Although the Deprivation of Liberty Code of Practice is written in black and white it becomes very grey when being interpreted. The assessment of patients, who are effectively being restrained for large periods of the day under DoL’s can be frustratingly inconsistent for those trying to work within the Code.
How it has been explained to me is that it is more of a ‘continuum’ of restriction of liberty than definitive rules. So for instance if the door of the unit is locked and not accessible to the patients, that would in all probability not need assessing under DoL’s. Even if some of the patients were on the third floor of the building and were highly unlikely to be able to access the garden. If the patient was then held to support the delivery of care, let’s say the changing of a pad, up to four or five times a day, then again, it still wouldn’t meet the criteria for DoL’s. However, if you have a client that keeps falling out of bed in the night and you put the rails up on the bed, or if they keep falling out of their wheel chair so you use a lap belt to keep them safe it probably would meet the criteria.
So why is there so much confusion with cases of patients who are being restricted but to nowhere the near the same degree? One of the main issues is that assessors interpret the guidelines differently.
My final piece of advice I give when working with care homes is to try and be as consistent as possible when you are considering the issue. Look at both the degree of restriction in terms of environmental, physical and mechanical but also the length of time the person is restricted for. The more restrictive the methods used in each of those categories and the longer it lasts for the more likely it is you need to get a DoL’s assessment done.
My send piece of advice is to find out what is available to you in terms of advice, guidance and training in your local area. Try to build good working relationships with professionals from outside agencies you deal with on a regular basis such local community mental health team.
Local authority DoLs information:
Free DoL’s training available in Staffordshire:
Other useful links:
Blogged by Gary Firkins –
De-escalation, Management and Intervention Lead for South Staffordshire and Shropshire Healthcare NHS Foundation Trust
How it has been explained to me is that it is more of a ‘continuum’ of restriction of liberty than definitive rules. So for instance if the door of the unit is locked and not accessible to the patients, that would in all probability not need assessing under DoL’s. Even if some of the patients were on the third floor of the building and were highly unlikely to be able to access the garden. If the patient was then held to support the delivery of care, let’s say the changing of a pad, up to four or five times a day, then again, it still wouldn’t meet the criteria for DoL’s. However, if you have a client that keeps falling out of bed in the night and you put the rails up on the bed, or if they keep falling out of their wheel chair so you use a lap belt to keep them safe it probably would meet the criteria.
So why is there so much confusion with cases of patients who are being restricted but to nowhere the near the same degree? One of the main issues is that assessors interpret the guidelines differently.
My final piece of advice I give when working with care homes is to try and be as consistent as possible when you are considering the issue. Look at both the degree of restriction in terms of environmental, physical and mechanical but also the length of time the person is restricted for. The more restrictive the methods used in each of those categories and the longer it lasts for the more likely it is you need to get a DoL’s assessment done.
My send piece of advice is to find out what is available to you in terms of advice, guidance and training in your local area. Try to build good working relationships with professionals from outside agencies you deal with on a regular basis such local community mental health team.
Local authority DoLs information:
- Wolverhampton City Council:
http://www.wolverhampton.gov.uk/article/2968/Deprivation-of-Liberty-Safeguards-DoLS - Staffordshire County Council:
http://www.staffordshire.gov.uk/health/care/reportingabuse/DeprivationofLiberty/home.aspx - Stoke-on-Trent City Council:
http://www.stoke.gov.uk/ccm/content/social-care/adult-social-care/deprivation-of-liberty-safeguards.en;jsessionid=azwefXptgDla - Shropshire County Council:
http://www.shropshire.gov.uk/disability-information/mental-capacity-act/deprivation-of-liberty-safeguards-(dols)/
Free DoL’s training available in Staffordshire:
Other useful links:
- Social Care Institute for Excellence:
http://www.scie.org.uk/publications/ataglance/ataglance43.asp - Care Quality Commission:
http://www.cqc.org.uk/public/publications/reports/deprivation-liberty-safeguards-2011/12
Blogged by Gary Firkins –
De-escalation, Management and Intervention Lead for South Staffordshire and Shropshire Healthcare NHS Foundation Trust