Abstract
Aims and methodA group of lawyers, psychiatrists, best interest assessors and independent mental capacity advocates were asked to make binary judgements about whether real-life situations in 12 vignettes amounted to deprivation of liberty. Kappa coefficients were calculated to describe the level of agreement within each professional group and for the total group of professionals.ResultsThere was total agreement between all professionals about deprivation of liberty in only 1 of the 12 cases. The overall level of agreement for judgements made by all professionals was ‘slight’ (κ=0.16, P < 0.01).Clinical implicationsThere are practical difficulties involved in making reliable deprivation of liberty judgements within the Deprivation of Liberty Safeguards (DoLS) legislation. A clear interpretation of deprivation of liberty is necessary to facilitate professionals' decision-making in this area.
Highlights
Clinical implications There are practical difficulties involved in making reliable deprivation of liberty judgements within the Deprivation of Liberty Safeguards (DoLS) legislation
The interview provided information about: situations described in the DoLS Code of Practice as possibly amounting to deprivation of liberty; the patient’s experience of the admission process; and the experience of being an in-patient during the current admission, including whether or not the person thought he or she should be in hospital
Full data from six lawyers, six psychiatrists, six independent mental capacity advocates (IMCAs) and five best interest assessors are presented for eight cases and a further four cases are included where incomplete data were available from three of the four groups
Summary
Comparison of deprivation of liberty judgements by different professional groups The percentage proportion of professionals in each group who judged that the individual in the vignette had been deprived of his or her liberty (rather than having their liberty lawfully restricted) is summarised in Table 1 for the 12 cases. The rows are the reference groups; the odds of an independent mental capacity advocate (IMCA) judging the vignette to indicate deprivation of liberty are 2.07 times higher than a best interests assessor (BIA) making such a judgement. His son felt that his father was very well looked after and did not think he behaved in a way that suggested he objected to living in the unit Regarding this vignette, psychiatrists, IMCAs and best interest assessors were all in agreement that there had been no deprivation of liberty. In addition to the patient’s lack of mental capacity, factors listed as important in determining that Z had been deprived of his liberty included: he had only escorted leave; he was not free to leave the ward to go elsewhere; the duration of his detention (4 months); placement decisions had been made on his behalf; he believed he was detained under the Mental Health Act; and he was not happy in his current situation. Factors listed in support of the situation representing a lawful restriction (rather than deprivation) of Z’s liberty included: the measures were reasonable to ensure his safety; he had not tried to leave and was not actively objecting to being in hospital; he had adhered to treatment; and he did not present as distressed on the ward
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