It’s all about the training! CQC and Deprivation of Liberty Safeguards

Inveraray Jail

Today, as Community Care reports, the CQC has published its annual report into the operation of ‘Deprivation of Liberty’ safeguards for 2010/11.

Deprivation of Liberty safeguards are a particular part of the Mental Capacity Act which allows a legal process of authorisation where there is felt to be a ‘deprivation of liberty’ in a care home or hospital related to someone who lacks the capacity to make a decision about whether they remain there or not. The process of decision-making relating to whether a Deprivation of Liberty is authorised revolves around the managing authority (the organisation which is potentially depriving the person of their liberty) and the supervisory body (the local authority or PCT (or whatever they are called now) where the person is or who is responsible for the care of that person (if, for example, they have been placed out of the local area the responsibility remains with the placing authority).  The decision is made on the basis of a number of assessments (six actually) which are undertaken by at least two people, one of whom must be a doctor and one of whom must be a ‘Best Interests Assessor’ (who can be a social worker, nurse, occupational therapist or psychologist).  The Best Interests Assessor, unsurprisingly, makes a recommendation not only on whether the deprivation is in the person’s best interest,  but whether the framework and care plan constitutes a deprivation of liberty at all.

So that’s DoLs in a nutshell. What have the CQC got to do with it? Well, amongst other things, monitoring these Deprivation of Liberty authorisations is another part of their work.
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What makes a good Best Interests Assessor?

Paperwork
Community Care carried an article a couple of days ago about Paul Burstow and the College of Social Work potentially turning their attention to the current training of Best Interests Assessors and finding the paucity of the system as it exists now to be in need of reform.

I’m a Best Interests Assessor as well as an AMHP (Approved Mental Health Professional). There’s a general awareness within the sector about what being an AMHP may be – there’s a lot less understanding about what is involved in being a Best Interests Assessor. The role itself is much newer having developed from the Deprivation of Liberty Safeguards which were a tacked onto the Mental Capacity Act (2005) by the Mental Health Act (1983) as amended 2007.

Lots of dates and lots of legislation but the role came into being in 2008 and created this role of ‘Best Interests Assessors’ who could be nurses, social workers, psychologists or occupational therapists with a couple of years experience who would be trained specifically to carry out particular assessments under these new legislative frameworks and make recommendations on the basis of these assessments as to whether someone who lacks capacity is being a) deprived of their liberty in a hospital or care home and b) whether it is in their best interests.

It can get enormously complicated but that’s perhaps, the reason that the focus has turned to the training of BIAs.

I was an ‘inaugural’ BIA, meaning that my training took place before the legislation had actually ‘gone live’. It took place over five days at postgraduate (masters) level training  delivered by a university and requiring an examined essay and presentation.

The problem is that we were then released into a ‘vacuum’ – there was an incredible feeling of insecurity about what these assessments required but there was also a hope that case law would eventually arrive to clarify! (oh, how deluded we all were!).

As it happens, case law is coming thick and fast now and each legislative decision adds layers of complexity. We have a better idea of the rate of referrals and the amount of time a good quality assessment takes so reappraising the course isn’t a bad idea.

Some AMHP courses now incorporate Best Interests Assessor training. I’m not sure I see this as necessary.

I’m not even sure more than five days is needed regarding an understanding of the legislation.

What is absolutely needed is constant and ongoing updates/training/discussions and forums to promote constant learning.

Currently there are no established and consistent  regulations concerning continuous professional development of BIAs – it is up to the local authorities to themselves decide. I’m fortunate that I have access to a host of BIA update training and a chance for specific supervision related to this role. I see it as fundamentally necessary, particularly at the rate with which the legislation framework changes, to be constantly in touch with the latest developments.

I also think that it is necessary for any new BIA (something that was impossible for me when I trained for obvious reasons) to have a similar experience as AMHPs have of ‘shadowing/fronting’ assessments with a more experienced BIA alongside them to get a feel for the type of work that i is.

This feels like a neglected corner of social work and social care in that it is a role that still is predominantly taken by social workers but few apart from those who actually do it, have an understanding of what it might entail.

We need to support each other on this – especially as so few of the trainers are actually Best Interests Assessors themselves – in my experience. This is an area where peer-led learning and understanding of the role could really move into the fore front.

I revert back to my premise that everyone working in social care with adults needs a better understanding of the Mental Capacity Act. That would form a better basis for those who do go on to become Best Interests Assessors.

I’ll be interested to see if Burstow picks this up. There’s a long way to go to improve both the Deprivation of Liberties Safeguards and the way that they are assessed and implemented. It’s quite right that the training and in particular professional development of BIAs is considered alongside this.

I’d be interested in what other BIAs thought about how training both initial and ongoing could be improved. Please feel free to leave comments!

Photo by anniebby

Policing and Mental Health

[Guest Post by Mental Health Cop]

The police service is key to the delivery of effective community based mental health care. There is an inevitability of police officers being called to incidents involving service-users, carers and professionals because some will occur unpredictably and because a few involve responding to significant risks.

 A fact of law: it is the police who must take certain decisions and exercise certain functions required by the Mental Health Act 1983. It is a matter of ethics and law: that the police should support colleagues in the health & social care professions as they administer the Mental Health Act, in order to keep everyone safe as they do so. Continue reading