This came up in a managers hearing around less restrictive option for a client on a elderly dementia ward
DoLS have just suddenly changed the way they operate on the ward and seem to be being much more harsh with the criteria for patients to be eligible for DoLS, meaning that the consultants are having to use section 3 as their only option, even if it isn’t completely suitable, because some sort of legislation is required to keep them safe. DoLS are now telling the ward that if the clients are on covert medication, then they need to be under the MHA, so a lot of patients have needed to be moved onto a section 3 and will remain on this until discharged, because most of them do require covert meds.
Why are DoLS changing the way they work without any apparent change to guidance or legislation.
It is probably because someone has spotted that DOLS may not have been beng used properly in the past.
If the MHA could be used instead the Mental Capacity Act says that DOLS cannot to be used to keep someone in hospital for mental health treatment if they are objecting to being in hospital or ro receiving some or all of the treatment. In deciding whether someone is objecting, assessors has to have regard to all the relevant circumstances, including {among other things) the person’s behaviour.
Presumably people are being given medicine covertly because they’d refuse to take it if they knew about it. Refusing to take medication is very likely to be behvaiour which indicates an objection. If so, they are probably not eligible for DOLS.
This isn’t, incidentally, really anytgung to do with what is the less restrictrive option. Being detained under DOLS is every bit as restrictive as being detained under the MHA. But it does affect the safeguards patients get - for example, if they are detained under the MHA their medication will have to be approved by an independent second opinion appoimnted doctor (SOAD).
The “objection” rule is there essentuially so that patients who are getting treated in a mental health hospital against their wishes get the same safeguards whether or not they have legal capacity to withhold consent.
It is not the case of the Dols being used properly in the past.
This person isn’t showing any behaviours that warrant concern it is why it was asked why a section 3. Does not know they are in hospital just doesn’t like taking medication .They are considered stable.
My question was Why are DoLS changing the way they work without any apparent change to guidance or legislation When in the past covert medication was allowed under Dols
As Richard had suggested, “Refusing to take medication is very likely to be behaviour which indicates an objection.” and then read that alongside what the MHA Code states in the reference above:
Individual objects to the proposed accommodation in a hospital for care and/or treatment; or to any of the treatment they will receive there for mental disorder [my emphasis]
+
Individual lacks the capacity to consent to being accommodated in a hospital for care and/or treatment
=
Only the Act is available
Would be interested to hear any other views though.