Earlier today I forwarded two documents to Thomas Body, senior caseworker at the Parliamentary Health Service Ombudsman. The first document was the Investigation Report sent to me by the Association of Child Psychotherapists in 2023 following my formal complaint about their registrant, Mark Birbeck.
The second document was my rebuttal of the findings of that Investigation Report, sent to the Association of Child Psychotherapists later in 2023.
I forwarded these two documents to Thomas Body as evidence to support my daughter's own complaint about CAMHS, Bramblys Drive , Basingstoke and the wider Sussex Partnership NHS Foundation Trust now being investigated by the Parliamentary Health Service Ombudsman.
Both documents are lengthy so I have only published the second, the rebuttal, which does repeat much of the first, the Investigation Report itself.
SPOILER ALERT The document published below falls outside the chronological order of the biographical account of my journey through mental health services in Basingstoke, currently at Chapter Three, 'Just Caws'.
I believe that the document below categorically proves that Mark Birbeck was grossly incompetent and guilty of clinical neglect while my daughter was under his therapeutic care, that CAMHS, Bramblys Drive, Basingstoke were grossly negligent in managing my daughter's mental health needs and for planning her transition from child services to adult services in line with policy and protocol and that the investigation carried out by the Association of Child Psychotherapists was flawed, superficial, amateurish and unprofessional.
In my opinion, everyone ROYALLY FUCKED UP!
'MY REBUTTAL OF THE FINDINGS OUTLINED IN THE ‘INVESTIGATION REPORT’, COMPLAINT 2023/1, COMPILED BY THE ASSOCIATION OF CHILD PSYCHOTHERAPISTS IN RESPONSE TO MY COMPLAINT ABOUT THEIR MEMBER, MARK BIRBECK
The ‘Investigation Report’ wording is copied and pasted from the original while my rebuttal, along with factual corrections, is entered at each relevant part in italics, numbered and introduced in a capitalised statement for easy identification.
Investigation Report - Complaint 2023/1Investigating Panel (IP) Members: Sue Byrne (SB), Lay Member EPGJulia Mikardo (JM), ACP Member EPGComplainant: Mark Stock (Mr. S)Members: Mark Birbeck (MB).
This panel was convened to investigate a complaint against an ACP member, Mark Birbeck, received from Mr Mark Stock (Mr. S) in relation to the care of his daughter, Megan Stock (MS), a patient at Hampshire Child and Adolescent Mental Health Service (CAMHS). The complaint outlines that the Hampshire CAMHS to AMH (Adult Mental Health) Transition Care Protocol (2017) was never shared with either his daughter or himself and that they were never involved in a decision to delay the transition to adult services.
The panel was asked to investigate whether these sections form the ACP Code of Professional Conduct and Ethics may have been breached:⋅ Section 1.1 Patients’ welfare and best interests are paramount and accordingly a Member of the Association of Child Psychotherapists (‘the Association’) shall in the conduct of his/her profession maintain the highest professional and ethical standards.⋅ Section 4.3 Patients’ autonomy and rights to be involved in decision making should be respected as far as their individual circumstances allow.
The IP initially consisted of Julia Mikardo (JM), member of the ACP Ethical Practice Group, and Erica Bradley (EB), Lay Member of the EPG. Due to unforeseen circumstances EB had to withdraw and Sue Byrne (SB) joined as the Lay Member.The IP held separate online meetings with the member and the complainant. Further correspondence, documents and information were then taken into consideration.1. Online meeting with MB on 18.7.23. Also present was Sarie Hodgson (SH), Lead Child and Adolescent Psychotherapist in Hampshire CAMHS.To give some context to this discussion MB explained that he joined the Trust in October 2020. MS was one of the first young people he saw. He worked with her for a year; other colleagues were involved from CAMHS and also other agencies. Following assessment for psychotherapy MS had been on the Child and Adolescent Psychotherapist waiting list for some time before MB arrived. (The COVID epidemic during this period had a major impact on the timing of the delivery of treatment in CAMHS).
1) ACCORDING TO NHS DIGITAL, THE IMPACT OF COVID 19 DID NOT HAVE SIGNIFICANT IMPACT ON NHS SERVICES UNTIL APRIL 2020 ( https://digital.nhs.uk/data-and-information/publications/statistical/hospital-outpatient-activity/2020-21/covid-19-impact ) My daughter was initially assessed by Abigail Lee, Primary Mental Health Worker at CAMHS on the 13th December 2018. The failure to admit my daughter into the service was largely outside of the influence of Covid 19.
MS was considered to be a complex case, under the clinical pathway for Trauma, with symptoms of depression and anxiety/ Obsessive Compulsive Disorder (OCD). During her psychotherapy treatment MS was given a diagnosis of Autism Spectrum Disorder (ASD). Concurrent work with Mr. S was arranged alongside her psychotherapy treatment.Regarding the Health Trust Transition Care Protocol, MB explained that he was aware a policy was in place but acknowledged he may not have been aware of it in detail. When he joined the Trust he was placed on Induction training, but this was cancelled after two sessions due to COVID, when the Trust instructed that all non-essential activities should be stopped in order for clinical work to be prioritised. This meant that MB did not attend the planned Induction session on the Protocol. MB said that he had not previously been involved in operationalising a transition for a patient, and was not aware or made aware of a specific document that needed to be shared with the patient/ family. His understanding of transition was as a process of thinking together with a patient as to what might be needed in the future as their 18th birthday approached.
