My First Best Interests Assessment

Yesterday I completed my first Best Interests Assessment since the relatively new Deprivation of Liberty Safeguards went live on 1 April 2009.  In brief these assessments grew from the need to clarify the legal position of those who lack capacity when certain restrictive conditions apply which ‘deprive them of their liberty’.

The generally communicated opinion seems to be that rather than the onslaught of assessments from the “live” date of 1 April – there has, instead, been something of a trickle and those who took up the Best Interests Assessments courses to supplement retirement income might be having a few second thoughts now. I’m not wholly convinced by the lack of referrals coming in though and personally expect there to be a slightly higher rate of referral as information trickles out to residential homes – possibly as review processes come around or the CQC (Care Quality Commission) begins to inspect the homes regularly.

Being in a relatively unusual position therefore, of having actually completed a ‘live’ assessment, I thought it would be a useful experience to share.  I don’t intend to look particularly at any of the details of the case that I was presented with but more my responses to the processes.

We are still in the ‘transition’ period. This means that the legal time limits on carrying out the assessments have been extended just for the period of April 2009. So rather than the seven calendar days that I would usually have to complete an assessment, I had the rather more comfortable 21 day limit.  This was particularly useful as the time period fell over the Easter holidays.

I received a telephone call from our DoLs co-ordinator who asked me about my availability to complete an assessment. I agreed to undertake the assessment, not least because after the training course and the written work, I was eager to see how things panned out in practice.

They then sent me copies of the forms that had been completed by the Managing Authority – in this case –  a residential home. There was the request for urgent authorisation of a deprivation of liberty, the request for a standard authorisation of a deprivation of liberty and a comprehensive care plan as well as the request form for a Mental Health Assessor (who has to be doctor).

Myself and the doctor involved seemed to play telephone tennis for a couple of days, leaving messages for each other at particularly inconvenient moments – until in the end with an awareness of the time limitations, she left me a message saying ‘I’m going to do this assessment tomorrow – are you with me?’  At that point, we were able to make contact and I postponed for a day in order to gather more information but at least we had a day when we could both assess at the same time.

In that period, I called everyone I could find that had had come kind of contact with the person involved – Social Worker/Care Manager, CPN, staff of residential home, GP and most importantly, next of kin.

I requested a couple of extra ‘background’ documents from the social worker and CPN, just to give me a better idea of some of the background history as the signs pointed to someone with very significant cognitive impairment.

On arriving at the residential home, I had a chat with the key worker and a look through the file. When the doctor arrived, we made a quick decision relating to who would complete which forms – I did the age assessment (!), eligibility, no refusals and of course, the Best Interests Assessment and she did the Mental Health Assessment and the Mental Capacity Assessment.

There was an obvious path to take with the way the interview progressed. We had agreed to start with capacity but as it happened, it was more a type of discussion/interview that we both added to but that provided all the necessary answers.

After the interview part, we discussed briefly the recommendations that we were making. She had expected me to hand her a claim form and we commented on the differences with the Mental Health Act Assessment – namely that our role is to make recommendations to the Supervisory Authority rather than to make the immediate decisions.

A couple of thoughts then from the process – the forms didn’t actually take as long to complete as they look like they might. The paperwork is enormous but comparing to my work as an AMHP,  I would say a Mental Health Act Assessment is significantly more time-consuming and involved. Partly this is because with the BIA (Best Interests Assessments) the ‘setting up’ is done by the supervisory body and while there is still a necessity to gather information, there isn’t the same responsibility for engaging doctors, police if necessary, ambulance and hospital bed.  For this assessment, apart from the prior information gathering, I turned up and assessed.

Of course, it has to be considered that the assessment I carried out was fairly clear-cut in that it could have been written up as a model case study in some respects so obviously if decisions are more borderline that is a different matter entirely.

I had some thoughts about the time limit on the authorisation (because I did recommend an authorisation of a deprivation of liberty). I did not go for the full allowable one year but instead a shorter period because I felt it would be useful to reassess the position to see how and if things were progressing. In retrospect, I wonder if this was a slightly arbitrary decision.

It was extremely useful doing the assessment jointly with the Mental Health Assessor – especially as we are still feeling our way around to a certain extent. I think it generally leads to a better experience for the person being assessed as had we visited separately we would have repeated a lot of the same questions.

My slight concern remains that the seven day limit will seem to be a little tight.

I am though, relieved to have finally completed an assessment and seen through the process in action.

4 thoughts on “My First Best Interests Assessment

  1. Interesting stuff. Halfway through my first and currently not going to recommend DoLS but want to see some changes to the care plan. Not DoLs because most of the things are being done to protect other service users from harm and not him…

    Anyway would be fascinated to hear how the conversations with the relatives went- I envisage real misgivings and concerns that it might pre-empt a move. And how did you find the process of appointing a Representative and were the relatives willing to take on this role? Will drop you a line about my assessment when it’s done. Hoping to meet with the family this week. More training this week and discovered someone in a care home on a Guardianship order that I’m not sure was necessary and perhaps not even legal…

    • I was lucky in the sense that the allocated social worker had spoken extensively to the nearest relative beforehand. She was expecting my call and had a good idea of what was being proposed as she was very heavily involved in the care plan in any case.

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