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Mental Capacity and DoLS up-date

Mental Health, Mental Capacity and human rights

BIHR's "Delivering Compassionate Care" project aims to place human rights at the heart of mental health services, helping to ensure frontline staff have the knowledge and skills to fulfil the vital role they can play in upholding the dignity and human rights of the people using their service.

This booklet is about human rights in services supporting people with mental health and/or mental capacity issues, and is aimed at practitioners working in these settings. Lots of information in the booklet may also be useful for people using services, their family, carers or advocates.

 

DoLS Applications 2015-6

Official figures reveal councils are getting through far more DoLS applications but still struggling with the impact of the 'Cheshire West' ruling. The judgment effectively lowered the threshold for what constituted a deprivation of liberty for people who lacked the capacity to consent to their care arrangements, requiring providers to make many more DoLs applications.

The DoLS are used to authorise deprivations of liberty in care homes and hospitals - Councils are required by law to complete Dols applications within either seven days or 21 days of referral, depending on whether the care placement has started or not.

Key findings:

  • 195,840 DoLS applications were reported as having been received by councils during 2015-16.  This is the most since the DoLS were introduced in 2009 and represents 454 DoLS applications received per 100,000 adults in England.
  • Variation is apparent between regions however, with the North East having almost three times as many received applications (900 per 100,000) compared to London (319).  The remaining regions received between 400 and 500 applications per 100,000 adults in 2015-16.
  • Following a period of relative stability during 2013-14 (prior to the 2014 Supreme Court judgment and where the total number of applications received was 13,715), a period of month-on-month growth occurred during 2014-15.  This peaked with 14,930 applications received in March 2015, before monthly figures look to have re-stabilised at just above this level throughout 2015-16.
  • 105,055 completed applications were reported in 2015-16, compared to 62,645 in 2014-15.  This represents an increase of 68 per cent and follows a 380 per cent increase in completed applications between 2013-14 and 2014-15 (from 13,040 in 2013-14).
  • Of the 105,055 completed applications in 2015-16, 76,530 (73 per cent) were granted and 28,530 (27 per cent) were not granted.  Whilst the proportion of completed applications that have been authorised has generally shown an upward trend since DoLS were introduced in 2009, the proportion of applications that were granted in 2015-16 (73 per cent) represents a reduction compared to the proportion observed in 2014-15 of 83 per cent (52,125 of 62,645).
  • The North East has the highest rate of applications completed, with 665 applications per 100,000 residents. This is more than two and a half times the next highest region, the South West (258). The other eight regions display some variation, with the South East having the lowest rate of completed applications (179 per 100,000 residents).
  • Although the proportion of applications granted was relatively consistent across most regions, only 44 per cent were granted in the South West, whereas 86 per cent were granted in the North East and London.

DOLS desktop assessments

Councils are set to use desktop assessments to complete deprivation of liberty cases in a bid to clear a backlog of more than 100,000 referrals.

An advice note issued by the Association of Directors of Adult Social Services (ADASS), said this approach should only be used for cases triaged as ‘low priority’ or renewals of existing Deprivation of Liberty Safeguards (DoLS) authorisations of at least six months.

All such cases should be screened against nine criteria, including whether relatives object or there are any safeguarding concerns, ADASS said. If none are present “the more proportionate approach” should be used, with a best interests assessment carried out on papers alone or with a “shorter” visit than would normally be expected.

Examples suitable for a desktop assessment could include people in hospices or settled placements where a person has severe learning disability or no communication “such that a face-to-face interview is unlikely to add any additional detail to that which can be obtained from others”, according to the advice note.