Best Interest Assessments
The Deprivation of Liberty Safeguards
The Deprivation of Liberty Safeguards (Dols) are designed to uphold the interests of people who lack the capacity to consent to the care and treatment they need. They apply in England and Wales.
The Dols apply to people aged over 18 who:-
Have a disorder or disability of mind;
Lack the capacity to give consent to the arrangements made for their care or treatment;
For whom such care is deemed to be a necessary and proportionate response in their best interests to protect them from harm.
How do they work?
Whenever a care home or hospital believes someone is likely to be deprived of their liberty in their care, they must apply for an authorisation to detain them. In this context, care homes or hospitals are known as managing authorities and they must apply to a supervisory body: a local authority in the case of a care home or a primary care trust or health board in the case of a hospital.
Urgent and standard authorisation:
If someone needs to be treated or cared for in an emergency, the care home or hospital can issue an urgent authorisation, giving their reasons in writing for why a deprivation is necessary. This expires after seven days after which a standard authorisation, granted by the supervisory body is required.
The supervisory body must carry out six assessments to determine eligibility for the Deprivation of Liberty Safeguards:
1. An age assessment to determine whether the person is over 18.
2. A no refusals assessment, to determine that the authorisation does not conflict with a valid advance decision made by the service user before they lost capacity; or that it does not conflict with a decision made on the service user’s behalf, either by a person given lasting power of attorney or by a deputy appointed by the Court of Protection.
3. A mental capacity assessment to determine that the person lacks the capacity to decide on their care or treatment.
4. A mental health assessment to determine that the person is suffering from a mental disorder.
5. An eligibility assessment to determine that the person is not subject to treatment under Mental Health Act 1983, in which case they will be ineligible.
6. A best interests assessment to ensure that the deprivation is in the best interests of the person concerned, necessary in order to prevent harm to them and a proportionate response to the likelihood of them suffering harm.
If any of the assessments conclude that the person does not meet the criteria, the supervisory body must turn down the application. Steps must then be taken to arrange alternative care or treatment for the individual.
If all of the assessments are passed, then the application is granted. An authorisation lasts a maximum of a year and is no longer than the time recommended by the best interests assessor.
The Best Interests Assessor (BIA) must consult with any deputy or attorney acting on the person’s behalf, anyone named by the service user as someone to be consulted and anyone in engaged in caring for them or interested in their welfare.
If the BIA concludes that a deprivation is the right thing to do, they must recommend a person to be the relevant person’s representative to speak up for them, which should often be a family member. If no family member is available, the supervisory body will appoint a representative. The representative’s role is to support the service user in all aspects of the authorisation, request a review if necessary or apply for the case to be considered by the Court of Protection. Anyone who does not have family or friends to speak up for them will have an Independent Mental Capacity Advocate appointed to act on their behalf.
The Best Interest Assessor will be employed to carry out statutory duties as defined by the Mental Capacity Act and Support and Assist the Deprivation of Liberty Safeguards Service Co-ordinator and the DoLs Service in its day to day functions on behalf of the Supervisory Body.
• Undertaking DoLs Assessments, including reviews, under the Deprivation of Liberty Safeguards within legal timeframes
• Supporting and Assisting the DoLs Co-ordinator and the DoLs Service in its day to day functions on behalf of the Supervisory Body.
• Undertake a consultative role for managing authorities; frontline teams and existing BIA’s.
• Act as a resource, including training, for care home/hospital settings.
• To be responsible for ensuring practice and procedures are compliant with regulations, Mental Capacity Act and in line with the Deprivation of Liberty Safeguards Code of Practice.
• Liaison with mental health assessors, advocates, care homes and hospitals as required as part of the assessment process.
I have successfully completed training that has been approved by the Secretary of State to be a best interest’s assessor; and have regularly completed further specific training relevant to maintaining competence in the role as a best interest’s assessor.
I possess the skills necessary to obtain, evaluate and analyse complex evidence and differing views and to weigh them appropriately in decision making and have 4 years’ experience in completing Best Interest Assessments under the Deprivation of Liberty Safeguards.
For further information please email [email protected]