2) HERE IS THE FIRST RECORDED ADMISSION THAT MARK BIRBECK WAS AWARE OF A TRANSITION POLICY. Elsewhere in this Investigation Report are further admissions by Mark Birbeck that he was aware that referral to Adult Services was an option. Surely a responsible clinician would have made immediate proactive steps to further their knowledge of transition protocol upon joining a new service. Mark Birbeck had already considered referral to Adult Mental Health Services at the beginning of his work with my daughter but is recorded later in this Investigation Report that he felt it was not clear whether referral on to Adult Services would be needed. This is evidence of poor clinical judgement by Mark Birbeck. Surely Mark Birbeck’s understanding of transition being only a process of thinking together with a patient as to what might be needed in the future as their 18th birthday approached is wholly inadequate and not aligned with even the basic principles of referral to Adult Services?
In the case of MS, MB felt that at the beginning of their work it was not clear whether referralon to Adult Mental Health would be needed: whether the mental health component of MS’s difficulties could be concluded at CAMHS; or whether other services may be more appropriate.
3) IT WAS ABSOLUTELY CLEAR TO ME AS A FATHER AND MAIN CARER THAT THE MENTAL HEALTH COMPONENT OF MY DAUGHTER’S MENTAL HEALTH DIFFICULTIES COULD NOT BE CONCLUDED AT CAMHS. I made myself clear on this point on multiple occasions including during a meeting with Mark Birbeck immediately after my daughter was admitted into the service on the 5th February 2021. It has already been established that Mark Birbeck was aware that a Transition policy was in place at CAMHS. He was then immediately appraised of my daughter’s mental health issues in detail by me, her father and main carer. Mark Birbeck made a clinical decision to override my concerns and I was left throughout the duration of my daughter’s time at CAMHS feeling voiceless, unheard and dismissed. This surely contravenes ⋅ Section 4.3 Patients’ autonomy and rights to be involved in decision making should be respected as far as their individual circumstances allow. as referred to at the beginning of this Investigation Report?
For example, when the ASD diagnosis was made there were discussions with MB’s Clinical Psychology colleague that it could be helpful to MS to be referred on to a specialist Autism service. As MS had been out of education for some time, MB was also considering whether it could benefit her to be offered a mentor. MB acknowledged that although MS’s OCD symptoms were pronounced at times in their work, there was forward movement.
4) THERE WAS NO EVIDENCE OF ‘FORWARD MOVEMENT’ WITH REGARDS TO MY DAUGHTER’S OCD SYMPTOMS. Did the ACP investigators ask for evidence by way Mark Birbeck’s Session notes or avail themselves of further evidence by way of clinical notes recorded outside of the therapy sessions. What did the ACP investigators deduce from those records and was there good reason to challenge and cross-examine the information available in those records? Following my reading of this Investigation Report I have advised my daughter to initiate an Access to Records disclosure through Information Governance at the Sussex Partnership. Disclosure is currently underway.
When she attended, she was open to discussion about what kind of support she might need in the future.MB noted that for a period of six months, MS’s attendance then became more patchy and sothe opportunities to discuss services after CAMHS became more limited.
5) MEG’S MOTIVATION WANED PRECISELY BECAUSE THEIR WAS NO ‘FORWARD MOVEMENT’. She became disillusioned with the therapy from around June/July 2021 and it was up to me to motivate her to regularly attend her sessions with Mark Birbeck. There was some utility in Mark Birbeck’s therapy regarding my daughter’s difficult relationship with her own mother. I am quoted in other sources as saying I believed he was responsible for good work in helping my daughter with her relationship with her mother but it was my daughter’s chronic and debilitating OCD that was causing immense psychological distress and therefore an immediate and pressing issue.
MB also noted that as work progressed Mr. S was making it clearer that he was finding it harder to cope with MS’s difficulties and the energies of the CAMHS team were directed to ensuring appropriate referrals were made for him.
6) THIS IS CATAGORICALLY UNTRUE. When my daughter was admitted into the service on the 5th February 2021 I was already overwhelmed as a single parent and main carer. My mental health DID NOT deteriorate throughout almost the entirety of my daughter’s time at CAMHS. My mental health DID start to deteriorate during the final weeks of the ‘parent work’ with CAMHS art therapist, Sally Mungall. This deterioration was largely down to the inappropriateness of the psychotherapy that Sally Mungall utilised during ‘parent work’. The Sussex Partnership have already admitted that Sally Mungall acted outside of her remit and competency and she is currently being investigated by her own regulatory body on multiple points of contention, further details of which are beyond the scope of this Investigation Report. No referrals were actually made for me until 13th January 2023 following my daughter’s ‘final review’ attended by my daughter, me, Mark Birbeck and Sally Mungall. I had become suicidal over the Christmas of 2021 and approached my GP practice on 29th December 2021. Sally Mungall had a telephone conversation with my GP on the 13th January 2022. A ‘Professionals meeting’ was requested by Sally Mungall and Mark Birbeck by letter on the 1st February 2022 and convened on the 8th February 2022. The ‘energies of the CAMHS team’ that ‘were directed to ensuring appropriate referrals’ for me happened almost exclusively outside of the therapy sessions that Mark Birbeck conducted with my daughter, 5th Feb 2021 to 28th Jan 2022.
