–Dark and Activity Rhythm Therapy (L-DART) to Improve Sleep in People with Schizophrenia Spectrum Disorders: A Single-Group Mixed Methods Study of Feasibility, Acceptability and Adherence

“…L-DART was acceptable to recipients, as reflected in satisfaction ratings and qualitative accounts, and as can be inferred from good attendance at therapy. This agrees with separate survey work that found the prospective/hypothetical acceptability of L-DART was high in a wider severe mental illness sample (n = 190 service users, n = 147 staff) [41]. Overall, participants were motivated to attend sessions, showed good engagement with therapy discussions and homework tasks, adhered to either some, or many, recommendations (for those summarised quantitatively, 67%), and all continued with therapy until the end.…”