Deprivation of Liberty Safeguards (DOLS) – a survey exploring the views of psychiatrists

Publication Date02 Mar 2012
AuthorSusan Varghese,Aynur Gormez,Tim Andrews,Rachel Griffiths,Matthew Stephenson
SubjectEducation,Health & social care
Deprivation of Liberty Safeguards (DOLS)
a survey exploring the views of psychiatrists
Susan Varghese, Aynur Gormez, Tim Andrews, Rachel Griffiths and Matthew Stephenson
Purpose – Psychiatrists are among the front-line professionals involved in the implementation of
Deprivation of Liberty Safeguards (DOLS). This paper aims to explore how the safeguards areperceived
and practised amongst psychiatrists.
Design/methodology/approach – The authors carried out a postal survey among 519 psychiatrists on
their views and experiences on DOLS.
Findings – A total of 171 psychiatrists (36 per cent) responded to the survey. Nearly three-quarters of
the participants had received DOLS training and 81 per cent of individuals who had training believed
that DOLS would protect the rights of vulnerable people. Almost half of both groups agreed that DOLS
make a valuable contribution to the provision of necessary care in the least restrictive way possible. The
most common concern raised was possible increase in bureaucratic process. Interface between
the existing legislations continues to be a grey area for many practitioners with difficulties in interpreting
the relevant Code of Practice. In total, 50 per cent of the participants felt DOLS should extend to
community placement provisions.
Originality/value – The views and concerns expressed by psychiatrists in this paper are relevant to all
professionals working with adults who lack capacity to consent to their care or treatment in any setting.
As the process continues to widen, it is important to recognise the issues, encourage use of DOLS
process to protect human rights, and to address key gaps in training.
Keywords Ethics, Human rights, Deprivation of liberty, Safeguards,Learning disability, Training,
Intellectual disabilities
Paper type Research paper
The Deprivation of Liberty Safeguards (DOLS) have been implemented in England and
Wales since April 2009. DOLS were introduced as an extension to the Mental Capacity Act
(MCA) (Department of Constitutional Affairs, 2005) through amendments to Mental Health
Act (MHA) (Department of Health, 2007). They provide a legal framework to protect the
human rights of those over 18, who have a mental disorder as defined in the MHA 2007,
and who lack capacity to consent to their care in a hospital or registered care home, and for
whom provision of this care or treatment might entail deprivation of liberty.
DOLS were developed in response to a judgement by the European Court of Human Rights
(ECHR) in the well-known case of HL v. UK (2004), which is often known as the Bournewood
judgement. HL was a man with autism and intellectual disabilities who was admitted
informally to hospital for treatment with no capacity to consent or dissent. The court held that
the care and treatment of HL during a period in which he was not formally detained under the
MHA 1983 constituted infringement, in the form of deprivation of liberty, of his rights under
Articles 5(1) and 5(4) of the European Convention on Human Rights (1). Article 5(1) was
breached because the manner in which he was deprived of his liberty was not in accordance
VOL. 6 NO. 2 2012, pp. 52-61, QEmerald Group Publishing Limited, ISSN 2044-1282 DOI 10.1108/20441281211208419
Susan Varghese is a
Speciality Trainee Registrar
(ST-6) for Tees, Esk & Wear
Valleys NHS Foundation
Trust, Middlesbrough, UK.
Aynur Gormez is a
Speciality Trainee Registrar
(ST-6) for Oxfordshire
Learning Disability NHS
Trust, Oxford, UK.
Tim Andrews is a
Consultant Psychiatrist for
Oxfordshire Learning
Disability NHS Trust,
Oxford, UK. Rachel Griffiths
is a Mental Capacity Act
Implementation Manager at
the Social Care Institute for
Excellence, London, UK.
Matthew Stephenson is a
Consultant Psychiatrist for
Oxfordshire Learning
Disability NHS Trust,
Oxford, UK.
The authors would like to
acknowledge Dr S. Bhaumik,
former chair of Faculty of
Learning Disability Psychiatry
RCPsych,and Dr J.S. Chalmers,
Consultant Psychiatrist,
Oxford Health NHS Foundation
Trust, for their valuable
suggestions in the
development of the data
collection tool.

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