It then became clearer that MS would also need onward referral to the Adult Mental Health Team. MB reflected that his ideas on referring MS on to Adult Mental Health were perhaps adversely affected by a culture of pessimism within CAMHS as to whether that service were positive about accepting referrals. He said that the complaint had led to a process of self-reflection regarding possible clinical matters he could have managed in a different way.
7) THIS STATEMENT CLEARLY DEMONSTRATES MARK BIRBECK’S INCOMPETENCE. If he was a truly competent clinician endowed with sufficient practical knowledge about OCD he would know that OCD is best treated by use of CBT, Cognitive behavioural Therapy INCLUDING ERP, Exposure and Response Prevention. Did the ACP investigators ask Mark Birbeck to forward evidence that he was applying CBT including ERP to deal with my daughter’s chronic OCD? Where is that evidence, written in session notes or other clinical records? My own observations of the therapy and other clinical interventions currently being delivered by clinicians at Adult Services at the CMHT The Bridge Centre, Basingstoke support the belief that CBT including ERP IN CONJUNCTION with ADDITIONAL intense, specialist psychological therapy running in conjunction with CBT and ERP is the best course of treatment for my daughter. Mark Birbeck decision to attempt to deal with my daughter’s OCD within CAMHS has denied appropriate and timely treatment by truly competent clinicians. Mark Birbeck allowed a culture of pessimism to cloud his clinical judgement. IT WASN’T UP TO HIM, NOR ANY OTHER OF HIS COHORTS WITHIN CAMHS TO ALLOW THEIR FATALIST ATTITUDE TOWARD ANOTHER HEALTHCARE TRUST TO INFLUENCE A CLINICAL DECISION. That is an APPALLING admission by Mark Birbeck, and indeed, Sarie Hodgson, Lead Child and Adolescent Psychotherapist of CAMHS. The collective, unprofessional cynicism of Mark Birbeck and his cohorts within CAMHS delayed competent psychotherapy by at least 9 months and, according to NICE guidelines on Transition from Child Services to Adult Services by 13 months. I will remind you AGAIN that I made a credible attempt on my own life during April 2022 while waiting for CMHT The Bridge Centre to accept my daughter into their service. I could, if not for a certain amount of good fortune, actually be dead by now. Mark Birbeck and his cohorts would then have been partially culpable.
SH added that the Trust Child and Adolescent Psychotherapist group had also considered the complaint together, and stressed that she would want Mr. S to know they had taken his concerns seriously and wanted to learn from them.
8) I AM CYNICAL OF ANY ASSURANCES GIVEN BY CAMHS BASINGSTOKE CLINICIANS. I have gathered around 800 pages of evidence in the process of investigating failures by CAMHS, the Sussex Partnership NHS Foundation Trust, CMHT The Bridge Centre and Southern Health NHS Foundation Trust. That evidence proves multiple examples of deception, misrepresentation and blatant lies by CAMHS clinicians and leadership staff working for the Sussex Partnership. Information Governance at the Sussex Partnership ( inadvertently? ) forwarded incriminating evidence to me before a decision was made by them to cease cooperating with me. I believe that Mark Birbeck has also been guilty of misrepresenting me. Evidence reported in this very Investigation Report proves him to be an unreliable witness, at least.
Regarding the question of whether a Lead Practitioner was identified for the case, MB explained that after three months of work with MS it became clearer that further support was needed from CAMHS colleagues. MB therefore brought MS’s case for discussion at the Multidisciplinary Team Care Planning meeting dated 30.06.21 with the aims of securing a colleague to undertake parent work, and the allocation of responsibility to a Lead Practitioner. At this meeting it was agreed that a colleague would offer to work with Mr. S to support MS’s treatment. She was not able to begin this work immediately but started three months later. MB clarified there was no discussion at the meeting regarding a Lead Practitioner, and he therefore assumed this role in the absence of any other clinician. MB explained that this was within the context of the service as a whole being very under resourced and therefore Lead Practitioners were only being allocated for those cases considered to be most highly at risk.
9) MARK BIRBECK CONSIDERED REFERRING MY DAUGHTER TO ADULT MENTAL HEALTH SERVICES AT THIS MEETING. Now I understand that he assumed the role of Lead Practitioner following this meeting. Mark Birbeck became the defacto Lead Practitioner and is recorded as having considered referring my daughter to Adult Services. I have already supplied document ‘megan 1365700-30.06.2021 MDT discussion’ to the ACP investigators that states ‘MB considering referral to AMH’. Things could not be any clearer. Mark Birbeck considered referring my daughter to AMH services on the 30th June 2021 but chose not to. His lack of knowledge of the actual precise details of the CAMHS Transition Protocol is now made irrelevant at this point.
Any allocation of a Lead Practitioner would have to be officially sanctioned through the service Team Manager. Regarding whether the issue of transition - either to Adult Mental Health or as a general discussion - was discussed together with Mr. S, MB recalled holding four review meetings with Mr. S - one by himself, and the further three together with the parent worker. MB’s memory was that transition would have been discussed with Mr. S in the later reviews, but this would need to be clarified.
10) CATAGORICALLY UNTRUE. MARK BIRBECK ACTUALLY ATTENDED JUST ONE ‘REVIEW MEETING’ WITH ME AND THE PARENT WORKER, SALLY MUNGALL AND THAT WAS ON THE 13TH JANUARY 2022 FOR MY DAUGHTER’S ‘FINAL REVIEW’. No mention of transition to Adult Services was ever mentioned during any of my other meetings with Mark Birbeck, even though he had considered referring my daughter throughout the therapy sessions.
