Psychologist scope of practice and behavioural sleep medicine in Australia: a rationale and pathway towards trialling limited psychopharmacotherapy authority

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ABSTRACT Insomnia is one of the most prevalent sleep disorders in Australia, estimated to affect up to 25% of the population. Psychologists provide the gold-standard intervention for insomnia, Cognitive Behaviour Therapy for Insomnia (CBTi), however 90% of general practice consultations for insomnia result in a medication being prescribed. The current scope of practice for Australian psychologists does not include providing consultation or management of pharmacotherapies, preventing them from tapering and ceasing patients’ hypnotic medications once they are receiving behavioural sleep medicine intervention. Despite its low-risk profile, current scope also prevents psychologists from prescribing and advising on optimum timing of melatonin as a sleep phase shifting agent in circadian rhythm disorders. Whilst a growing number of US states have enacted psychologist psychopharmacology authority (RxP), and the UK is rapidly expanding non-medical prescribers, pharmacotherapy models of care for psychology have yet to be trialled in Australia. This paper outlines the rationale for limited RxP in an Australian hospital outpatient behavioural sleep medicine setting – the ExPEDiTe Sleep project (Expanding psychology scope of practice for Pharmacotherapies Emphasising Deprescribing during behavioural Treatment of Sleep).