Transcript Slide 1
Including
The Deprivation of Liberty Safeguards
Practitioner Level
Housekeeping
Smoking Toilets Fire Procedure
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Mobile Phones / Devices Breaks Finishing Time
Training Transfer
Getting learning into practice
•
“50% of learning fails to transfer to the workplace”
(Sak, 2002) Including •
“The ultimate test of effective training is whether it benefits service users”
(Horwath and Morrison, 1999)
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Training Transfer
Individual Characteristics Workplace Factors Training Design and Delivery
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Introductions
• Name • Place and nature of work • What do you want to get out of today’s session?
Outcomes
Including • Understand the legal framework for providing care, treatment and support • Consider the implications of using restraint to keep people safe from harm • Be aware of cumulative effects of restrictions and ways of minimising their use / impact • Understand what is meant by Restriction, Restraint and Deprivation of Liberty and the significance of the differences between them
Ground Rules
Safeguarding is a dynamic world and we continue to learn about how to prevent people from being harmed on both a strategic / organisational level and as individual practitioners. Including Safeguarding is about partnership, it is not about blame. All agencies and individuals need to take responsibility, to reflect and learn to safeguard people who may be vulnerable.
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Ground Rules
Confidentiality within the group will be respected but may need to be broken if a disclosure of unsafe practice, abuse or neglect is made during the course – this will usually be discussed with you first.
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Emerging Changes / Considerations
• Many of you will be aware that there has been a Supreme Court Judgement • This is currently being considered on a national basis and some elements are being reflected in this training but can not be discussed at length.
• Additional information is available by organisations such as CQC web site and decisions need to be taken by providers at a local level at this time
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The MCA “Process”
Is there a concern about a persons capacity ? (with regard to a
specific decision
) Undertake a Capacity Assessment Or Their own decision Best Interest decision (even if we think it is unwise) (multi-agency)
Best Interest Decisions
• Encourage participation • Identify all relevant circumstances • Find out the person’s views (past and present wishes, feelings, values and beliefs; including any advance decisions to refuse treatment) • Avoid discrimination • Assess whether the person will regain capacity • Consult others • Avoid restricting rights Including • Don’t be motivated by a desire to bring about the person’s death
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Principle 4: Best Interest
If a person has been assessed as lacking capacity then any action taken, or any decision made for, or on behalf of that person, must be made in his or her best interest.
Principle 5: Least Restrictive
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action.
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Case study – Val & Vernon
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Human Rights & Mental Capacity
• Vernon has been admitted to hospital. Val lacks capacity to make decisions about her care needs. • No-one has any legal authority (i.e. Lasting Power of Attorney or Deputyship) to make decisions on her behalf. • A decision will need to be made about what is in Val’s Best Interests.
The Best Interest Decision
What are the options?
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How restrictive are they?
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What could you do if Val refuses:
1. To go to the care home?
2. To take her medication?
3. To stay at the care home?
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What is Restraint?
Someone is using restraint if they: • Use force – or threaten to use force – to make someone do something that they are resisting, or • Restrict a person’s freedom of movement, whether they are resisting or not Section 6 (4), MCA, 2005
Examples of Restraint
• Chemical • Financial • Manual • Physical/ environmental e.g. Barriers, Locks • Removal of equipment, clothing • Preventing contact • IT / phone removal Including • Psychological
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Restraint
Any action intended to restrain a person who lacks capacity must follow the following two conditions: – The person taking action must reasonably believe that restraint is
necessary
to prevent
harm
to the said person – The amount or type of restraint used and the amount of time it lasts must be a
proportionate
response to the likelihood and seriousness of harm
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Guidance / good practice
•
Social Care Institute for Excellence (SCIE) ADULTS’ S ERVICES REPORT 25
Minimising the use of ‘restraint’ in care homes: Challenges, dilemmas and positive approaches
www.scie.org.uk
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Break
Limits of Section 5 Decisions
Restriction/ Restraint
Type Duration Manner
Deprivation of Liberty Including
Best Interest Decision -> -> -> -> -> -> -> -> -> Deprivation of Liberty Authorisation
Human Rights Act, 1998
“All human beings are born free and equal in dignity and rights.” The HRA is known as a higher law.
