Legal terminology can often be confusing and hard to understand. In this blog, we explain some of the key terms and roles related to the Deprivation of Liberty Safeguards, often known as ‘DoLS’.
Note: the key reference for this blog is the Code of Practice for DoLS (2008) – a vital document that is essential reading for anyone working professionally within this area.
Deprivation of Liberty (DoL)
Under Article 5 of the Human Rights Act (1998), every person has the right to liberty, regardless of their health, ability, culture, religion, age or appearance. This is a non-absolute right. This means that if a person’s liberty is prevented in some way, then the officials must be able to show that the Deprivation of Liberty is lawful, legitimate and proportionate.
Deprivation of Liberty Safeguards (DoLS)
The Deprivation of Liberty Safeguards are part of English and Welsh legislation that enables a DoL if specific criteria are met. Without which, any DoL would be unlawful and those placing restrictions and restraint in place would be liable to criminal investigation. Therefore, this framework not only protects the person whose liberties are restricted, but also protects those providing care and treatment.
A ‘relevant person’ is the person who has been determined to lack capacity to consent to their care and treatment, and has a DoLS authorisation in place. The purpose of the DoLS authorisation is to ensure that the person’s rights are protected and any deprivations are the least restrictive option. These provisions should be regularly monitored and reviewed, with a representative (currently known as a ‘relevant person’s representative’ or RPR), to support them and represent their views and raise any objections that the relevant person may have.
Relevant Persons Representative (RPR)
An RPR is one of the key safeguard protocols in place as part of the DoLS process. The role of the RPR is to support the relevant person, ensuring they know their rights, while also monitoring any restrictions and restraints that are put in place, and raising a challenge if required.
Independent Mental Capacity Advocate (IMCA)
An IMCA is an advocate who can support a person who lacks capacity for a specific decision, at a specific time, if they do not have a suitable representative. They ensure that the person’s thoughts, feelings, wishes and views are kept at the centre of decisions and that they are included in the decision making process.
They also support the relevant person by informing them of their rights, helping them to ask questions and to ensure that any Best Interest decision keeps the person at the heart and is the least restrictive option. An IMCA can also be requested to support an RPR if a family or friend is assigned, to help them develop the knowledge and confidence to perform their role.
There are a number of types of IMCA – for more information, contact your local advocacy team.
Managing Authority (MA)
The managing authority is the care/nursing home or hospital where the relevant person is deprived of their liberty – the place where responsibility for care and treatment resides. The managing authority is responsible for ensuring a person-centred care plan is put in place, and applies all relevant legislation to promote the relevant person’s quality of life and rights.
Supervisory Body (SB)
The supervisory body in England could be the Local Authority or Primary Care Trust, while in Wales it may be the Local Health Board or Welsh Ministers. A central responsibility of the SB is to determine if a DoL is taking place, arranging appropriate assessments in line with the Code of Practice (2008), then authorising a DoL if deemed appropriate. Alongside which, they have many other purposes within their role, including but not limited to, arranging an appropriate RPR and/or IMCA, informing relevant parties of the DoLS, monitoring and reviewing DoLS cases etc. All of these roles are documented within the Code of Practice for DoLS (2008).
Section 12 Doctor
A section 12 doctor is directed by the supervisory body and is primarily responsible for the Mental Health Assessment within the DoLS assessment process, determining if the relevant person has a condition or disturbance of the mind that is impacting their capacity to consent to care and treatment. They must also take into account how a DoL may affect them, or is currently affecting them, if an application is being made for a further DoLS authorisation.
The section 12 doctor may also be requested to complete an eligibility assessment, which determines in the relevant person is under, or would be better placed under, a Mental Health Act section.
Approved Mental Health Practitioner (AMHP)
The supervisory body may request an AMHP to complete the eligibility assessment, dependent on circumstances and resources.
Best Interest Assessor (BIA)
The BIA is a role who only works under the DoLS for the specific purpose of assessing capacity for the decision to consent to care and treatment at the specific care/nursing home or hospital. From which, if lacking capacity, they will complete a Best Interest Assessment, consulting relevant parties and upholding the five principles of the Mental Capacity Act. Both of these assessments are documented on Form 3.
In addition to these two core roles of the BIA, the SB may also request the BIA to complete the Age and No Refusal assessments of the Act.