Last week, I carried out a Best Interests Assessment for a man whom I had first assessed six months ago. In fact, he was the first person I had assessed under the new Deprivation of Liberty Safeguards. I had, at that point, recommended that the Deprivation of Liberty that he was experiencing in the care home in which he was placed be authorised – and I recommended that the authorisation be for six months.
So I was asked back. It makes a lot of sense. Although it was one visit six months ago, I had, at that point, made contact with and discussed the situation with his family members, his care team and his CPN, as well as having a meeting with him directly.
I had made some recommendations the last time I visited but they were not binding conditions, just some aspects of his life that I thought might make a difference to the quality of his life and was pleased to see that these had been actioned almost immediately that I had left the previous time.
It is obvious to say, but it is much easier, reassessing than assessing the first time. Immediately on seeing him, it was obvious to me that he looked physically better, less troubled and agitated. Although I only see a snapshot, by conversation and discussion, that was the picture that was painted for me all around.
My initial choice of six months was because it just felt wrong to me to go for a full year authorisation – especially as I felt that there were a number of adjustments that could be made in the short-term.
In retrospect, I’m glad I did it. I’m glad I was able to go back and see things having improved.
Some aspects of the Deprivation of Liberties Safeguards are flawed, I think. We have not had a lot of referrals coming in, certainly far less than were envisaged.
Partly I think this is due to the policy guidelines and thresholds being adjusted upwards to more narrowly define what a Deprivation of Liberty is.
I think it is also partly due to a reluctance of managing authorities to make referrals, perhaps seeing it as a criticism or a failing, instead of a positive.
I placed someone in a care home a couple of months ago and I felt immediately on placing her that the placement would be an unfortunate but necessary deprivation of liberty. I informed the home manager that I felt this was the case and recommended that she refer to the Supervisory Body. She was horrified and assured me that the resident was happy at the care home. It took a bit of nagging and the involvement of her IMCA (Independent Mental Capacity Advocate) to facilitate the Deprivation of Liberty Safeguards process but I wondered if her reaction was typical of home managers.
We have also had a number of requests for authorisations come from our psychiatric in-patient wards – particularly those for over 65s. A number of people who have been referred have failed the ‘eligibility’ part of the assessment process meaning that they meet the criteria for a Mental Health Act Assessment rather than the DoLs process.
If anything, it has led to more people being detained formally in hospital. I’m of the mind that this is no bad thing as the Mental Health Act has more robust appeals processes in place than the Mental Capacity Act and the DoLs process which has very weak appeals processes.
Then there is the sticky issue of the right to (free) care under Section 117 of the Mental Health Act – so if a person has been subject to Section 3 of the Mental Health Act, the authorities are responsible for paying for after care services. I should probably devote a whole post to this at some point. It has become a major issue in our Trust and most, I assume, as older people who might not have been formally admitted previously, are now entitled to free aftercare – often through placements – which is some of the most expensive aftercare possible.
I often ponder if people, in general, are aware of their rights to free aftercare but as I said, that’s probably another story for another day..
A knock-on effect of the new safeguards, locally, at least, seems to be that there are more formal admissions.
I’m not sure this was the way that things were ‘meant’ to work but lots of interesting issues being thrown up..