It defines the role of the State in upholding our freedom, dignity and rights; this includes protecting us from each other.
It also establishes if, when and how our rights may Including be restricted or withdrawn.
Human Rights: A Balancing Act
Some rights may be withdrawn or limited “
in accordance with a procedure prescribed by law
when
necessary
in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of Including health or morals, or for the protection of the rights and freedoms of others .”
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Human Rights Activity
Match the statements with the Rights
HL v. UK
HL was an autistic man with a Learning Disability who lacked capacity to consent to treatment Admitted to hospital in emergency Not treatable under MHA Discharge to carers refused ECtHR – illegal - no formal procedure for Including admittance or appeal against detention
Key Considerations for DoL
• Is the Person under continuous supervision and control?
• Is the Person be free to leave (or would they be if they could)?
• Is the Placement imputable to the State?
Including • Impact, relative normality and purpose are no longer relevant
Your Rights if You are Arrested:
Including • be told in a language you understand why you have been arrested and what charges you face • have a trial within a reasonable time • go to court to challenge your detention if you think it is unlawful • compensation if you have been unlawfully detained.
Your Rights if You are ‘Sectioned’:
Including • Be told in a language you understand why you have been detained and what the treatment is for • Be told about any side-effects • Support from an Independent Mental Health Advocate • To appeal against your detention if you feel it is unlawful
Your Rights if You Are ‘Deprived’:
Formal process for deprivation of liberty Representation/advocacy during assessment and if authorised (IMCA) Opportunity for the Deprivation of Liberty to be reviewed and monitored Including A Right of Appeal
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Case Study: Paul
Deprivation of Liberty Safeguards
Allow the lawful deprivation of liberty of an individual (who lacks capacity) in a care home or hospital • Must be
necessary
harm (not others) to prevent them coming to • Must be in their
best interests
(not the organisation’s) Including • Must be
proportionate
to the risk of harm
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Referral for DoL Authorisation
The managing authority (the person or body with management responsibility for the care home or hospital where the person is being, or may be, deprived of their liberty) must apply to the supervisory Body (the Local Authority) for DoL authorisation where it Appears that a person is, or may be, deprived of their liberty.
Deprivation of Liberty
Including For those people who are not in a Care Home or Hospital but who are deprived of their liberty, a S.16 Personal Welfare Application to the Court of Protection will be required.
(Includes 16 / 17 year olds)
DLS Service
• • DLS info line Tel : 01392 381676 [email protected]
will need to follow) (signed paper copy • DLS / MCA secure fax : 01392 383327 Including Call the team to discuss 3rd party referrals and S.16 Court of Protection applications
Case Studies
• Does this appear to be restraint under s. 5 of the MCA or is the person being deprived of their liberty? • Consider type of restraint, duration & manner of implementation. • Don’t forget that even those who are compliant may be deprived of their liberty. Including
Summary
• If a person lacks capacity to make a particular decision, a decision will need to be made in their best interest • When making decisions for others workers must be able to show what they did and why they did it • Restraint is permissible if necessary to prevent harm to the person, it is in the person’s best interests, it is proportionate to the likelihood and seriousness of that harm and there is no less restrictive alternative.
Including • Deprivation of Liberty must be authorised by a Best Interest Assessor.
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Any Questions?
Useful Websites
Including • • • • • • http://www.devon.gov.uk/index/socialcarehealth /adult-protection/mentalcapacityact.htm
www.dh.gov.uk
www.publications.parliament.uk
www.cqc.org.uk
www.scie.org.uk
www.scils.co.uk
Password available from [email protected]
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