If you haven’t heard of them, you’re not alone and if you have, like many, you may not like the name or fear what they imply. So what are they for?
Deprivation of Liberty Safeguards (DOLS) are for people in care homes or hospitals. They are for those who lack capacity to make some important decisions because of a mental impairment. People with dementia, learning disabilities and brain injuries may have them.
The safeguards involve assessments by people called Best Interests Assessors, who are independent and ask a lot of questions. They ask about care plans, a person’s wishes and feelings, and they also seek the families’ view of the placement. They talk to staff about whether people are objecting to their situation and want to leave. Crucially, they ask whether the person can make choices and decisions, or if every aspect of their life is controlled.
These Best Interest Assessors then decide if someone is being deprived of their liberty; and if they are, whether it is in their best interests. Further assessments take place and a decision is made whether or not to authorise the deprivation. Sometimes, deprivation of liberty is considered to be in a person’s best interests; and sometimes the result is that people are best cared for where they are and their care plans meet their needs. Often, Best Interest Assessors recommend conditions to make the care plans better and more person centred, to give the person a better quality of life, with greater freedom, autonomy and liberty. Other times, they will think there are better alternatives; that some people really want to go home, their families really want them to and that they can and should do safely, with appropriate support.
So what have DOLS achieved? Lots!
They have allowed a spotlight to be shone on the care of people who often don’t have a say in their care, who can’t discharge themselves or persuade others they value their autonomy, their home and their environment more than living in the safety of an institution.
More broadly, DOLS help many of us in health and social care to think much more about what we can do to promote the liberty and autonomy of people living in institutions who may have dementia or severe learning disabilities. DOLS are about helping to ensure a better quality of life, about choices, wishes and feelings. They are part of culture change where we listen more closely to people and respond more effectively.
And once people start talking about liberty, exciting things happen. In Birmingham, nurses have started using the heading ‘Promoting liberty’ in their care plans. In Shropshire, a 99 year old lady, adamant she wanted to die at home, has been helped to return to her flat from a nursing home. And in Cumbria, very disabled teenagers who come under the adult services remit have reviews where social workers ask questions designed to discover what more the local authority could do to promote their liberty.
So – even if you still don’t like the name, rest assured, DOLS are doing a lot of good!
Further information
Find out more about Deprivation of Liberty Safeguards
6 comments
Comment by Sally Kenny posted on
Thanks Lucy, this is great - really helpful.
Comment by Stephen Ward posted on
I agree with everything Lucy says and can only add how much more could be done for people whose authonomy is restricted in the interest of their welfare and safety if only the process was less complex and easier to use. As the regulations stand there are just too many contradictions, complexities and conflicts with real life.
Comment by Patricia Kearney posted on
It is vital that professionals working with people who may lack capacity fully understand their responsibilities under the Mental Capacity Act (MCA) 2005. SCIE has been commissioned by the DH to provide a range of resources to support good practice in the management and implementation of the Deprivation of Liberty Safeguards (DoLs) and other aspects of the MCA. These resources, explore the sometimes difficult decisions that have to be made about mental capacity and information specifically for independent mental capacity advocates (IMCAs). They include SCTV films and eLearning tools. http://www.scie.org.uk/publications/reports/report66.asp
Patricia Kearney , Director of Innovation and Development , Social Care Institute for Excellence.
Comment by Dr Felix Ugwumadu posted on
Deprivation of Liberty Safeguarding (DOLS):
It is very important for this tool to be widely publicised given the fact that; we are becoming an ageing society, engineered by advancement in bio-medical technology, that has enhanced longevity. This is an advantage on the one hand but, other hand; it has the propensity to produce a high proportion of people with dementia/challenging behaviour, who might need long-term residential placement in their life-time. In the light of this, what is needed is to create; awareness, information directory and wide ranging training opportunities for health and social care professionals to undertake "just in time" assessment to support residential care organisations and families.
Comment by Martin Benfield posted on
I have no problem with the term Deprivation of Liberty Safeguards. I'm not sure that this summary explains it terribly well and I also think there is a lot of misunderstanding, including among professionals. This misunderstanding is especially (it seems to me) prevelant among lawyers who seem to want to define liberty as a one size fits all concept, thus missing the point of liberty, which is about expression of the self as a unique invididual. As such, I do really like the bit where it is recognised that freedom is still important to people even when they have limited mental capacity.
Comment by shurleea posted on
Sadly DOL is used as an easy option where a patient requires extra 'man hours', a bit more understanding and where fear of the system prevents cooperation.
DoL does little for a patient who is detained under the MCA, locked in a ward whilst staff sit in offices typing up reports. A patient detained under the MCA cannot walk in a garden because there are not enough staff to escort him / her. OT can be very demeaning, so the patient 'kicks off' often resulting in being restrained. Day rooms are larger areas where you sit looking at the fellow inmates whose behaviour may add to the patients own disturbed feelings.
Mental health cares depends too much on medication and very little on root causes, and as always the 'clock ticks on' never allowing the patient the time to 'open up'.
It is time that care providers realised that a patient is not going to sit down and pour their heart out to someone they have just met in a twenty minute time slot. In the care system, at appointments, on the wards, there is never enough time to be able to just sit and talk, develop a relationship with someone you trust, and talk about what really matters.
when the patient gets upset, disturbed, frustrated, there is always the 'belt and braces' approach of 'sections', if patients don't do what staff want them to, you can force them by 'sectioning'!