4. The DoLS assessment
An assessment will decide whether the deprivation of liberty is allowed to happen or not. A DoLS assessment will take place if a person with dementia is in a care home or hospital setting and it is felt that they are being, or will be, deprived of their liberty.
If the person with dementia is living in supported living, there is a different system for having a deprivation of liberty authorised. This is outlined towards the end of this page – see ‘Supported living’.
Who requests the assessment?
Usually, the care provider – the care home or hospital – will request the DoLS assessment. In England, they would request the assessment from the local authority. In Wales, for assessments of people in care homes it would be the local authority, but for people in hospitals it would be the local health board.
Can anyone else request an assessment?
If you feel that someone is being deprived of their liberty, you should speak to the person in charge of their care. In hospital this may be a doctor, nurse or administrator, and in residential care it will be the care home manager. The first step is to talk about whether changes can be made to the way care is provided so that the person’s freedom is not restricted. However, if the person in charge of their care believes that restricting the person’s freedom is necessary to keep them safe, they must apply for a deprivation of liberty authorisation.
If they have not got an authorisation, and they do not think that an authorisation is necessary, you should talk to the local authority (or local health board in Wales). You should ask them to look into the person’s care arrangements and carry out an assessment, if necessary. There are template letters at the end of this page that you can use.
Who does the assessment?
DoLS assessments are carried out by at least two people. They are:
- the best interests assessor
- the mental health assessor.
They are appointed by the local authority (or health board), who must ensure that they have had the appropriate level of training and experience.
Generally, the best interests assessor is a qualified social worker, nurse, occupational therapist or chartered psychologist. They must not be involved in the person’s care or in making any other decisions about it. The mental health assessor must be a doctor who is able to assess whether a person has a ‘mental disorder’ (the term used in law to describe a set of mental health conditions, including dementia) and how a deprivation of liberty will affect their mental health.
What does the assessment involve?
There are six parts to the assessment. These are divided between the two assessors. Their job is to decide whether the person and the care that they receive meet the criteria for authorisation. The six parts are as follows:
- Age – Is the person aged 18 years or over?
- Mental health – Does the person have a ‘mental disorder’?
- Mental capacity – Does the person lack ‘capacity’ (the ability) to make their own decisions about treatment or care in the place that is applying for the authorisation?
- Best interests – Is a deprivation of liberty taking place? If so, is it:
– in the person’s best interests?
– needed to keep the person safe from harm?
– a reasonable response to the likelihood of the person suffering harm (including whether there are any less restrictive options and if they are more appropriate)?
- Eligibility – Is the person already liable to detention under the Mental Health Act 1983, or would they meet the requirements for detention under this Act?
- No refusals – Does the authorisation contradict or conflict with any advance decision the person has made refusing treatment, or with any decisions made by, for example, a court-appointed deputy or someone with Lasting power of attorney?
If someone meets all the criteria, the assessors will report back to the local authority (or local health board) that the deprivation of liberty should be authorised, ie given the legal ‘go ahead’.
When the criteria are not met
If the assessors decide that the person or the proposed care doesn’t meet the criteria, they will inform the local authority (or local health board) of this and the reasons for it. The deprivation of liberty would then not be authorised, and it should not happen. What happens next will depend upon the reasons why the criteria were not met.
For example, if the assessment showed that the person has capacity to consent to and make the decision about their care and where they will live, they should be empowered to make their own decision, and this should be followed.
If an assessment failed because it was decided that there are less restrictive options, these should then be pursued. An example of this might be that the care home proposes to lock a person’s bedroom door at night to stop them from walking round the care home and into other residents’ rooms. An assessment may decide that this is not allowed as there are less restrictive options, such as making it possible for the person to stay up later, and having staff on hand to talk to them and encourage them to not enter people’s bedrooms.
In an emergency, or in situations where there is no time to go through the assessment process, the hospital or care home management can grant themselves an urgent DoLS authorisation. This is valid for seven days, but they must also apply for the normal DoLS assessment and authorisation at the same time. If the assessment has not been carried out in the following seven days and the deprivation of liberty is still needed, the urgent DoLS authorisation can be extended for a further seven days.
Before an urgent DoLS authorisation is given, steps should be taken to consult with a person’s carers and family members.