Hospital Setup At Home Based Care Assesment

DoLS assessment1
DoLS Assessment
Student’s Name
Institution
Date

DoLS Assessment2
DOLS Assessment
Introduction
DOLs means deprivation of Liberty Safeguards. According to Morgan (2017), six assessments
be carried out successfully before a supervisory body comes in to authorize the deprivation of the
Liberty of an individual in any hospital setup or at home-based care. These assessments are done
following the Mental Capacity Act Deprivation of Liberty Safeguards and should be performed
appropriately by fully qualified assessors whose appointment has been done by the concerned
supervisory body. To carry out these six assessments, various provisions have been made in the
necessary legislation and DOLs code of practice, a document that is ever consulted by everybody
performing tasks related to MCA DOLs. DOLS Makes sure that those people who are unable to
make consent on their arrangements of care at homes or hospitals are protected, especially when
their liberty is deprived through those arrangements. The care arrangements are assessed to
verify whether they are vital and covers the best interests of the person (Williamson & Daw
2013). Through DoLS, other safeguards such as representation and deprivation challenge are
provided.
The six assessments carried out to satisfy MCA DoLS requirements
The six assessments carried out to satisfy MCA DoLS requirements are described in paragraph
4.23 and 4.7 of the practice codes (Brown, Barber, & Martin 2015). These assessments must be
carried out in a particular order where to begin; age assessment is done, followed by No refusals
assessment. Assessment of mental Capacity is done, followed by mental health assessment,
assessment of eligibility, and finally, best interest’s assessment (Williams, Toft, Thompson,

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Moss, & Reynolds 2019). The six assessments take 21 days to be completed to ensure the
authorization of deprivation of Liberty or before the given urgent authorization expires.
Assessment case of a patient about deprivation of Liberty
I was introduced and witnessed deprivation of Liberty assessment of a patient’s case, named
John. John suffers from Prader – Willi Syndrome, has disabilities` of learning, and his weight has
overtime increased to 120 kg. John has received a lot of support from his home staff who have
been trying to help him eat healthy by making choices of healthy foods which contains little
effects. Through assessment, it has been proven that he has no capacity to make his own
decisions about the food he should eat and their quantity. The best interest of John has been
proposed as to be stopped from going to the kitchen, should always be supervised when out and
be prevented from spending all the money he has and stealing of food substances. The home
manager is sent an application to make standard authorization due to their believes that these
restrictions would deprive John of his Liberty.
Deprivation of liberty can be authorized under DoLS in various ways. This only applies to those
confined at care homes or hospitals just like John. These people may be deprived of their liberty,
but it is a process that should follow steps concisely. The managing authority in the home John
was staying for care was written an application letter to make a standard authorization. In return,
the managing authority wrote to the supervisory body to get the needed authority to deprive
John. They filled in a form through which they requested standard authorization, and within a
specified period of 21 days, the response was expected. Assessors were sent to the care home to
verify whether the patent whose authority they sought met the conditions that can make a person
be deprived of their authority (Dimond 2016). The assessors verified whether John was aged 18
years and above, suffered mental disorder, lacked capacity to decide for himself, the restrictions

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that could deprive the Liberty of this person, If the restrictions were at the best interest of John, if
John could be allowed for detention under the Mental health act, and if there lacks valid decision
that could hinder treatment or be overridden by the process of DoLS ("Deprivation of Liberty
Safeguards at a glance,”).
According to Nesossi, Biddulph, Sapio, & Trevaskes (2016), authorization of deprivation of
liberty cannot be authorized by the supervisory body if the person does not meet all the
conditions mentioned above. If it is not authorized, the care home might change their plan of care
to support the person in a way that seems less restrictive (Vermeulen, Paterson, & Knapen 2011).
When all the conditions are met, the supervisory body authorizes liberty deprivation towards the
party involved and informs him/her and the managing authority in the form of writing. The
restrictions are then undertaken for the period specified, which is then stopped after this period
ends where the person is no longer deprived of their liberty. When more standard authorization is
required after the first one ends, the managing authority writes to the supervisory authority still
requesting for standard authorization.
Age assessment
Age assessment involves verification whether the mentioned individual is above 18 years of age
to allow deprivation of liberty. This was done to John and it was verified that he was above this
age.
No refusals assessment
After the assessors verified that John was aged 18 and above, no refusals assessment was done
through which it was verified that authorization of liberty deprivation would not conflict with the
decision making authority in John under the mental Capacity Act of 2005.

