Mind the gap: integrating physical and mental healthcare for children with functional symptoms

Functional symptom disorders—often termed ‘medically unexplained symptoms’—are being increasingly recognised as a major source of distress, confusion and—not least—cost. The 2016 Kings Fund report—‘Bringing Together Physical and Mental Health’—estimated that the National Health Service in England spends about 3 billion pounds per year on this group of conditions in adults and children. Though published studies have revealed the importance of recognising and treating functional symptoms in adults, the literature in children is sparse. Raper and colleagues in this issue add significantly to our knowledge by reporting on a 20-year experience, in their centre, of children with functional neurological disorder (FND).1 FND, also known as conversion disorder, refers to a spectrum of neurological symptoms which have no established neurological cause and are assumed psychological in origin. Adult patients with FND are reported to have disappointing rates of recovery, but this long-term follow-up study highlights the emerging optimism for outcomes in children. Less than a quarter of those followed long term appeared to experience persistent severe functional symptoms in adult life. Notably and unusually the reporting hospital has been accurately diagnosing and coding functional neurological symptoms reliably and routinely over the last 20 years. Precise recording and communication of the diagnosis of these patients seems to have become embedded in the culture of the setting for this study and is likely to be key to recovery. For progress to be made, this practice needs to be widely adopted nationally and internationally. The positive endorsement of a FND diagnosis …