Countdown to DoLs

The Deprivation of Liberties Safeguards (DoLs) go ‘live’ in  just over a week now. These were a part of the amended Mental Capacity Act (2005) which establish a legal framework by which someone who lacks capacity may be ‘deprived of their liberty’ if it is assessed to be in their best interests and according to a stream of conditions and indicators. It means we are preparing to receive referrals to assess those who are in this situation currently or of whom there are plans to do so in the future.

We are counting down to the 1st April – and while I should be concentrating my efforts on finishing up the coursework, I’m really at the ‘looking for distraction’ stage of studying that necessitated another posting.

We had a meeting of Best Interests Assessors last week in the borough. Currently there are about 30 and that covers the Primary Care Trust, the Mental Health Trust and the local authority. Most are social workers – including all the dual-trained AMHPs (Approved Mental Health Professionals)  but there are also a some OTs (Occupational Therapists) as well as some Learning Disability Nurses and Mental Health Nurses.  The meeting was an opportunity for the newly-established DoLs Office to distribute their freshly minted policy and for us to meet with some of the directors who will be ‘our’ signatories. We also met our ‘legal advice’ team which was quite comforting. It was also an opportunity to discuss thoughts and concerns in the run up to April 1st (with chocolate biscuits – they really know how to sell these things to us!).

One of the main organisational concerns seems to revolve around the Mental Health Assessors who are doctors trained specifically to carry out these parts of the Assessments. Apparently, a list is going to be held centrally (and nationally) of all the doctors who have completed this training.  There seems to be a minor rumbling of concern about how many doctors have actually completed this training.

Each full set of assessments needs to be completed by at least two people, a trained Best Interests Assessor and a Mental Health Assessor at the very least so we can see where potential concerns may be coming from.

As for expectations, they seem to be relatively low regarding the amount of assessments that will come in. We have quite a lot of (general) hospital beds in the borough and that seems to be causing a fair amount of stress as they (the acute Trust) have developed an extraordinarily robust policy which seems to set a fairly low threshold for ‘Deprivation of Liberty’.

Of course, developing a robust policy isn’t concerning but there is a thought that perhaps a lot of referrals will come from that source.

We heard though that there is likely to be at least an element of reliance on neighbouring boroughs regarding possibly sharing out some of the workload – as there is a regional local implementation network that has been making these kinds of plans for months.. but even just over a week away some of the details are less than clear.

As for us, best interests assessors (although while I still have this deadline for essay hanging over me I’m almost reluctant to tempt fate in this way!), we have completed a ‘profile’ form to match our background and experience with those who we will be assessing – including home addresses and areas of England which we would find it easy to travel to (I indicted for example, where my siblings live – just in case my borough has placed anyone in those areas – one person who is trained, for example, commutes in from Brighton – I expect he will she kept fairly busy on the south coast.. !).

Being in central London we make quite a lot of out-of-borough placements, so while the council has done a lot of work with the local nursing and residential homes as well as the hospitals, there is an unknown factor relating to how many out-of-borough assessments will come in.

I forsee a lot of seaside trips in my future.. Bognor in May. Lovely.


5 thoughts on “Countdown to DoLs

  1. One of the main organisational concerns seems to revolve around the Mental Health Assessors who are doctors trained specifically to carry out these parts of the Assessments.

    Pah~ like you need a medical degree to assess capacity or impaired judgment?
    Do the medical staff have to undergo special training too?
    Perhaps I should as Shrink.

    I believe most docs can guesstimate – but are not generically trained to make precise or structured ethico-medical decisions when it comes to having the right to make a bad choice.
    The majority will still go with clinical decisions and organisational practice – or their own ‘preferred choices’ – before they get to individuals’ rights.
    As we know, anyone who doesn’t choose the same as a doctor has no insight, lacks good judgment and is intellectually impaired.

  2. My understanding (and I reserve the right to be completely wrong on this as my attention hasn’t always been as firm as it should be) is that the Mental Health Assessment is basically ‘Does P (patient) have a mental disorder or not?’ it is really set that low. The training (which is an online course for doctors) is probably more about procedural protocols.

    The Mental Capacity Assessment can be undertaken by a doctor who has completed this training OR a Best Interests Assessor (who can be a Social Worker, Nurse, Chartered Psychologist or Occupational Therapist with at least 2 years work experience – I can’t remember the exact details but those are the professional groups anyway).

    The only legal constraints are that at least two people need to be involved in the six assessments – one has to be a doctor (for the Mental Health part) – one has to be a Best Interests Assessor (see above re: professionals involved) and apart from those two assessments, the other parts can be undertaken by one or the other or a third assessor!

    The other consideration is that neither can be involved in the care of P. Or be supervised by someone who is involved in the care of P.

    Phew. And back to work for me!

  3. Sounds like you have it all sown up locally. There are general concerns about the availability of Section 12 Drs to act as mental health assessors and there don’t appear to many of them trained. The general knowldge and awareness of DOLS is limited despite DoH and local areas communicating extensively with care homes and hospitals.

    Interesting about your local acute trust. I think the bar is high and not many people in acute trusts will fall into the DOLS criteria.I did some training this week for the acute trust matrons and very few could think of people they might refer for DOLS. Most interesting was someone detained under the Public Health Act.

    You are right about the mental health assessment. Very different from MHA, no risk assessment, no treatment decisions, no recommendations, no diagnosis. Just simply does the relevant person have a mental disorderf as defined by the MHA & how might being deprived of their liberty impact on their mental health.

    Many of the LAs in the South East are going to sign up the ADASS protocol re out of area assessments to avoid staff havin gto travel distance but not to remove the Supervisory Body responsbilities. I understand there was something similar for London. If you are having trouble sleeping I can send it to you.

    Would be interested to hear on-going DOLS issues and assessment outcomes. Bring on 1st April…..!

    • Yes, there’s a similar protocol in London (probably the same one!) – my understanding of it is that we have agreed to undertake our own assessments wherever they are in London – I was about to give some examples but realised it would probably identify the borough I’m in! We have a particular arrangement with one neighbouring LA where we may likely swap assessments much more freely but generally we’ll be doing our own assessments.

      Interesting times anyway – now some of the pieces seem to be falling into place, I am almost anxious to get started!

  4. Pingback: Assessing Liberty « Fighting Monsters

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