Deprivation of Liberty Safeguards (DoLS)

Legal Framework and Purpose of DoLS

1. Mental Capacity Act 2005 (MCA): DoLS is part of the MCA, designed to protect people who cannot make decisions about their care or treatment due to a lack of mental capacity.
2. Safeguarding Rights: Ensures that any deprivation of liberty is in the person’s best interests, necessary, and proportionate to prevent harm.
3. Legal Compliance: Provides a legal framework for depriving someone of their liberty, ensuring safeguards are in place to protect their rights.

When DoLS Applies

1. Lack of Capacity: The person must lack the mental capacity to consent to their care or treatment.
2. Deprivation of Liberty: The person is under continuous supervision and control and is not free to leave their place of residence or care setting.
3. Care Settings: Applies to hospitals and care homes; for other settings, a Court of Protection order is required.

Key Concepts

1. Mental Capacity: The ability to make decisions about one’s own care and treatment.
   • Assessment: Assess whether the person can understand, retain, use or weigh information relevant to a decision, and communicate their decision.
2. Best Interests: Any action taken must be in the best interests of the person, considering their past and present wishes, feelings, beliefs, and values.

Process for Assessing and Authorizing DoLS

1. Request for Standard Authorisation:
   • Responsible Person: Typically, the managing authority (e.g., hospital or care home) makes the request.
   • Timeline: Request should be made in advance if deprivation of liberty is likely to be required.
2. Assessments:
   • Age Assessment: Confirm the person is 18 years or older.
   • Mental Health Assessment: Determine if the person has a mental disorder.
   • Mental Capacity Assessment: Confirm the person lacks capacity to consent to the care or treatment arrangements.
   • Best Interests Assessment: Assess if deprivation of liberty is in the person’s best interests, necessary, and proportionate.
   • Eligibility Assessment: Ensure the person is not detained under the Mental Health Act 1983.
   • No Refusals Assessment: Check if there are any valid advance decisions or lasting power of attorney that would refuse the proposed care or treatment.
3. Authorisation:
   • Supervisory Body: Usually the local authority, grants the standard authorisation if all assessments support it.
   • Duration: Typically valid for up to one year, but can be shorter.
4. Urgent Authorisation:
   • Immediate Need: Can be granted by the managing authority for up to seven days, with a possible extension of another seven days.

Managing Care Under DoLS

1. Care Planning:
   • Least Restrictive Option: Ensure that the care plan uses the least restrictive option for achieving the intended outcome.
   • Regular Review: Regularly review the care plan to ensure it remains appropriate and lawful.
2. Documentation:
   • Record Keeping: Maintain detailed records of the assessments, decision-making process, and care plan.
   • Communication: Clearly communicate the DoLS authorisation and care plan to all relevant staff and family members.
3. Advocacy and Support:
   • Independent Mental Capacity Advocate (IMCA): Appoint an IMCA if the person has no family or friends to support them.
   • Family Involvement: Involve family members or friends in the decision-making process where appropriate.

Roles and Responsibilities

1. Managing Authority:
   • Ensure that appropriate DoLS authorisations are in place.
   • Make necessary referrals for assessments.
   • Implement and review care plans in accordance with DoLS requirements.
2. Supervisory Body:
   • Conduct assessments and grant authorisations.
   • Monitor and review authorisations to ensure compliance.
3. Healthcare Professionals:
   • Understand and comply with DoLS procedures.
   • Participate in assessments and care planning.
   • Report any concerns about deprivation of liberty to the managing authority or supervisory body.