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Mental capacity assessment
The other assessment witnessed was the assessors perform the mental capacity assessment on
John. This was done to establish whether John lacked decision-making capacity on whether he
should be accommodated in the named hospital for caregiving purposes (The British Medical
Association 2015).
Performing mental health assessment
The next step involved performing a mental health assessment. A mental health assessment is
done by assessors to verify whether John was of unsound mind to be allowed lawful detention as
stipulated in the European Convention of human rights (Reid 2011). The objective medical
expertise was used to prove that John suffered from Prada – Willi syndrome, which is a serious
neurological disorder that negatively impacts the central nervous system (Bouras & Holt 2010).
This syndrome makes the growth of the brain impaired until a person is unable to make any
decision due to brain deficits. It is most probably the condition that caused obesity in John since
this condition also characterizes obesity. When carrying out a mental health assessment, it must
be ensured that the way an assessor defines a disorder remains to be as it was described.
Learning disabilities do not fall under the category of mental health disorders according to the
mental health Act, and MHA defines a mental health disorder as any disability or disorder of the
mind (Khan 2016). The assessors performed the mental health assessment guided by various
definitions of mental health disorders. Mental health disorders can fall under various categories,
which include organic mental disorders like dementia, changes in behavior and personality as a
result of injury and damages caused to the brain (Hazen, Goldstein, & Goldstein 2010). There are
also behavioral disorders of the mind that arise from the use of psychoactive substances,
delusional disorders and schizophrenia. Another category includes affective disorders which

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includes bipolar disorders and depression, neurotic disorders and those that emerge from stress
such as phobic disorders post traumatic disorders and obsessive, compulsive disorders. There are
also eating disorders expressed through eating habits, non – organic sleep disorders and disorders
of non – organic sex. In this category there are also personality disorders which include
borderline and antisocial disorders and also autistic spectrum disorder.
DoLS code of practice explains in section 4.33 that the main aim of mental health assessment is
to know whether the mentioned person has a mental disorder in line with the provisions made at
the Mental Health Act of 1983. Any disability of the mind falls in this category except the ones
arising from the use of drugs and substances. According to this Act, all learning disabilities fall
in this category because the assessment is not based on treatment provision. This is what brings
the big interface between the Mental Health Act of 1983 and the Mental Capacity Act of 2005.
The DoLS codes of practice go beyond to explain that there is a big difference between the
mental health assessment and mental capacity assessment. One of the distinctions is that even
though a person’s mind is impaired or has a disturbed functioning or his/her brain lacks capacity;
it does not mean that they have a mental disorder as dictated to the 1983 health Act. The mental
health assessment aim is determining whether the person is regarded to be of ‘unsound mind’
through medical diagnosis, and this comes in the scope of article 5 of the European Convention
on Human Rights (Bartlett & Sandland 2013). This article informs that every person is mandated
to the right of liberty and security, which is a compound concept that a person must be familiar
with to avoid separate interpretations in case of a court case (Harris, O'Boyle, Bates, & Buckley
2014). The assessor must, therefore, remember the standard form of mental health assessment in
which they consider how detaining the person with the mental health condition might affect
his/her mental health. The assessor is reminded of the need to notify his/her interests based on

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MCA of 2005 paragraph 36 and must consult with IMCA via section 39A of the Mental Capacity
Act if need be.
This Act still provides that if a person is under a subsequent authorization, the assessor of mental
health must make sure that he considers the response of the person during the previous period of
authorization where if the person shows less sign of reconciliation with the authorization, the
assessor must be conversant to rule whether the provided restrictions results to risk of harm
evidenced by unhappiness displayed by the restricted person. The findings of the mental health
assessors and those of best interest assessors must be discussed to bring across their findings and
opinions. If any divergent opinion occurs and the party for restriction fails ant assessment, there
is no safeguard that can be used to protect their rights ("Most care homes use deprivation of
liberty safeguards incorrectly," 2014).
Not every person qualifies to perform mental health assessments. When performing mental
health assessment, the assessors must use a checklist ("Mental Health Physical Security Review
Checklist" 2015). Through the checklist, the assessors must be able to diagnose the mental
disorders already defined using the available clinical notes, through the interview or made
observations. Through the checklist, the assessor can know whether there lacks formal diagnosis,
which is a basis of satisfaction that the presented mental disorder supports the opinion through
relevant symptoms and signs description as defined in MHA. The assessor can know whether
he /she has described the signs and symptoms of the mental disorder sufficiently to allow
diagnosis, he/she considers to notify the relevant supervisory body when there lacks mental
disorder in the case presented as displayed in the Act to halt further assessment plans and
procedures. Through the checklist, the assessor can know whether their opinion has been
considered of how they affect the deprivation of liberty on the mental health of the mentioned

