It's quite a short article, and essentially boils down to getting mental health services involved earlier so psychological packages of care can be introduced sooner. I think the framing is a bit weird, seeming to imply that folks should be diagnosed with one of these FNDs in order to bring about that care, even if the recommendation ends up being sensical (ie - when patients are undergoing a host of investigations and don't yet know what's causing their issues, psychological support is probably a good idea)
What I'd be worried about is the labelling of those who'd naturally recover with something that may bias future treatments, or that by getting that diagnosis other investigations stop. If you rolled it out to other areas where implementation would likely be very different than in a dedicated children's hospital, I think there's a lot of risk that comes from such an approach. That said, I think Trish has nailed it - it seems to be a reflection on how things are working for them, but it's not a research study.
Notably, cites Sharpe in their final paragraph, as someone who aspires to have mental healthcare be as good as physical, and delivered in all parts of care services.
My issue is whether it is actually mental health care (or what Sharps actually ‘delivers’ in his big ‘all illnesses have a bit of the mental’ proposed actual care).
I’ll be straightforward in that medicine and how most deliver healthcare is shockingly harmful to mental health and not using psychology to replace the lack of natural empathy missing due to ‘the system’ and sadly too many individuals (for whatever reason including by the sound of it that vital skill being ‘trained out’ under the misnomer it’s ‘female bring soft snd kind’ and not ‘skills like Oliver Sacks to be able to have insight into how things will affect other humans’).
An example is that instead of thinking ‘gosh the last thing this person needs is a huge wait for results to find out how far they’d cancer has spread’ and that will cause unnecessary mental injury along with other inconsiderate treatment by abrupt unthinking people (which can happen) and so it needs to be built in to sort these issues with the staff and system as it will save these injuries and cost long-term due to them , they instead think ‘the impact is mental’ (rather than expected, logical and caused by our collective treatment and problems that can be resolved) so ‘outsource, label’ and want to train the patient to ‘deal with what they do and how they want to work’ and think how they want them to behave - NOT what is actually healthiest for their health or happiness or getting past all of it without a scar if it’s from bad treatment. Just a facade in surveys of questions not directly relevant and a tick box to cover their back if they fray nerves unnecessarily ‘It’s ok cos we sent them off to a tick box course no one asks the details of’
I don’t see him discussing proper psychologists rather than psychiatrists, liaising on sorting their environment, situation and making adjustments so it’s less frightening and a kinder situation thereby reducing impact on all (is it not a canary in the coal mine if your service terrifies 90% who go through it, just like you’d want to look at timetables or bullying if a school year had high number ms of kids with anxiety, not ‘teaching the kids mindfulness whilst keeping the exam-culture or rubbish bullying policy untouched). eg for those with autism or who are away from home for the first time and it’s very distant or other things.
Or Sharpe/them talking about counselling for support and accurate but supportive way of explaining things and making them feel I control if they’re i or a body despite the situations thryvd been thrust into perhaps feeling different from that.
Instead it’s normally a nonsense generic ‘CBT’ can now be what I call fake CBT that wasn’t the type developed by carefully studying the illness, mapping different types, and a model saying there us an underlying thing patients agree with us the core and that technique happening to have been developed around it. But a twisting of that term where an off the shelf delivery mode has been part-nicked from those real CBTs because it’s nice and one-way and short and happens to be a lot like the old school teachers behavioural paradigm and behaviourists idea of just tell em to stop behaving in a way you don’t approve as the behaviours the issue not something which is of interest as it’s the symptom to allow you u to I get to the bottom of the condition if you are interested enough to hear insight into it.
but ‘reeducation’ (they are even now calling it almost that: ‘psychoeducation’ ) and I find it so weird that old, proper psychologists who’ve been trained, and who were told to check and think that both logic and testing and history/feedback/progress at an individual level there is a match between diagnosis and person and a chosen specific treatment, allow/have allowed this nonsense stuff to be using these very same terms when it isn’t mental ‘health’ at all but concealing a lot if ambiguous ‘other stuff’ without that matching process and developed with an attitude of the stigmatic old school ‘they are mental and not thinking right way as far as I decide’ nonsense.
the idea this is being dumped on children- and I don’t think CBT should be used on them at all to be honest except in the rarest snd most specific if conditions snd circumstances eg phobia, serious OCD, and with a heck of a lot more gentleness and understanding snd less hostility snd ‘stick’ , ‘push’, manipulation than for adults - because they’ve not been around the block to see manipulation as manipulation and realise not everything works and they have to speak up etc
but also because they are in very vulnerable to coercion, perceived threat situations and need proper, safe, advocates. And not people who are looking to label them into losing their autonomy or their testimony being believed. It’s even harder for them to say no thanks or ask why they aren’t being heard and could they have a second opinion.
this seems the opposite dangerously of what such people would need if this was safe under a switch snd bait because the term mental health has been allowed to be employed ambiguously, the old specifics on certain treatments having to match and requiring certain level of qualifications not just for diagnosis but delivery as people are allowed and expected to change that if it becomes clear it wasn’t accurate, instead of trans diagnostic nonsense that is just re-education not based on ‘what helps’ but what someone thinks is the norms that need to be drilled into others.
So what might these children be getting dropped into? And what might they need to exhibit to end up under that? And who will be delivering it snd what level of kindness or care given their vulnerability is specified here?
Why is it when it’s perceived ‘mental’ (ie doctors attitude upsets patient and they don’t want to ‘deal with’ ‘that’) all these vital safeguarding questions about whether something is one thing or another that might be appropriate or not it safe or not - well apparently it’s rude to ask. Even though really it’s like giving someone the wrong drug if they end up on combative re education CBT when counselling and adaptations while they go through a hard time are what’s needed. Except the diagnosis ends up sticking as a label even when the drug doesn’t work.
It used to be that ‘no one’s normal’ ‘nothings normal’ was the key message if psychology because it is a nonsense and a hegemony thrown at people to judge them and make them miserable based on no evidence it’s ‘good’ or’better’ if ‘healthier’ fir them. When did we end up here when we’ve certain peoples visions of how certain others should behave being pumped through and not really caring to check on the health status overall or long term of this ‘because’ they’ve now been labelled.
I mean what specialism if subject gave itself free reign to feel free of checking for harms first and safety and not having to report on whether people’s objective health of all who attended to them (whether dropped out if labelled) long term. So they start caring as it’s in their books when people are made worse long term with five year follow-up stats (just like outcome is reported on in other illnesses - and they can get independent objective ones gif these, I mean come in if someone walks in and wheelchairs out if your treatment that IS a measurable others can see if legally bound to not ‘pretend not to’ and such objective stuff is required rather than just surveys if their own choice permitted) wondering why some end up much worse than if they weren’t treated and why no one thought to get to the bottom of s misdiagnosis when they didn’t improve but got worse two years in etc?
so I’m summary my issue is the specialisms lack of measuring harms has toxified snd changed the culture of their research and treatment and there’s a huge issue which they are talking about getting involved and who. And it needs to start being required to be clarified snd science being brought back in so the bad stuff is kept away and the very precisely defined good stuff and staff who are checking outcomes properly and are interacting to protect the full health and well-being of the patient rather than misguided idea of re educating to be ‘more resilient to us acting as we do’ being made very clear in any papers like this. The two seems opposites almost
