Spending cuts mean training for social workers in mastering the deprivation of liberty safeguards (Dols) is “unlikely to be affordable in the foreseeable future”, a report has warned. The Mental Health Alliance (MHA) said cuts were likely to “reduce still further the training for all professionals involved in the scheme”, despite such training being “essential” to helping practitioners “master the excessively complex process”.
Many councils and primary care trusts, who have a statutory role in assessing and authorising applications from care homes and hospitals to deprive people of their liberty for care, have disbanded specialist Dols teams, it said. Refresher training for people performing roles under the Dols was as little as one or two days a year, despite the complexities of the scheme, said the alliance report, reviewing five years of the Mental Health Act 2007, which introduced the safeguards.
Social workers often act as best interest assessors (BIAs), who assess whether people have been deprived of their liberty in hospitals or care homes and recommend to councils or PCTs whether this is in their best interests. The report said the general level of competence of BIAs had increased greatly in the past two years, particularly in areas where there had been significant numbers of Dols cases. But it said “substantial training opportunities” still needed to be provided to all those performing roles under the Dols.
The Dols are designed to protect people who lack capacity to consent to care or treatment and whom providers believe need to be deprived of their liberty. However, there have been massive local variations in Dols applications by providers and in authorisations by councils and PCTs. The MHA said this meant the protections of the Dols were effectively unavailable to vulnerable people in areas where applications and authorisation rates were low. This may reflect some of the complexities of the scheme include the lack of a statutory definition of a deprivation of liberty, creating a lack of consensus on the issue, and the difficulties for non-lawyers in interpreting case law from the Court of Protection.
Besides better training, the alliance urged the government to conduct a wholesale review of the scheme to address “basic structural flaws”, including:
• the lack of a statutory definition;
• the lengthy and complex process for users and families in appealing against a deprivation; it said the Court of Protection was unsuitable as the first stage of appeal;
• the exclusion of people in settings other than hospitals or care homes from protection under the Dols;
• the ‘over-bureaucratic’ nature of the Dols, leading to it stretching scarce professional resources.
However, it also raised concerns about the Department of Health’s capacity to reform the Dols, pointing to the “disbandonment of the central Dols implementation team in England and its regional leads”.
Latest Dols figures published
The MHA report coincided with the publication today of the latest government figures on Dols cases. This showed there were 11,435 Dols applications from care providers in 2011-12 in England, up from 8,982 in 2010-11, though the success rate has remained roughly constant at 56%, compared with 55% in 2010-11.
Compulsory treatment concerns
The MHA report also raised concerns about the increasing use of compulsory powers under the Mental Health Act, with increasing rates of detention in hospital and higher than expected numbers of community treatment orders (CTOs). The orders, which were brought in under the 2007 Act, place requirements on people detained in hospital for their subsequent treatment in the community, with a failure to comply potentially leading to them being recalled to hospital. While it praised the introduction of independent mental health advocacy services (IMHA) under the 2007 Act, it warned commissioners were failing to fund services adequately or monitor provision sufficiently.
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