Implementing group ‘Cognitive Behavioural Therapy for Insomnia’ in community mental health and substance misuse services: a real-world service evaluation

Background People using secondary mental health or addictions services commonly report poor quality sleep. ‘Cognitive Behavioural Therapy for Insomnia’ (CBTi) is the first-line intervention recommended by clinical guidelines, and is evidenced to improve sleep quality. Despite this, availability of CBTi worldwide is poor, and reports of its delivery and feasibility in real-world clinical services are few. Process evaluation and implementation outcome data could support the up-scaling or adaptation of this intervention. Methods In this service evaluation patients with subjective sleeping difficulties under the care of a community mental health team or addictions service in North West London could be referred over 12 months, to a 6-week in-person group CBTi programme. Results Of 65 people referred, 39 attended an initial assessment, 23 attended at least one group session and 18 completed sessions. The 11 people who were still under the care of these services 3-months later provided further follow-up data. Cohort improvements in subjective sleep quality and co-occurring mental health outcomes were observed. Conclusion In a real-world setting there was poor uptake of CBTi when offered to people using secondary mental health and addictions services, but of those who do engage there are good completion rates and clinically important improvements in multidimensional sleep disturbances. We describe our experience in the practicalities of introducing a group CBTi programme to aid further implementation science. The findings underscore the need for adaptations of the intervention, and careful thinking about service delivery approaches to better integrate CBTi into complex mental health and addictions care. Clinical trial number Not applicable.