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Sarah* is 34, works in administration, and has spent two years without a diagnosis. Her symptoms began with cognitive episodes — words vanishing from her screen mid-sentence and memory lapses — followed by functional seizures and right-sided weakness requiring emergency department care. CT scans and an MRI were unremarkable. She was variously labelled with migraine and anxiety and referred back to her GP. Patients like Sarah are common, yet our health system offers no clear pathway for their care.
Functional neurological disorder (FND) is a condition in which the nervous system stops working properly, not because of structural damage, but because of a disruption in how brain networks process and direct movement, sensation, and cognition. It is a genuine, involuntary, and often disabling condition. Although FND affects people of all ages and genders, around three quarters of cases occur in women.
The Australian Institute of Health and Welfare reported on FND for the first time in 2025, estimating that 21 500 Australians are living with the condition, likely an underestimate driven by poor diagnostic coding and inaccessible healthcare. Hospitalisations nearly doubled over the past decade to 6 100 annually, including 2 300 emergency department presentations. The burden is unequally distributed: rates are almost twice as high in the most disadvantaged communities, and more than double among First Nations Australians. Despite disability comparable to multiple sclerosis and epilepsy, dedicated services remain scarce.
In 2022, our team at the Neuropsychiatric Institute established one of the few publicly funded FND clinics in Australia at the Prince of Wales Hospital, Sydney, supported by the Mindgardens Neuroscience Network and the Centre for Healthy Brain Ageing (CHeBA), UNSW. Led by neuropsychiatry and delivered in partnership with psychology and allied health, the service provides a tailored six-week programme for each patient. Nearly 200 patients have completed treatment, and the clinic was a finalist in the 2024 NSW Premier’s Awards for Health.
Referrals reflect a recognisable pattern: typically a woman in her thirties with functional seizures, limb weakness, fatigue, and cognitive difficulties, often in some combination, and usually after years of diagnostic delay and multiple specialist reviews. Many are unable to work at presentation. With coordinated care, most return to employment or study; a 65% return-to-work rate has been reported, including in our patients’ own accounts published in the Sydney Morning Herald.
Lived experience data highlight a consistent trajectory of denial, disbelief, and dismissal, with often years of fragmented care prior to diagnosis. Even after accessing appropriate treatment, progress can be undermined by single invalidating clinical encounter. Grace, who travelled from regional NSW for our programme, described it as giving her back control of her life, a testament to her efforts to recover with specialist clinical guidance.
Our published work documents these system gaps. A binational survey of FND clinics across Australasia identified limited capacity, inadequate funding, and poor access to allied health as key barriers. Calls for a coordinated national action remain unanswered. Work from our group and others has also clarified functional cognitive disorder, the cognitive subtype of FND, as a distinct and underrecognised condition that can improve over time with treatment, and our group’s neuroimaging research in children with FND demonstrates altered brain network function that reinforces the biological reality of this condition.
Demand for our service continues to exceed capacity — a marker of unmet need and service rarity.
FND can and should be diagnosed on positive clinical signs: exhaustive exclusion is unnecessary. Make the diagnosis clearly and communicate it with confidence and empathy. Clinicians should recognise the full symptom spectrum, including cognitive difficulties, fatigue, and pain, which are major contributors to disability and distress — and as much a part of FND as functional seizures and weakness.
For health services, the evidence now supports integrated, multidisciplinary FND services as standard care, not one-off pilots. A coordinated model combining neuropsychiatry, psychology, and other allied health-led care can produce meaningful clinical improvement and is cost-effective for the health system. The scale of the problem is now visible in the data, and it falls to our health systems to act without further delay.
The inequities in this data demand targeted attention. Women, First Nations Australians, and those in regional areas and socioeconomically disadvantaged communities bear the greatest burden of FND while having the least access to services. Scalable models already exist but require investment in funding, workforce development and political will.
FND must also be incorporated into medical and allied health curricula. Without this, clinicians will continue to miss the diagnosis, and patients will keep cycling through emergency departments at an estimated $26 500 per patient before receiving appropriate care.
The 2025 AIHW report places FND on Australia’s health data map for the first time. It now needs to be reflected in service provision. Patients like Sarah continue to present every week. The question is whether the system is ready to meet them and provide the care they deserve.
*Sarah is a fictional example
Adith Mohan is a senior consultant neuropsychiatrist at the Neuropsychiatric Institute (NPI), Prince of Wales Hospital, Sydney, Australia. The NPI is a leading neuropsychiatric facility in Australia with an excellent reputation for tertiary specialized services. Here he is involved in the care of patients with a range of neuropsychiatric and neurocognitive disorders including functional neurological disorders, neurodevelopmental disorders, the neuropsychiatry of epilepsy, immune mediated and degenerative neuropsychiatric disease, and drug-induced movement disorders.
He is also a Research Fellow with the Centre for Healthy Brain Ageing (CHeBA), and a Senior Lecturer with the Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW Sydney, Australia. UNSW. His research interests include clinical care in Functional Neurological Disorders (FND), functional genomics of human brain ageing, Immunopsychiatry as well as therapeutic neuromodulation in neuropsychiatric disorders. He is the Chief Investigator on a clinical research program investigating a novel interdisciplinary clinical program in FND and is currently leading the establishment of a world-first clinical consortium for FND clinics in Australia and New Zealand.
He is actively involved in the Section of Neuropsychiatry (SoN) of the Royal Australian and New Zealand College of Psychiatrists, is the jurisdictional representative for the state of New South Wales on the SoN.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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