Future provision would also have been referred to, for example, in email correspondence. SH added that it is standard practice for discussion on transition to take place once a young person reaches 17. MB acknowledged that such discussion with the family could have been more timely. However, he did not believe that reading the Transition Care Protocol would have necessarily affected his thinking, due to the factors referred to above.
11) ACCORDING TO NICE GUIDELINES ON TRANSITION FROM CHILD SERVICES TO ADULT SERVICES, PREPARATIONS FOR TRANSITION SHOULD HAVE BEEN MADE ON THE 5TH FEBRUARY 2021 WHEN MY DAUGHTER WAS ASSESSED AS AN EMERGENCY CASE.
‘1.2 Transition planning Timing and review 1.2.1 For groups not covered by health, social care and education legislation, practitioners should start planning for adulthood from year 9 (age 13 or 14) at the latest. For young people entering the service close to the point of transfer, planning should start immediately.’
Reading the CAMHS Transition care protocol would have provoked immediate action from any other competent clinician. Mark Birbeck’s assertion that reading the protocol would not ‘have necessarily affected his thinking’ is surely an damning admission of poor clinical judgement and maybe even malpractice?
2. Online meeting with Mr. S on 28.07.23.Just before the meeting Mr. S sent a document further outlining the reasons for his complaint.He was thanked for this and assured that the IP would look at it in detail before compiling their report. Main points arising from the response of MB to the complaint (as in the notes above) were then outlined in order to give Mr. S the opportunity to consider these and respond in turn. These points related to the Transition Care Protocol, the referral on to Adult Mental Health, the Lead Practitioner role and the part played by a multi-disciplinary team. It was highlighted by the IP that MB had taken the complaint very seriously and had been reflective and professional in his response. It was explained to Mr. S that at the time MB became involved he was relatively new to the Service. His induction had been therefore ended by the Trust cancelling all non-clinical work, therefore the session on Transition policy did not happen as it should have. In addition, more experienced, senior staff do not appear to have been as forthcoming with advice as they might have been.Mr. S conveyed his concern about the severity of his daughter’s OCD symptoms, which had worsened in the time between her assessment and the offer of psychotherapy treatment, and resulted in his taking her to A&E as an emergency. He said he took the earliest opportunity he could to meet with MB to explain his concerns and despair. At that point he felt that his daughter needed ‘something more’, that is, specialist care for OCD as per the NICE guidance, and possibly residential care. He felt CAMHS would not be ‘up to the task’. At the same time, Mr. S recognised that his daughter had abandonment & trauma issues as a result of her mother’s actions, and that these matters could be helpfully addressed through psychotherapy. He reported that his daughter liked MB, and that he himself also found MB to be personable. However, Mr. S felt that when things were not getting better and he tried to explain his concerns about the OCD again to MB, offering to write down all that happened at home, MB was ‘quite dismissive’. Mr. S became unsure if MB had the right skill set to help with MS’s OCD symptoms, and shared his view with MB that a different intervention was needed. He said in response MB offered 4 additional sessions which would extend the treatment by a month. MS shared his view with the IP that parents know their child best and that MB did not seem to take this into account. It was highlighted to MS that work with the parent is offered alongside psychotherapy with the young person as an important way of including parents; and that their helpful ideas about their child can inform the Child and Adolescent Psychotherapist’s treatment of the child via the parent worker, who can also advise the parent on managing troubling behaviours. MS said in his view, in this case, the parent worker ‘abused her position and was guilty of clinical malpractice’.Regarding the referral on to Adult Mental Health, Mr. S was informed of the reasons given by MB as to why this did not take place sooner (see above). Mr. S said that he did not feel autism or trauma were the main significant factors and that the OCD symptoms had become the major concern. Mr. S spoke of the severity of MS’ OCD symptoms - her lack of self-care, for example not having washed her hair for a considerable period of time. Mr. S explained that he had attended many courses regarding autism which had assisted him in understanding his daughter. However, she had become ‘unrecognisable’ and needed specialist care which hecame to feel MB wasn’t able to provide, and that MB should therefore have referred MS on to another treatment. Mr. S added that he was subsequently advised by a clinician in the Adult Mental Health Team that if MS had been referred earlier, she would have seen an ‘OCD specialist’ sooner and be better by now.Regarding the role of Lead Practitioner, Mr. S said he had understood that MB’s colleague, the parent worker, was the Clinical Lead. His understanding was that these were the only CAMHS professionals involved in his daughter’s case, and that the parent worker was MB’s supervisor. It was explained to him that the decision to offer psychotherapy to MS would likely have been made by a previous Child and Adolescent Psychotherapist who assessed MS before MB joined the service. He would have then been allocated her case. It was also the case that the Multidisciplinary Team would have had a part to play in the Care Planning Meeting, where more senior professionals than MB were present. These colleagues would have taken into account the current presentation and queried the offer of psychotherapy treatment if they thought that was not appropriate. Mr. S said there had been over a year between assessment and treatment during which time his daughter had deteriorated significantly. In the absence of an identification of a Lead Practitioner by more senior colleagues at the Care Planning meeting, MB had taken on this role by default. It was explained to Mr. S that at that time a Lead Practitioner was only being allocated only for cases considered to be at ‘high risk’: and that this would need to be agreed by the CAMHS Team Manager.It was also explained that MB had regular supervision from a Child and Adolescent Psychotherapist, and that the ACP has a system in place to ensure the governance of this. Mr. S asked for the name of the supervisor and whether supervision sessions are recorded. Neither of these queries could be verified by the IP but it was stated that it is considered best practice for notes of the supervision to be taken. Mr. S conveyed his concern about the Health Trust, who he felt were responsible for ‘serious mismanagement and lot of bad housekeeping’. He said he was being denied access to records, and was seeking a court order as the Trust was ‘hiding lots of bad practice.’ Mr. S explained that he ‘just needed to get to the truth’, and was ‘determined to do the right thing’. He added that he would accept the findings of the IP.3. Following these two meetings the IP was able to look at the documents sent by Mr. S, as well as further information supplied by MB. From this information the IP clarified the following:
a) The Hampshire Transition Care Protocol concerns those cases where a transition to Adult Mental Health is considered necessary. It lays out what steps should be taken from when a patient reaches 17 years, and when decisions need to be made at 17.5 yrs. In paragraph 5.3 it also discusses potential exemptions:5.3 Flexibility of age of Transition In some cases it may be necessary for services to be more flexible. Where there are important clinical reasons, CAMHS will extend their work beyond the 18th birthday for a period of time. Reasons can include: It is possible to complete a piece of therapeutic work so that transfer of care to Adult Mental Health/Learning Disability services is not deemed necessary at the time.