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person and the reasons for the opinion. It enables the assessor to inform the best interests of the
assessor about their opinion and how the opinion affects the person’s mental health deprivation
of liberty and enables the assessor to consult with IMCA as stipulated through Section 39 of
MCA if applicable. The checklist also enables the assessor to make sure that he legibly
completes the assessment form, signs it, and dates it, and finally, the assessor takes back the
filled-in form to the office of the supervisory body in an appropriately secure format within a
short time. Deprivation for liberty safeguards assessment can only be done by two persons that
include the best interests’ assessor and the mental health assessor. These people are appointed by
the local authority or the health board, who must contain the appropriate training level and
assessment experience. The best interest assessor is mostly a social worker who is qualified
enough to do the assessment, a nurse, or an occupational therapist or a psychologist from the
charter. These people must not be involved in offering any care of the person or in the decision-
making process. The mental health assessor is always a doctor with the knowhow to assess any
mental disorder and how depriving liberty in the named person may affect their mental health
state (Justice 2011).
Eligibility assessment
The next step involves eligibility assessment. In this step, what is looked at is what relates to the
status of the health of the individual, and his potential status as according to what has been
stipulated in the 1983 mental health Act. A person is eligible unless if he/she is detained under
the 1983 mental health Act, he/she is subject to an obligation placed under them via 1983 mental
health act, for example, an order of guardianship ordering them to shift ad go to live to another
place if there is a relationship between the proposed authorization and the deprivation of liberty

DoLS Assessment9
in a hospital completely or party to treat the mental disorder presented a person shall be rendered
eligible if they go against the idea of being admitted to a health facility or completely refuse the
treatment and if at all they meet the application for admission criteria as stipulated in Mental
Health Act of 1983 section 2 or 3. The supervisory body must ensure that the assessor must have
no financial interest towards the case under the assessment, must not be related to the person
under assessment, and should not have any financial interest towards the case of the individual.
There is the definition of the term ‘relative’ in the secondary legislation. Finally, the potential
assessor must be having experience in the field of mentally incapacitated individuals, for
example, the old who mostly experience dementia and those who suffer injuries of the brain
(Kansas Department for Aging and Disability Services 2017). This shall enable the assessor to
identify the mental needs of the case presented clearly. The assessors must as well satisfy the
supervisory body of the adequate and appropriate indemnity arrangement of insurance that they
possess, for example, NHS indemnity or the MPS indemnity. The supervisory bodies receive the
indemnity arrangement evidence from the assessors in the form of written evidence. In eligibility
assessment, the mental health Act of 1983 applies when the named party is under detainment for
psychiatric treatment, he/she is detained under Mental Health Act of 1983, section 2 or 3, if the
person is on leave of detention absence under supervised community treatment or conditional
discharge, the person is unwilling to undertake all of their psychiatric treatment or if the relevant
person would like to object the treatment if at all they got a chance. This Act also applies when
the individual has been detained in a care home as part of plans of treatment as according to the
mental health Act if the person goes against all their psychiatric treatment and if there was a
chance for the objection of treatment, the individual would do so (World Health Organization
2013).

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Assessment of the best interests of an individual
The next step involves the assessment of the best interests of the individual presented. If the
deviation policy is taking place, it must then be assessed whether the best interests of the person
has been considered. The best interests of John considered were proposed as to be stopped from
going to the kitchen, should be always supervised when out, and be prevented from spending all
the money he has and stealing of food substances. The best interests of an individual are aimed at
keeping the person safe and free from harm and there must be a reasonable response if there is a
likelihood of a person suffering particular harm. Less restrictive options can as well be used in
this case if they are appropriate as a reasonable response (Letts 2014). The mental capacity Act
of 2005 states that any action carried out or any decision made on behalf of a person /adult
unable to make their own decisions/incapacitated must put their best interests into consideration.
The best interests are of a wide scope and cover financial interests, health interests and the social
care interests’ decisions. These decisions are made by the individual taking care of the patient,
the family member offering care to the patient, or the health care staff member who has the
responsibility of carrying out a certain procedure/treatment to the individual. An LPA or a
deputy of the protection court might undertake the decision making part as well. According to
the mental capacity Act of 2005, the best interest must be obtained through a test. When
determining the best interests of a patient, it should be taken into account the past and the present
feelings and wishes of the person, the values and beliefs that has facilitated the making of the
decision if the person was not incapacitated and other factors that could be put into consideration
if the patient was in full capacity should be put into account. Any decision made must be
accompanied by objective reasons, and one must show the consideration of all the relevant
circumstances when deciding the question. During the assessment of the best interests of the

