Professionals at odds over deprivation of liberty safeguards

Social workers need much clearer guidance about the deprivation of liberty safeguards (Dols) after a study found widespread disagreement between professionals about what constituted a deprivation.

The existing level of confusion could lead to unequal access to care and safeguarding for individuals who have similar needs, warned the study published in the September edition of Royal College of Psychiatrists’ magazine The Psychiatrist.

A group of lawyers, psychiatrists, best interest assessors (BIAs) – who are often social workers – and independent mental capacity advocates (IMCAs) were asked to judge whether 12 real-life situations constituted deprivations of liberty.

In just one case of a 91-year-old man with advanced dementia and exhibiting challenging behaviour did all professionals agree that the decision to keep him locked in a continuing care ward when he was repeatedly asking to return to a care home constituted a deprivation of liberty.

In a second case, there was agreement between psychiatrists, BIAs and IMCAs that there had been no deprivation of liberty in a case involving an 80-year-old man with advanced dementia in continuing care accommodation. But in all other cases there was widespread disagreement between and within professional groups.

The Dols were introduced in April 2009, under the Mental Capacity Act 2005, to protect the interests of people detained in care for their own protection, but there has been concern about their application ever since, including because of their complexity.

Last year, a Mental Health Alliance report called for an urgent review of the Dols after finding that health and social care professionals lacked the understanding to properly implement them. It criticised the lack of clear guidance about what constituted a deprivation.

This latest paper, produced by a team from London’s Institute of Psychiatry and the South London and Maudsley NHS Foundation Trust, said: “The findings of our study raise serious concerns about the complexity of the Dols legislation and particularly the practical difficulties involved in making reliable deprivation of liberty judgements within this legislation. It is an open question whether training can significantly improve the reliability of assessments. Much will depend on whether a clear interpretation of deprivation of liberty can be constructed for practical use.”

Among other findings, the study found that lawyers were more likely to conclude that a deprivation of liberty had occurred than best interest assessors or psychiatrists.

● Read Judgements about deprivation of liberty made by various professionals: comparison study.

Related stories

Guide to mental capacity assessments

The Deprivation of Liberty Safeguards

Safeguards to prevent wrongful detentions in care ‘need review’

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