Deprivation of Liberty Safeguards (DoLS) ✅

Related Subjects: |Dementias |Mental Capacity Act 2005 |Behavioural and Psychological Symptoms of Dementia

Deprivation of Liberty Safeguards (DoLS) are legal protections within the Mental Capacity Act 2005 designed to safeguard adults who lack capacity and whose freedom must be restricted in order to receive care or treatment safely. They ensure that any deprivation of liberty is lawful, necessary, proportionate, and in the person’s best interests.

🧠 What is a Deprivation of Liberty?

A deprivation of liberty occurs when a person who lacks decision-making capacity has their freedom significantly restricted in order to provide safe care or treatment.

This situation commonly arises in patients with:

• 🧠 Dementia
• 🧩 Learning disability
• 🧠 Brain injury
• 🧠 Severe mental illness
• 🏥 Delirium during hospital admission

Examples of restrictions that may contribute to a deprivation of liberty include:

• 🚪 Preventing the person from leaving a ward or care home.
• 👀 Continuous monitoring or supervision by staff.
• 🛏️ Restricting movement for safety.
• 📅 Staff determining daily routines or activities.

⚖️ The “Acid Test” (Cheshire West)

The UK Supreme Court case Cheshire West (2014) clarified when a deprivation of liberty occurs.

A person is deprived of liberty if:

• 👀 They are under continuous supervision and control
• 🚪 They are not free to leave

❗ Importantly:

• ✔ It does not matter if the person appears happy or compliant.
• ✔ It does not matter if the care arrangements are beneficial.
• ✔ The key issue is whether liberty is being restricted.

🏥 Where Do DoLS Apply?

DoLS apply only in specific settings:

• 🏥 Hospitals
• 🏡 Care homes

They apply when:

• 👤 The person is aged 18 or over
• 🧠 The person lacks mental capacity to consent to the care arrangements
• 🔒 The care arrangements amount to a deprivation of liberty

🏠 If a person living in their own home or in supported living requires similar restrictions, authorisation must instead be obtained through the Court of Protection.

🎯 Purpose of DoLS

DoLS exist to protect vulnerable individuals and ensure restrictions are applied appropriately.

Any deprivation of liberty must be:

• ⚖️ Lawful
• ❤️ In the person’s best interests
• 📉 The least restrictive option
• 🔎 Independently assessed and authorised

💡 Key principle: Healthcare professionals should always attempt to provide care in a way that restricts the person’s freedom as little as possible.

📋 The DoLS Authorisation Process

If a hospital or care home believes a person is being deprived of liberty, they must apply to the local authority (the supervisory body) for authorisation.

Six formal assessments are required:

• 👤 Age assessment – confirming the person is aged 18 or older.
• 🧠 Mental capacity assessment – confirming the person lacks capacity to consent to the care arrangements.
• 🧩 Mental health assessment – confirming the presence of a mental disorder.
• 🚫 No refusals assessment – ensuring there is no valid advance decision or lasting power of attorney refusing the care.
• ⚖️ Eligibility assessment – ensuring the person is not subject to the Mental Health Act in a way that would conflict.
• ❤️ Best interests assessment – confirming that the deprivation is necessary and proportionate.

If these criteria are satisfied, the local authority may grant a DoLS authorisation for a defined period.

👥 Relevant Person’s Representative (RPR)

Every person subject to DoLS must have a Relevant Person’s Representative.

• 👪 Usually a family member or close friend.
• ⚖️ Ensures the person’s rights are respected.
• 🗣️ Can raise concerns or challenge decisions.

If the person has no suitable representative, an Independent Mental Capacity Advocate (IMCA) may be appointed.

⚖️ Right to Challenge

The person or their representative has the legal right to challenge the deprivation of liberty through the Court of Protection.

• 🧑‍⚖️ The court reviews whether the deprivation is lawful.
• 🔎 The court can require changes to the care arrangements.

🔁 Reviews

A DoLS authorisation:

• 📅 Is granted for a limited period.
• 🔎 Must be reviewed regularly.
• ⚖️ Must end if the deprivation is no longer necessary.

📘 NICE Guidance and Good Practice

Although DoLS arise from legislation, healthcare professionals should also follow principles outlined in NICE guidance on decision-making and mental capacity (NG108).

• 🧠 Always perform a formal mental capacity assessment.
• 🗣️ Take all practicable steps to help the person make their own decisions.
• 👪 Involve family, carers, or advocates whenever possible.
• ⚖️ If the person lacks capacity, decisions must be made in their best interests.
• 📉 Choose the least restrictive option.

👩‍⚕️ Practical Advice for Healthcare Professionals

• 📋 Recognise when care arrangements may meet the deprivation of liberty criteria.
• 🧠 Document a clear capacity assessment.
• 🏥 Inform senior clinicians or safeguarding teams if DoLS may be required.
• 📨 Ensure the appropriate application is made to the local authority.
• 🔁 Regularly review whether restrictions remain necessary.

⚖️ DoLS vs Mental Health Act

• 🧠 Mental Capacity Act / DoLS: used when the person lacks capacity and requires care arrangements that restrict liberty.
• 🏥 Mental Health Act: used when detention is required primarily for treatment of a mental disorder.

Specialist assessment may be required when both legal frameworks could apply.

🎓 Exam and OSCE Tips

• ⚖️ The “acid test” is commonly examined.
• 🧠 Always start with a capacity assessment.
• 🏥 DoLS apply only to hospitals and care homes.
• 🏠 Community settings require authorisation from the Court of Protection.
• 👥 Patients must have a Relevant Person’s Representative.
• ⚖️ Patients or representatives can challenge the deprivation in court.

💡 Memory aid: Think CARL
Capacity lacking
Acid test met
Review and representation
Least restrictive option