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individual, he/she must be encouraged to participate in making decisions by using particular
communication signs /methods such as pictures, symbols, simple language, or using a specialist
who can help in making communication easy. Discrimination should be avoided at the highest
degree. The Act spells out that making decisions on an incapacitated individual should not be
based on their age, their condition, appearance, or any of the person’s behavior aspects. It states
that appearance aspects include even the physical appearance aspects of the individual and the
condition includes difficulties of learning, illnesses resulting from age, and any other temporary
conditions such as drunkenness. All relevant issues to the person with no capacity must be
identified before the specific decision is made which varies in individual cases, and finally, the
decision must be deferred if there is the probability of regaining capacity by the individual. One
does not wait for the individual to regain capacity in case of emergencies, and a health
practitioner cannot be held liable of the decisions they make if at all they comply with the best
interest test as stipulated under Section 4 (9) of the 2005 Act of Mental Capacity. When making
life-sustaining decisions about treatment, the healthcare professional must decide whether the
treatment/restrictions they are giving to the individual is life-sustaining in every situation.
Selecting any treatment must include the best interest tests consideration, and any statements
prior made by the patient, their family members, or the carers must be put into consideration.
When there arises a dispute about life-sustaining treatment and the best interest of the patient,
MPS should be contacted for advice or protection court should as well be approached to help in
making decisions concerning what is in the individual’s best interests ("Mental Capacity Act
2005 - Best interests tests - England and Wales,").
Interventions when making decisions on deprivation of liberty

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There are broad types of interventions that should be applied when making decisions about the
deprivation of liberty. Before any decision is made, the individual under assessment must go
through psychotherapies such as psychodynamic therapies, interpersonal psychotherapy,
problem-solving therapies, and cognitive-behavioral therapies. The individual must also be under
community –based treatment interventions through the assertive treatment of the community and
the episode psychosis interventions (Leahy et al. 2015). If the individual with no capacity has
gone through these interventions with no change/improvement, the assessor must note it down
and be evidenced in the form of writing. Further mental assessment interventions may render the
individual worthy of liberty denial. Interventions on a community basis and population levels
play a very crucial role in ensuring that the mental health of an individual is promoted. This
protects and prevents the individual from experiencing the onset of mental disorders and protects
those people with MNS disorders. If a person is subjected to these interventions, only severe
cases, which are very rare can reach the level of applying for denial of liberty of an individual.
The family members and carers are as well involved in offering various interventions to an
individual before it reaches the extent of DoLS.
Dilemmas on decisions about DoLS assessment
There are very many dilemmas that may arise when making decisions about DoLS assessment
(Elder, Evans, & Nizette 2011). For example, a person must put into account the mental Capacity
Act, the judgments of best interests, and liberty safeguards deprivation in a more explicit manner
(Videbeck 2010). Separate legal structures must be used in the provision of mental healthcare in
some countries based on risks and incapacity. England and Wales use these jurisdictions, and the
psychiatrists must adhere to the Mental Health Act of 1983 and the Mental Capacity Act of 2005.
The dilemma also arises when detention cases in hospitals or places of care arise because of legal

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difficulties. The jurisdictions made by the European Convention on Human Rights causes a big
dilemma when it comes to any psychiatric setting (Roca & Santolaya 2012).
The first dilemma is that treatment offered to any individual should be voluntarily done if there
is the need to those suffering from specified degrees of mental disorders. The dilemma of
application of this establishment is the degree of the mental disorder in which consent is needed
and the risks an individual is subjected to. The Mental Health Act provides a general framework
that should be followed when making decisions about individual medical treatment. These
decisions can be made on behalf of the individual /an adult who lacks the capacity for making
decisions. The individual must completely lack capacity of decision making and this Mental
Health Act basic concern is the reduction of risk of harm to the individual and other people while
the basic concern of Mental Capacity Act is people to make their own decisions so that they may
reflect their own best interest and the use of the least restrictive intervention. Individuals lacking
capacity are not treated informally due to the common law, and the Mental Capacity Act
principles must be used if the principles of the Mental Health Act are not used. Because the
treatment is all about liberty deprivation, making the decision for detention must include the
Mental Health Act and liberty safeguards application where one must choose what to follow.
This is guided by factors such as objections presence from the individual’s part.
Another dilemma is about the people who are detained but have the capacity for decision making
under the Mental Health Act. People view this practice unlawful, and concerns have been
expressed about ethics and its arising stigmatizing consequences on capacity and the autonomy
of an individual according to the mental health law (Wright, Stern, & Phelan 2012).
Professional context

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John’s case presented and assessed is an example of the broad professional context where
healthcare practitioners are introduced to patients with different mental health cases and other
associated disorders. It reminds us of standing in of the patient and being their advocate to make
sure that their needs and rights are met (Rich 2011). This must be done by making sure that
procedures of various Acts, rules, and guidelines are followed, especially when it comes to
incapacitation and denial of an individual’s liberty. A health practitioner or manager must be
conversant with these acts to avoid the implications of law if the procedures are not followed at
all. Procedural practices must be followed just as it was done in John’s case in every practice to
know whether the patient qualifies for deprivation of Liberty Safeguards.

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