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Deprivation of Liberties Safeguards (DoLS)

The Deprivation of Liberty Safeguards is an addendum to the Mental Capacity Act 2005.

To meet the criteria of the safeguards a person must:

  • Be cared for in a hospital or care home; and
  • Be aged 18 or over;
  • Have a mental disorder, such as Dementia or a Learning Disability and not be liable for detention under the Mental Health Act 1983
  • Lack the capacity to consent to where their care is given
  • Need to be deprived of their liberty in their best interests to protect them from harm

The deprivation of a person’s liberty is a very serious matter and should not happen unless it is absolutely necessary. That is why the safeguards have been created: to ensure that any decision to deprive someone of their liberty is made following defined processes and in consultation with specific authorities.

Recognising Deprivation

There is currently no standard definition of deprivation of liberty, the code of practice says:

“to determine whether there has been a deprivation of liberty, the starting-point must be the specific situation of the individual concerned and account must be take of a whole range of factors arising in a particular case such as the type, duration, effects and manner of implementation of the measure of question. The distinction between a deprivation of, and restriction upon, liberty is merely one of degree or intensity and not one of nature or substance.”

When deciding whether someone may be deprived of their liberty, the following factors should be considered:

  • Was force or sedatives used because the person was resisting being admitted? This does not include the use of benign force, such as gently guiding someone by the arm.
  • Was the person deceived to make sure they co-operated? For instance, were they misled into believing that they would return home the next day?
  • Did the person’s relatives, or carers who live with the person, object to them being admitted?
  • Is the person sedated to prevent them leaving? Use of sedatives does not in itself mean that a person is deprived of liberty – it is only relevant if the purpose is to prevent the person from leaving the establishment.
  • Does the person make persistent or purposeful attempts to leave, which are prevented by means of force or a locked door? If immobile, does the person ask to leave in a persistent or purposeful way? A locked door does not constitute deprivation on its own, even if its purpose is to prevent residents from wandering. Likewise for the use of benign force, such as gently guiding someone by the arm to return them when they are wandering. This test is met only if the person’s attempts to leave are persistent and/or purposeful.
  • Is force being used to treat the person when they are resisting, other than in an emergency? Use of benign force to administer medication, or to feed or dress someone, does not deprive someone of liberty. Emergencies could include disturbed, threatening or self-harming behaviour.
  • Have relatives or carers asked for the person to be discharged to their care, and been refused?
  • Have the relatives or carers been refused access to the person, or had severe restrictions put on their access? Reasonable restrictions on visiting hours, etc, are not relevant.
  • Has the person been prevented from spending time with the people who matter to them? This would, for instance, include preventing the person from spending time with friends inside or outside the home/ward. It would NOT include guiding the person away from casual acquaintances who appear to be abusing or exploiting the person, or reasonable restrictions on the times when the person can socialise with friends, for instance because of the pattern of the establishment’s daily routine.
  • Does the way the person’s care is organised severely restrict what they can do in other ways? An example of severe restriction would be placing the person for a large proportion of their waking time in a position which prevents them from moving (e.g. using furniture which they cannot get up from). It would not be a severe restriction to use furniture designed to keep the person safe, which they cannot get up from unaided, it they are usually able to get help to get out of it when they show a persistent or purposeful desire to do so.
  • Has the person’s access to the community been severely restricted because of concerns about public safety? It is not deprivation of liberty to require someone to be escorted on trips out of the care home/hospital, if this is in the interests of their own safety rather than that of others, even if this means that the person is sometimes temporarily not permitted to leave.

How to refer if you feel a person is being deprived of their liberty

If you are a Managing Authority (Care Home or Hospital) and think you are already depriving someone of their Liberty you will need to complete Forms 1 and 4, (appended) and submit them to the relevant supervisory body. If you think that you will be depriving someone in the future, for example a new admission that has not yet arrived, you would only need to complete and submit form 4.

Care Homes submit to:

Laura Huckle
Dols Assessment Coordinator
Newbold Centre
Leicester Street
Leamington
CV32 4TE
laurahuckle@warwickshire.gov.uk

Tel 01926 431813
Fax 01926 315518

Hospitals submit to:

Tracy Redgate
Deprivation of Liberty Safeguard & Quality Lead
NHS Warwickshire
Westgate House
Market Street
Warwick
CV34 4DE
tracy.redgate@warwickshire.nhs.uk

Tel: 01926 478113
Fax: 01926478117

If you are a friend or relative of someone you feel is being deprived of their liberty, firstly you would need to raise it with the relevant Managing authority (Hospital or Care Home) and ask them to refer; if they fail to do so please notify the relevant supervisory body in writing. (Standard letter appended for your use)

If you have any questions about the process or are unsure whether to make a referral please do not hesitate to contact the relevant supervisory body, if you don’t know which supervisory body is appropriate please contact Laura Huckle in the first instance.