QuestionSBA
QuestionChoice
The patient's next of kin's advice should always be sought and considered. However, if the patient does not have capacity, we must act in their best interest. In this case it would be to prevent the patient from leaving hospital.
62166
d
Ask the next of kin if they will allow the patient to leave
QuestionChoice
The Mental Health Act (MHA) is used to detain patients in their best interest if they **have a mental health disorder**, and are at **risk to themselves or others**.

Section 2 of the MHA is for assessment and treatment, and lasts 28 days.

This patient has acute, organic, lack of capacity secondary to delirium. He does not have a mental health disorder and therefore it would be inappropriate to detain him under the MHA.
62164
b
Detain the patient under the Mental Health Act Section 2
QuestionChoice
The Mental Health Act (MHA) is used to detain patients in their best interest if they **have a mental health disorder**, and are at **risk to themselves or others**.

Section 3 of the MHA is for treatment, and can last up to 3 months.

This patient has acute, organic, lack of capacity secondary to delirium. He does not have a mental health disorder and therefore it would be inappropriate to detain him under the MHA.
62165
c
Detain the patient under the Mental Health Act Section 3
QuestionChoice
A patient with capacity is allowed to make an 'unwise' decision. If a patient is deemed to have capacity they can of course leave hospital, but we asked them to sign s form declaring that they are doing so against medical advice - a 'self-discharge' form. This patient does not have capacity and it would be in his best interest to prevent him leaving hospital.
62167
e
Allow the patient to leave after signing a self-discharge form
QuestionChoice
Correct! The Deprivation of Liberty Safeguards is the procedure in law used where it is necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm. This patient lacks capacity so can be detained for their best interest. Mental capacity is guided by the principles of the Mental Capacity Act.
62163
a
Detain the patient using a Deprivation of Liberty Safeguard
QuestionComment
Not what DoLS is for - you detain them under the mental capacity act and DoLS protects the patient from us
28728
User
subscriber
Supine Kinase
Concept
Chapter
# Deprivation of Liberty

Article 5 of the Human Rights Act states that 'everyone has the right to liberty and security of person. No one shall be deprived of his or her liberty [unless] in accordance with a procedure prescribed in law'.

There is likely a deprivation of liberty if:

- The person is subject to continuous supervision and control _and_
- The person is not free to leave

# The Deprivation of Liberty Safeguards 

The Deprivation of Liberty Safeguards is the procedure in law used where it is necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm.

These procedures must be authorised by a supervisory authority e.g. local authority.

The following conditions must be met to allow a person to be deprived of their liberty under the safeguards:

- The person must be 18 or over.
- The person must be suffering from a mental disorder.
- The person must be a patient in hospital or a resident in a care home.
- The person lacks capacity to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment.
- The proposed restrictions would deprive the person of their liberty.
- The proposed restrictions would be in the person's best interests.
- Whether the person should instead be considered for detention under the Mental Health Act.
- There is no valid advance decision to refuse treatment or support that would be overridden by any DoLS process.

# Capacity 

- All patients are initially assumed to have capacity
- Capacity is decision-specific e.g. a patient may be able to decide which clothes to wear, but not where is safest to live
- Capacity can be impaired permanently, temporarily, or can fluctuate
- Patients deemed to have capacity are freely able to make decisions that the healthcare provider thinks unwise or dangerous

# The Mental Capacity Act 

The mental capacity act haas five key principles:

1. Every adult is assumed to have capacity unless proved otherwise
2. A person must be given all practicable help to make their own decisions before they are deemed to lack capacity
3. Unwise, unsafe or dangerous decisions does not mean that person does not have capacity.
4. All treatment given to a person who lacks capacity must be in the patients best interests
5. Anything done for a person who lacks capacity must be done in the least restrictive way possible

# Power of attorney 

This is a legal document drawn up by a competent adult that nominates another person to make decisions on their behalf. This can be related to financial and property, or health and welfare. It can only be used when that adult has lost capacity.

# Advance directives 

An advance directive is a medical decision made by a patient with capacity, regarding their future wishes for treatment. It only comes into force if a patient subsequently lacks capacity.

# References 

- [Social Care Institute for Excellence: Deprivation of Liberty Safeguards (DoLS)](https://www.scie.org.uk/mca/dols)
- [NICE Guidance: Decision-making and mental capacity](https://www.nice.org.uk/guidance/ng108)

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1082
Deprivation of Liberty
Topic
57
Geriatrics
12494
A 76-year-old man is admitted to the geriatrics ward with a urinary tract infection. He past medical history includes only COPD and hypertension. He has delirium but no background of cognitive impairment. He remains on IV antibiotics and requires further management.

He appears confused and states that he would like to be discharged and is planning to leave. He does is not able to understand the risks of leaving hospital and make an informed decision.

Which of the following is the best course of action?
a