12) IT WAS NEVER GOING TO BE POSSIBLE FOR MARK BIRBECK TO COMPLETE THE OCD WORK WITH ANY REASONABLE, EMPIRICALLY MEASUREABLE SUCCESS. More competent and experienced clinicians at CMHT The Bridge Centre have determined that my daughter is best served by a programme of CBT including ERP to run concurrently with specialist talking therapy in accordance with NICE guidelines on Treating Obsessive-Compulsive Disorder and Body Dysmorphic Disorder in Adults, Children and Young People.
b) MB’s additional information refers to his having previously worked within the Health Trust and having a reasonable working knowledge of the process of transition for young people, if not in its finer detail. MS was part of the first cohort of patients he was allocated, several of whom were over 17 and had been on the waiting list for an extended period of time. MB had frequent conversations with his Line Manager about all of these cases and requested holding them open to CAMHS past their 18th birthday, allowing for more time to complete the clinical work and oversee any possible referrals post 18. In the case of MS his intention had been to bring the clinical work to a close in the weeks following her 18th birthday and use the additional time for appropriate clinical discussions and care planning. She did then remain open to CAMHS for a further 4 months beyond her 18th birthday.
13 ) FACTUALLY UNTRUE WITH REGARD TO THE NUMBER OF MONTHS MY DAUGHTER’S CASE REMAINED OPEN. Again, another admission by Mark Birbeck, that he had a reasonable working knowledge of the process of transition for young people, which appears to go beyond his assertion that I addressed in rebuttal 2) above. Meg did, indeed, remain open to CAMHS for an additional THREE MONTHS beyond her 18th birthday and not four months but she only had an additional 4 therapy sessions with Mark Birbeck. No attempt to transfer my daughter to Adult Services until the 8th March 2022.
While it is true that in the event the Adult Mental Health referral was made only a few weeks before her closure to CAMHS MB notes that during that time letters were sent to her GP requesting that they review medication and monitor her mental health in the period she was awaiting the outcome of the Adult Mental Health referral. MB adds that the decline in Mr. S’s mental health necessitated multiple responses from CAMHS clinicians, including an Adult MentalHealth referral for him, Social Care Safeguarding referrals for both him and MS, liaison with Police, and the involvement of CAMHS managers and Safeguarding professionals. MB acknowledges that as a result of this there was a short but perhaps inevitable delay in the Adult Mental Health referral for MS.
13) CATAGORICALLY UNTRUE. See my rebuttal 6) above for details.
MB also reflects on the possibility that his knowledge of the entirety of the Transition Care Protocol was also affected by the absence of a Team Manager at Basingstoke over a period of several months, when he was initially working with MS. There was also a period during which all non-essential clinical tasks were halted to cope with the pressure on the service created by the post-COVID referrals.
14) DISPUTED. KNOWLEDGE OF THE ENTIRETY OF THE TRANSITION PROTOCOL WAS UNNECESSARY AS MB ALREADY HAD EXPERIENCE IN TRANSITION AND THAT EXPERIENCE SHOULD HAVE BEEN ENOUGH TO INITIATE TRANSITION, REGARDLESS OF THE DETAILS OF THIS PARTICULAR PROTOCOL. I have addressed this in rebuttals above.
15) TRANSITION REFERRAL SHOULD NOT FALL UNDER ‘NON ESSENTIAL CLINICAL TASKS’. Referrals to Adult Services are ESSENTIAL tasks, surely?
c) At the Care Planning meeting it is recorded that MB brought MS for discussion as she was 17.5yrs and still presenting with OCD symptoms. Although there is no record of the Transition Care Protocol being referred to in this meeting, the fact of MS having reached the threshold for consideration for transition was implicitly noted by stating her age.
16) ‘IMPLICITLY NOTED BY STATING HER AGE’ IS UNPROFESSIONAL AND DISPLAYS AN ATTITUDE OF LAZINESS AND CASUAL INDIFFERENCE. A trained professional healthcare worker with responsibility over such a vulnerable, mentally ill patient should NOT be relaying on implied statements. Having stated my daughter’s age, Mark Birbeck should have EXPLICITLY raised the consideration for referral. That EXPLICIT referral should have made its way into my daughter’s medical record. It DIDN’T which is evidence that it was allowed to slip during the Care Planning meeting. Referral to Adult Services was overlooked during the discussion because Mark Birbeck relied on implied information and not explicitly stated information.
