23rd December, 2021 Meg had already celebrated her 18th birthday by the time we made our way to the first of two scheduled ‘review’ meetings with Sally Mungall and Mark Birbeck. Arrangements had already been made for an additional four therapy appointments, postponing Meg’s discharge from CAMHS by a few short weeks. Her final therapy session with Mark was to be held on the 28th January, 2022 but it felt like time had already run out. Meg was hanging on borrowed time and I was living in a constant state of anxiety, uncertain of what would happen after she was discharged. I had a filing cabinet of questions lined up for Mark but the opportunity for any meaningful conversation was already gone by the time Meg and I had arrived at CAMHS, Bramblys Drive. I had been incorrectly informed of the time for the appointment which meant that we were over an hour late by which time Mark was thinking of his next meeting. He stayed for around ten minutes and then he was gone. There was much on my mind as I watched him leave the room.

So, this post becomes a 'review' of Mark Birbeck and his work with Meg over the year, instead. I was later forced to report him to his professional and regulatory body, the Association of Child Psychotherapists and will write a detailed account about that in the sequel to Four and Twenty Dead Crows; I was unaware, during December, 2021, of the multitude of failures at individual and institutional level to properly attend to the mental health needs of my daughter. The following is the first of two parts that tell something of Mark's involvement in that story as it unfolded at the time. Part two will be told in my next blog post.

Mark Birbeck had been working with Meg for more than ten months since the ‘emergency’ specialist assessment carried out at CAMHS, Bramblys Drive on the 5th February, 2021and there had been no appreciable improvement in my daughter’s mental health presentation. There had been a marked improvement in Meg’s relationship with her mother which I initially attributed, in part, to Mark’s work with Meg. I am on record acknowledging his contribution to improving that relationship although it should be noted, also for the record, that considerable efforts to mend that relationship had been simultaneously undertaken by me. So, maybe, it was a collaborative piece of work which, as it turned out, provided only a temporary respite. Meg’s relationship with her mother deteriorated again towards the end of 2022.

The primary mental health issues that were adversely affecting Meg’s psychosocial functioning, particularly with regards to her debilitating OCD and the truly negative impact on her quality of life remained worryingly unaddressed. She was still overwhelmed by compulsions and rituals, socially isolated and, due to increasing depression and the affects of medication, listless, cognitively impaired and largely confined to bed. Preparations were being made to discharge her from CAMHS while the only appreciable difference in my daughter was that she was now heavily sedated with Sirtraline.

Hindsight and access to medical records means that I can write these words with assurity, confident of the facts surrounding Mark Birbeck’s therapeutic intervention. I know that Meg actually missed many of the sessions allotted and did not take up other opportunities to make up for missed sessions. Some opportunities were missed due to national holidays, some due to Mark’s own holidays or his absence due to illness but it is shocking to register just how many sessions were missed because Meg failed to turn up. Most of the time she didn’t turn up because she felt unwell. Sometimes Meg was unwell due to unrelated factors. Most of the time Meg was unwell because of her mental issues, unwell due to symptoms related to her OCD, to her medication and her depression. Compulsions and rituals rendered her almost perpetually tired. Paradoxically, she would sometimes find sleeping really difficult and would stay awake for up to 48 hours at a time. And there were times, all too often, when she was obviously overwhelmed by therapy, times when she simply felt ill-equipped to engage. Meg is on record saying that she didn't always attend sessions because she felt the 'pressure of needing to know the magic answer' or 'magic subject', or 'the pressure of finding the words'. The records currently at my disposal suggest that Meg actually attended just 20 therapy sessions. The same records indicate Meg missed at least 14 other therapy sessions due to illness. Mark Birbeck was ill for an additional 2 sessions and on holiday for another 2. There are a further 12 dates unaccounted for in the records. The most pressing questions that I would like to have asked Mark Birbeck at this review meeting would have been, 1) 'At what point would a reasonably competent clinician have conceded that there was not going to be enough time to contend with such severe and debilitating OCD symptoms?' and 2) 'Why had no action been taken to recommend transition to alternative, specialist or adult services?' It had been my firm opinion, held throughout the entirety of his work with Meg, that Mark was NEVER going to be able to contend with Meg's severe and debilitating OCD symptoms. Almost from the onset I recognised that he was doomed to failure.

I was frustrated with Mark Birbeck, having serious misgivings about his professional competence and what I perceived as his rigid, almost dogmatic adherence to a single therapeutic modality. He was extremely resistant to me and my legitimate concerns as a father and main carer, dismissing my insights and eventually refusing to engage with me.

I met Mark Birbeck alone, three times. The first meeting was on the 10th February, 2021, just days after the ‘emergency’ specialist assessment and I recall him being affable and gently spoken, a friendly man whose manner and tone seemed particularly suited to children and adolescent mental health patients. We spoke at length about Meg, her mental health issues and briefly touching upon the wider family dynamics. At that moment in time I was quietly reassured by his manner and tone, believing that he would probably be a good therapist, a good ‘fit’ for Meg. I quickly learned to tell the difference between the 'therapeutic presence' and the 'therapeutic authority'.

A lot of the idealized gloss had faded from Mark Birbeck by the time of the second meeting on the 18th June, 2021. I had become increasingly anxious at the deterioration in Meg’s mental health. Indeed, Meg’s symptoms had become so profound and so severely debilitating that I had, just a few weeks earlier, needed to contact CAMHS as a matter of emergency. She was no longer attending college, her sleep was even more severely disrupted and her OCD rituals so aggressive that I considered her to be a risk to herself. I had needed to remove access to all knives and other sharp objects within the house as she was self-harming, using her fingernails to scratch at her arms. I was giving serious consideration to proposing that she be taken into specialist residential OCD care, either as a part-time day patient or even full time in-patient. I raised the idea of residential OCD care with Mark Birbeck when I met him that second time but he dismissed this out of hand, preferring to give me general parenting advice, telling me to give Meg more space. I expressed my very real concerns over the lack of time left, pointing to Meg’s 18th birthday which was less than six months away, and her inevitable discharge from CAMHS. It was my firm conviction that Mark Birbeck did not have the competence to properly address Meg’s OCD but I kept that scathing assessment to myself. Mark Birbeck assured me that he was confident that he could still do good work with Meg and, if necessary, would make a formal request to extend therapy at CAMHS, possibly by a few extra months. I think he may have tried to reassure me by telling me that he had worked, successfully, with one other patient who had a similar OCD presentation and insisted that I trusted in him to deliver.

My third and final meeting with Mark Birbeck on the 5th November, 2021 was not so cordial.