18TH August, 2024, an anniversary.

It was the 18th August, 2021 when I received an invitation to attend an Art Therapy appointment with Basingstoke CAMHS clinician, Sally Mungall. At first I thought that there had been a mistake and that the invitation should have been directed towards my daughter, Meg.

When I brought my daughter into CAMHS, Bramblys Drive, Basingstoke on the 5th of February, 2021, it was already an emergency. Meg had been formally assessed by the CAMHS team and added to a waiting list on the 18th December, 2018. Meg’s mental health had deteriorated significantly during the intervening two years and two months. The last two months before that emergency intervention was the worst as she rapidly succumbed to a co-morbidity of mental health issues and by February, 2021, was virtually unrecognizable to me. Meg was suffering with profound and debilitating symptoms of OCD, was totally neglecting personal hygiene, was socially isolated, regularly dissociating and becoming increasingly violent. It was very difficult for me as a single dad and main carer. I failed to recognize it at the time but I was suffering from ‘carer burnout’. At the time I had been caring for my daughter, mostly on my own, for around 14 years. Every responsible parent or guardian of a mentally ill child knows exactly how demanding it can be, especially if you are trying to cope largely by yourself.

On the 5th of February, Meg and I found ourselves at CAMHS, Bramblys Drive, seated in a large room surrounded by several clinicians including Dr Roxanne Magdalena, Dr Naveen Nandakumar and newly appointed psychotherapist, Mark Birbeck. We were there for a session of consultation, review and planning and disclosed medical records describe the proceedings. Meg told the clinicians about her debilitating OCD, her obsessive thoughts, her compulsions and rituals, her general anxieties, her anger, constant tiredness, poor concentration, sleep disturbances and self-harm. She went further and told them that she thought she might be autistic and would welcome a formal test to confirm a diagnosis. When asked what help she expected from CAMHS she said that she was hoping for relief from her OCD. I told those present about parental separation and eventual divorce and confirmed Meg’s suspicions around autism.

It was agreed that Meg would be taken immediately into the CAMHS service. She was prescribed an anti-depressant, Sertraline and Mark Birbeck was appointed as her psychotherapist.

I didn’t know it at the time but there should have been strict internal policy and protocol in place at CAMHS, based on NICE ( National Institute for Health and Care Excellence ) guidelines, to ensure that patient’s nearing adult criteria are transitioned from child to adult services. There was just over 10 months until Meg’s 18th birthday when she would ordinarily be discharged from CAMHS services. NICE guidelines outlined in ‘Transition from children’s to adult services for young people using health or social care services’, NG 43 published on the 24th February, 2016 suggests that CAMHS should already have begun making arrangements for Meg immediately following the emergency meeting on the 5th of February, 2021 or at the latest by June when Meg turned 17 and a half years old. I later discovered the actual ‘Hampshire CAMHS to AMHS Transition Care Protocol’ ( Final Feb 17 ) document which, at the time, stated under ‘Framework and Standards for Transition’ , ‘This protocol puts the needs of the young person at the centre of their transition process, supported by professionals to ensure their ( and their carers’ ) involvement at all stages of the process taking into account their developmental needs ( NG43, 2016 ).’ Neither Meg nor I were ever made aware of the child to adult service transition policy and so were never involved. The same document at the time stated under ‘Age of Transition’, ‘The consensus to date from various professionals involved in transition work has been that CAMHS staff should be discussing the transition process with a young person under their care by their 17th birthday and information about the various community supports available will be shared with the young person and their family. If they are likely to continue to need support for their mental health difficulties beyond their 18th birthday then CAMHS care coordinator will make a referral to the relevant adult mental health service and a joint review will be planned about 6 months prior to their 18th birthday ( ie by age 17 and a half years ). The first time that referral to adult mental health services was openly considered was during Meg’s ‘final review’ on the 13th of January, 2022 when she was two weeks away from being discharged by CAMHS without safeguarding and when I was in crisis and suicidal.

I found Meg’s appointed psychotherapist at CAMHS, Mark Birbeck, to be friendly and soft-spoken

Clinical psychologist Michael Alcee speaks authoritatively on the subject in his article ‘How to Master the Art of Developing Your Therapeutic Voice’. He wrote, ‘the therapeutic voice is the combination and interplay of therapeutic presence and therapeutic authority, the complementary and seemingly contradictory elements that like yin and yang, enable us to create a three-dimensional picture of our patients and ourselves.’ He goes on to describe the therapeutic presence as the ‘capacity to be receptive, mindfully attentive, emotionally available, non-judgmental and resonant with the clients unfolding experience.’ From what I understood of Mark Birbeck’s psychotherapist work with Meg was that he had some measure of therapeutic presence as Meg seemed to feel comfortable in talking about difficult emotions and concepts while in sessions. It was Mark Birbeck’s lacking in therapeutic authority that often troubled me. Michael Alcee says this of therapeutic authority, ‘ the command of theory and technique and a discriminating awareness of how to put these into practice.’ I was concerned, almost immediately, that Mark Birbeck’s lack of experience or lack of authority was compromising his work with Meg. I felt, at the time, that he was not open to my own insight into my daughter’s mental health presentation. In my opinion he demonstrated an obstinately rigid attachment to his own beliefs and was dismissive of my concerns as a parent. I believe his ego undermined a genuine expression of therapeutic authority. My opinion was validated later when I felt it necessary to complain about him to his regulatory body, the Association of Child Psychotherapists and I will publish the ACP Investigation Report later in this blog.

Suffice to say, by the time I received the invitation to attend an Art Therapy with CAMHS clinician, Sally Mungall, I was already overwhelmed by a pervading perception that my daughter, Meg was being failed by the service. When I responded to CAMHS Team Secretary, Gail Gray , accepting the invitation, I could never have anticipated just how bad things were really going to get for both Meg and for me, her already beleaguered dad.