No other clinicians at this multidisciplinary meeting are recorded as having advised MB to look at the Transition Care Protocol or to have queried the treatment plan for psychotherapy to continue, and it was agreed that MB would consider onward referral to Adult Mental Health.
17) IF IT WAS TRULY AGREED THAT MARK BIRBECK ‘WOULD CONSIDER ONWARD REFERRAL TO ADULT MENTAL HEALTH SERVICES THEN WHY DID HE NOT WHAT WAS AGREED?
d) In their sessions MB did discuss with MS issues regarding her future care - for example, in the light of her diagnosis for ASD - but this did not involve considering a referral to Adult Mental Health until MB observed that MS’s difficulties had become more pronounced. Until then his clinical judgement was that psychotherapy treatment could be effective in working with her. He had direct experience of this with a previous patient with compulsions no less pronounced, where he saw considerable success in symptom reduction. MB’s view was that had he decided that another treatment option would have been more appropriate MS would then have had a considerable further wait before being able to access something other than psychotherapy. There was a real urgency for an intervention for MS and MB acknowledges the possibility that the thought of returning her to a waiting list in a state of crisis might have played a small part in his thinking. However, his clinical opinion was that there were already solid grounds for the decision that MS could be helped by Child and Adolescent Psychotherapist. This aligns with the view of the assessing clinicians at the time of her referral to the service. MS had been placed on the Trauma pathway, and was seen for a Specialist Trauma Assessment on 12.9.19. Child and Adolescent Psychotherapist was recommended and MS had also expressed a strong preference for this treatment, explicitly stating she would like to work within a relationship where she could explore her feelings by talking. MB indicates that she reiterated this view to the duty clinician who spoke to her in the run up to his assessment, and again in the course of treatment.
18) IT WAS INAPPROPRIATE FOR MARK BIRBECK TO USE HIS EXPERIENCE WITH A FORMER PATIENT SO EXCLUSIVELY. My daughter is a patient in her own right with her own very particular psychological presentation. What does Mark Birbeck mean by ‘no less pronounced’? In what ways were there commonalities between my daughter and Mark Birbeck’s previous patient and in what ways were there differences? What were the actual ‘solid grounds’ for the decision that my daughter could be helped by a Child and Adolescent psychotherapist? How far did the ACP investigators pursue this line of enquiry?
e) MB’s additional information refers to guidelines for psychotherapy within the Trust. These outline that because psychotherapy involves in-depth work with some of the most complex patients in CAMHS, a Lead Practitioner should be allocated to allow a separation of roles and freedom to concentrate on the clinical task. However, at that time, the reality on the ground was that the team at Basingstoke was severely depleted and simultaneously struggling to manage a surge in referrals due to the pandemic. MB was therefore aware that if requested it was highly unlikely for a Lead Practitioner to have been allocated, and this was especially so once there were two allocated clinicians working closely on the case and MS also open to Psychiatry for medication review. There were not sufficient numbers of clinicians working in CAMHS at the time to meet the demand for Lead Practitioners, and those there were, were generally assigned to patients where there was risk of suicide or inpatient admission. This meant that MB and the parent work had to divide up the tasks which would in an ideal situation have fallen to a Lead Practitioner.
19) IF CAMHS WAS INDEED COMPROMISED AND THERE WAS NO ACCESS TO A LEAD PRACTIONER THEN MARK BIRBECK, AND PARENT WORKER, SALLY MUNGALL, SHOULD HAVE ERRED ON THE SIDE OF CAUTION AND PROMOTED SAFE POLICY BY REFERRING MY DAUGHTER TO ADULT SERVICES IMMEDIATELY. Such safe policy would have meant that my daughter would have a seamless and immediate transition to Adult Services should the therapy at CAMHS fail. Mark Birbeck assumed responsibility of Lead Practitioner role and therefore assumed ALL responsibility for my daughter’s welfare. He therefore should assume responsibility for ALL the failures in his role as a Lead Practitioner. I note that Sally Mungall also shared some of this responsibility and I will be forwarding this rebuttal to the Health and Care Professions Council who are currently investigating her in relation to multiple other issues of clinical malpractice.
f) Additional information sent to the IP by Mr. S elaborates on his remarks at the online meeting. He states that he voiced his scepticism over MB’s optimism that MS could be treated successfully within the relatively short period of time available. On at least two other occasions when MS, at short notice, felt she was unable to attend her therapy sessions with MB, he took the opportunity to use the session time to appraise MB of MS’s conditionand to further express scepticism at his insistence that another month or two extension beyond her 18th birthday was the best and only option. Mr. S states that was not aware that plans should already have been in place for transition to Adult Services. He says that this was not presented to him as an option, let alone as actual policy and protocol. Mr. S adds that he was not given a formal opportunity to raise any concerns or queries. And that he experienced resistance from MB at his attempts to raise them. Mr. S’s recollection is that the only time that Adult Services was mentioned was during the final review for MS and himself with MB and the parent worker held on the 13th January 2022. Even though he was visibly distraught at the understanding that MS was about to be discharged from CAMHS without any continuation of mental health care provision, his memory is that the clinicians voiced the view that Adult Services were patchy and inadequate and unlikely to be of any real help. By the end of this review the clinicians promised to raise Safeguarding concerns. In his written information Mr. S shared his view with the IP that ‘hindsight reveals there had been no intention, at that point, of referring MS to Adult Services’.Conclusion
In addressing the substance of the complaint regarding MB, the circumstances and context in which he was working need to be recognised. These include:⋅ a lack of resources within CAMHS which resulted in long waiting lists, delays in treatment, and staff shortages.⋅ the impact of COVID and consequent increases in demand, both on service delivery and the emotional pressure on clinicians to function at their highest level.Within this context were specific factors - the absence of a Team Manager for part of this period; the lack of availability of Lead Practitioners; a culture of ambivalence towards Adult Mental Health.
