Review Systematic review of integrated mental and physical health services for children and young people with eating and functional symptoms 2025 Massou+

Background
Evidence suggests that by recognising the psychosocial component of illness as equally important to the biological components, care becomes more holistic, and patients can benefit. Providing this type of care requires collaboration among health professionals, rather than working in isolation, to achieve better outcomes. However, there is a lack of evidence about the implementation of integrated health care. This review focuses on children and young people experiencing eating disorders (i.e. disorders related to feeding and eating) or functional symptom disorders (i.e. medically unexplained symptoms).

Aims
The present review is part of a larger study that will inform the development of a new children’s hospital in England. Both eating disorders and functional symptom disorders are conditions that may be particularly likely to benefit from an integrated approach to health care, and this review aims to investigate what service models have been used to integrate care, what factors influence their implementation, and what effects these integrated models have on access to and outcomes from care.

Method
We conducted a systematic review of studies based on children and young people with eating disorders or functional symptom disorders, investigating the effectiveness of integrated mental and physical health services versus any other type of services provided in these populations. We searched MEDLINE, EMBASE and PsycInfo® (American Psychological Association, Washington, DC, USA) electronic bibliographic databases in July 2024 without restriction on the date of publication or country of interest. We reviewed only studies written in English.

Results
We identified 2668 citations which resulted in 1939 papers eligible for title screening. Only one single-site Australian evaluation of an integrated care model from over 20 years ago was included in our review. The study reported significantly higher number of total admissions and total bed-days utilised in the integrated approach. However, the burden of care shifted from psychiatric wards to medical wards and as a result, the cost per admission and the cost per inpatient decreased.

Limitations
The lack of conceptual consistency about the definition of integrated care may have driven false screening and loss of some evidence. The same limitation applies in terms of the definition of functional symptom disorders.

Conclusions
The review identified a gap in the evidence base relating to integrated secondary service provision for children and adolescents with eating disorders or functional symptom disorders in comparison with generic services. No similar studies were identified for children and young people with functional symptom disorders. Our findings align with previous evidence and show that despite the existence of studies describing aspects of integrated care, integration of physical and mental health services for children and young people with eating disorders or functional symptom disorders is underexplored and the limited available evidence is of weak quality.

Open access

 

Functional symptom disorders
‘Functional symptom disorders’, previously called ‘medically unexplained symptoms’, is the name given to physical symptoms for which there is no clear pathological explanation. 15,16 The term has been debated and criticised; alternative labels, including ‘somatisation’, ‘bodily distress syndrome’ and ‘persistent physical symptoms’, are sometimes used interchangeably. 32,33 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) subsumes all these labels in the category ‘somatic symptom disorders’ and emphasises that individuals with functional symptoms can also have organic disease. 34 Syndromes frequently found within the category of somatic symptom disorders include chronic fatigue, irritable bowel syndrome, functional neurological disorders such as non-epileptic seizures, fibromyalgia and chronic pain.

Most of the time, functional symptoms are temporary and resolve on their own, but sometimes they persist, prompting patients and general practitioners (GPs) to seek a diagnosis and treatment. Many GPs find patients with functional symptoms challenging and often refer them for further investigation. On the other hand, many affected patients who do not receive a correct diagnosis push for excessive diagnostic evaluations and treatment attempts. However, this management strategy might have more negative than positive effects on patients’ symptoms and concerns. 35 In addition, research indicates that the investigation of functional symptom disorders consumes considerable healthcare resources owing to the frequent utilisation of services, referrals for specialist consultations, numerous diagnostic tests and attempts at treatments.

 

Damn, there is so much bizarre stuff in there.

Evidence does not suggest that. In fact there is no such evidence. People do suggest that. Studies can't suggest anything, they have no agency. But this could be phrased differently as adding a religious component makes it more spiritual and patients can benefit. Those statements are perfectly equivalent, and equivalently worthless. They are also judged on a mindless formula where more holistic, which means woowoo in this context, is good, so more holistic, more woowoo, makes it better. This is completely absurd.

Collaboration across specialties can be achieved without woowoo. Woowoo is not required to do this. Never has. Never will. In fact this is just about the worst way of achieving this, as it literally involves the wrong professionals, and excludes those who could actually achieve something. Plus, better outcomes are never achieved with woowoo, so the purpose is entirely defeated by design here.

But this is really the meat. The review did not "identify a gap in evidence". What it showed is that health care services have been provisioned for years based on absolutely no evidence, and will continue to do so because EBM brain leads people to conclude that this is not the problem, that the problem is that they should come up with evidence to retroactively justify having provisioned useless services for decades.

But EBM brain is especially finding it worthwhile to publish a "systematic review" of a single 20 year-old study. The problem isn't with whoever did this review, it's the entire process that has failed miserably here. Including the health care services that routinely provision such services based on zero positive evidence, and mountains of negative evidence. Which this review did include, and it will be entirely ignored.

This industry is so disturbing. It's what happens when there is zero accountability in a system that isn't subject to any supply-and-demand forces. This leads to destructive dynamics where useless things are put into motion, then can't be stopped because there is simply no mechanism to account for anything. So resources are wasted in places, while the places they are needed are starved of even basic interest. There's truly nothing else like it in the modern world, absolute peak mediocrity.