MB’s commitment to his patient is clear and they did have discussions about her future care in a general sense, and particularly following her diagnosis of ASD. MB’s previous clinical experience reinforced his belief that psychotherapy could help MS and alleviate her OCD symptoms.
20) MARK BIRBECK RECKLESSLY OVERESTIMATED HIS COMPETENCE. He should have recognised this immediately and referred my daughter to Adult Services as safe practice and a caution against failure by CAMHS to actually treat my daughter’s OCD. Mark Birbeck’s decisions fall somewhere between ignorance and actual hubris.
He had had limited time to work with MS and his opinion was that the treatment needed to be given a reasonable chance of taking root.
21) THIS COMMENT MAKES NO SENSE. Limited timeframes meant Mark Birbeck’s chances of successfully treating my daughter’s OCD were equally limited
At the Care Planning Meeting it would have been open to the other professionals present - including Consultant Child Psychiatrists - to query whether another treatment would be more appropriate but this did not happen. Given the shortage of resources and waiting times, it seems also that had a referral been made for alternative treatment in CAMHS there would not have been an available clinician within the time frame.
22) I ACTUALLY SUGGESTED TO MARK BIRBECK THAT MY DAUGHTER MIGHT BENEFIT FROM A RESIDENTIAL STAY AT A CENTRE SPECIALISING IN OCD TREATMENT. This would have been outside and beyond CAMHS purview.
MB’s knowledge of the Transition Care Protocol was hampered by the cancellation of his Induction Programme due to COVID, and the halting of non-essential clinical tasks. Moreover, it seems to be the case that none of his more senior colleagues drew his attention to the Protocol and that it would be best practice to follow it and share it with the patient. This did not appear to happen at the Care Planning Meeting, nor in other forums where MB presented the case, such as individual monthly supervision and the monthly Child and Adolescent Psychotherapist peer supervision meetings.
23) DISPUTED. KNOWLEDGE OF THE ENTIRETY OF THE TRANSITION PROTOCOL WAS UNNECESSARY AS MB ALREADY HAD EXPERINCE IN TRANSITION AND THAT EXPERIENCE SHOULD HAVE BEEN ENOUGH TO INITIATE TRANSITION, REGARDLESS OF THE DETAILS OF THIS PARTICULAR PROTOCOL. I have addressed this in rebuttals above.
The IP is therefore left with the conclusion that there does not seem to have been a general awareness in the team as a whole about the implementation of the Transition Care Protocol. This conclusion is perhaps given weight by the fact that a Practitioner within the team was subsequently identified to be a Link Person with Adult Mental Health.
24) THE FACTS AROUND THE LINK WORKER IDENTIFIED WITHIN CAMHS ARE AS FOLLOWS. I had been in protracted meetings with Farayi Nyakubaya, the Head of Nursing at CMHT The Bridge Centre throughout the autumn of 2022 and up until the beginning of 2023 to address my complaints about CMHT. It was Farayi who first posed the question ‘why had CAMHS not made a timely referral of my daughter to CMHT The Bridge Centre?’ This was followed up in communication with Gemma Stubbington, Head of Clinical Services at CMHT The Bridge Centre
‘Following a meeting earlier today ( 6th Jan 2023 ) with Farayi Nyakubaya, Head of Nursing at CMHT The Bridge Centre, held to bring the Southern Health portion of my complaint SP22020 to final resolution, I was informed that my daughter, Meg Stock, former patient at Camhs, Basingstoke, should have been referred to CMHT The Bridge Centre when she turned 17 and a half years old. Farayi told me that this was policy designed to provide a seamless and timely transition between Camhs and The Bridge Centre and where both teams of healthcare providers would be working together to provide Meg uninterrupted mental health care. According to this policy Meg should have been referred to The Bridge Centre on the 10th June 2021 but was not actually handed over until 8th March 2022. The delay in referral added considerable distress to both Meg and myself as her main carer and has significantly impacted psychological intervention by The Bridge Centre. Farayi has told me that Camhs failure to refer Meg at age 17 and a half was either a mistake or a clinical decision although he would not be drawn into speculating what clinical decision might have prevented a prompt referral. Please would you ask the appropriate clinicians at Camhs, Basingstoke to advise if the reason not to refer Meg to The Bridge Centre on the 10th June 2021 was a mistake or to advise me on the precise explanation for the clinical decision if this was the case.
Communication was finally concluded on Sun 19th March 2023 with the following email from Gemma Stubbington
Dear Mark
Thankyou for your email.
Jenny is the CAMHS transition link worker.
The meeting we have set up was already planned as when I arrived in Basingstoke in January I wanted to understand the local working plan and ensure the working process for both teams was in place, no new process will be made it is to ensure it is aligned with the planned process’.
The working agreement between Sussex partnership which is CAMHS and Southern health is embedded on the policy on transition from childrens services to adults services on the southern health website. I am unsure if this can be sighted by the public and will look to understand this for you.
Kind regards
Gemma
It is my understanding that the establishing of a Link worker at CAMHS was in direct response to my complaint initially being addressed by Farayi Nyakubaya. It is likely that this would have remained a serious oversight within CAMHS if not for my complaints.
It should be noted that the Transition Care Protocol is written to provide guidance to clinicians on good practice, rather than being a compulsory document.
25) IF THIS IS TRULY THE CASE THEN RECOMMENDATIONS FOR A REVIEW OF THIS POLICY SHOULD BE MADE IMMEDIATELY. Failure to follow transition protocol has potential for catastrophic consequences. My daughter’s case proves the need to make consideration of child to adult services a mandatory step in appraising patients within CAMHS.
Having noted all the above, however, it can be said that it would have been good practice for MB to acquaint himself with the Transition Care Protocol whilst treating a patient over 17 years. In sharing the Protocol MB would then have been in a position to allude to paragraph 5.3 (as above): In some cases, it may be necessary for services to be more flexible. Where there are important clinical reasons, CAMHS will extend their work beyond the 18th birthday for a period of time. Reasons can include:It is possible to complete a piece of therapeutic work so that transfer of care to Adult Mental Health/Learning Disability services is not deemed necessary at the time.
This would have provided MB with a basis on which to explain his clinical decision to continue and complete his clinical work using his judgement of the patient’s therapeutic needs.
26) JUST WHERE ARE THE RECORDS THAT DEMONSTRATE MARK BIRBECK’S RATIONALE BEHIND HIS CLINICAL DECISIONS? Did the ACP investigators ask Mark Birbeck for such evidence ?
Within the model of Child and Adolescent Psychotherapist it is recognised that it is helpful for the parent worker to take on the role of speaking to parents about such matters, leaving the Child and Adolescent Psychotherapist free to focus on the young person. So in this case it might have been expected for the parent worker to have shared the Transition Care Protocol with Mr. S, but it does not appear that this happened.
27) THE ‘PARENT WORKER’, SALLY MUNGALL, DID NOT UNDERTAKE A ROLE IN SPEAKING TO ME TO IDENTIFYING THE OPPORTUNITY TO TRANSITION MY DAUGHTER FROM CAMHS TO ADULT SERVICES. Where is the evidence that proves this role was formally discussed, delegated and agreed between Sally Mungall and Mark Birbeck?
MB did himself have some conversations with MS’ father when Mr. S asked to use her therapy sessions in her absence. However, MB may have understandably been cautious in opening up a detailed discussion with him about planning without having secured MS’s consent, as she was his patient.
28) MARK BIRBECK SHOULD HAVE ASKED FOR MEG FOR HER CONSENT TO OPENLY DISCUSS HER CASE WITH ME, HER FATHER AND MAIN CARER. Meg has always been asked to provide consent and given consent readily when dealing with ALL other aspects of her healthcare with ALL other healthcare providers and practitioners. It is my belief that Mark Birbeck thought I was unhealthily enmeshed with my daughter; he raised this very point during one of my meeting with him and I strenuously denied this. It is my belief that he was determined to sideline me as much as possible.
The IP acknowledges this could have been experienced by Mr. S as resistance. Attending to the Transition Care Protocol became less of a priority when the energies of MB and his colleagues were being directed towards acknowledging a decline in Mr. S’s mental health and ensuring that his welfare was being addressed by liaising with the appropriate agencies.
29) CATAGORICALLY UNTRUE. I have addressed this in previous rebuttals. I regard this persistent attempt by Mark Birbeck to blame his professional failures on my own mental health as particularly odious.
In taking all this into account, the IP has reached the decision that there has not been a breach of ACP Code with respect to either Section 1.1 or Section 4.3.Recommendation
The IP notes that MB has taken the opportunity to reflect on events and indicated a wish to learn from the experience with the aim of improving his practice. The IP recommends that this can best take place within the wider context of systemic issues also being considered and addressed. The IP will summarise these issues in a letter to the relevant managers within CAMHS.
30) IN SUMMARY I AM TAKING THIS OPPORTUNITY TO STATE THAT I BELIEVE THE INVESTIGATION REPORT COMPILED BY THE INVESTIGATORS ON BEHALF OF THE ASSOCIATION OF CHILD PSYCHOTHERAPISTS WAS BASED ON INCOMPLETE AND FACTUALLY INCORRECT INFORMATION. I have not seen evidence brought to bear by Mark Birbeck to corroborate his account of events or to substantiate his clinical decisions. It may be usual practice of ACP investigations to overlook such evidence and I am not in any position, as a complainant, to demand such evidence but I am dismayed and somewhat alarmed that Mark Birbeck’s word alone is considered sufficient during such investigations.
I had hoped to be satisfied with the investigation report and been in a position to accept its findings and decision but I cannot, in good faith, move forward with confidence that justice has been served.
I will, therefore, be forwarding this rebuttal by way of appeal to the Professional Standards Authority, and make the contents of this investigation report available to a much wider audience including private litigators working on my behalf and also to the national press. The information contained within is pertinent to wider concerns about CAMHS and the Sussex Partnership and is a matter of public concern.
Mark Stock
3rd November 2023'
