Difference between section 3 and DoLS

Law and practice Mental Capacity Act
1

Hi this question may look silly but please some help me. I am a newly qualified MH nurse and faced a question from one of the dementia patients family.
Patient was on section 2 and placed on DOLS when section 2 expired. They asked what is the difference between section 3 and DOLS. I told them that both are same on treatment wise but DOLS applied due to lack in capacity. One of the other colleagues laughed at me and said in front of everyone that “better you need to update your knowledge or find another job”. I asked her to explain me the difference but she didn’t say anything. Please can someone help me by explaining the difference between both

1 Like
2

Hi, you’ll get lots of replies to this explaining things far better than I could. Including references to a recent case involving Manchester which means it is possible (indeed likely) that S3 should have been applied instead of DoLS.
I just wanted to say that there is no shame in being confused about this- most people are, myself included. If everyone who was confused about the interface between the MHA and the MCA and DoLS needed to look for another job, there wouldn’t be many people left. The only person who should feel ashamed about the situation you describe is the person who laughed at you.

12 Likes
3

I think normally one would look to a DoLS if the patient was in a nursing home/ community. Section 3 would be better for a hospital.

4

Am I the only person on here to be absolutely dismayed by this whole conversation?

2 Likes
5

Why dismayed?

6

Hi Matths,

Section 3 is for mainly for treatment,but some times still assessing/investigating/stabilising meds etc or for ECTs.If patient has already confirmed diagnosis,takking meds,engaging with personal care,activities etc,apart from Lacking Mental capacity to make informed decisions regarding the admission & treatment,pleasantly confused,not trying to leave/exit or asking for discharge or expressing the wish to go home continuously etc then DOLs,least restrictive,at the same time keeping safe inspite of of depriving them their rights.

Hope I tried my best to explain.

Best wishes.

Sara.

2 Likes
7

hi Matths, check out this link. I find it very helpful The interface between the Mental Health Act 1983 and the Mental Capacity Act 2005 - Adults

2 Likes
8

Excellent accurate feedback Mr Nick Woodhead. Respect.
Cy Burns

1 Like
9

Dols is being used extensively in hospital to unlawfully deprive people of their liberty, remove their rights (under the MHA) and deprive them of s.117 aftercare.
Whilst the law sometimes provides a choice, there would have to be evidence of incapacity, evidence of no form of objection and evidence that it was a less restrictive option.
As it is taking on average 156 days for a standard authorization to be put in place, MCA DOL almost certainly will involve an unlawful DOL. It also excludes the role of the MHAA. Scandalous.

3 Likes
10

See Deprivation of Liberty Safeguards (DoLS) at a glance - SCIE for DOLS:

How is deprivation of liberty authorised under DoLS?

The Deprivation of Liberty Safeguards (DoLS) can only apply to people who are in a care home or hospital. This includes where there are plans to move a person to a care home or hospital where they may be deprived of their liberty. The care home or hospital is called the managing authority in the DoLS. Where a managing authority thinks it needs to deprive someone of their liberty they have to ask for this to be authorised by a supervisory body. They can do this up to 28 days in advance of when they plan to deprive the person of their liberty.

For care homes and hospitals the supervisory body is the local authority where the person is ordinarily resident. Usually this will be the local authority where the care home is located unless the person is funded by a different local authority.

The managing authority must fill out a form requesting a standard authorisation. This is sent to the supervisory body which has to decide within 21 days whether the person can be deprived of their liberty.

The supervisory body appoints assessors to see if the conditions are met to allow the person to be deprived of their liberty under the safeguards. They include:

  • The person is 18 or over (different safeguards currently apply for children).
  • The person is suffering from a mental disorder (recognised by the Mental Health Act).
  • The person lacks capacity to decide for themselves about the restrictions which are proposed so they can receive the necessary care and treatment.
  • The 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.
  • Whether a person who holds Lasting Power of Attorney (LPA) for Health and Welfare agrees with a DoLS authorisation (no refusals).

If any of the conditions are not met, deprivation of liberty cannot be authorised. This may mean that the care home or hospital has to change its care plan so that the person can be supported in a less restrictive way. There may be also be a need to consider asking the Court of Protection to look at the Deprivation of Liberty, supervisory bodies must seek legal advice in these cases.

If all conditions are met, the supervisory body must authorise the deprivation of liberty and inform the person and managing authority in writing. It can be authorised for up to one year.

The person does not have to be deprived of their liberty for the duration of the authorisation. The restrictions should stop as soon as they are no longer required.

Conditions on the standard authorisation can be set by the supervisory body. These must be followed by the managing authority.

Standard authorisations cannot be extended. If it is felt that a person still needs to be deprived of their liberty at the end of an authorisation, the managing authority must request another standard authorisation (or renewal).

See MHA COP for MHA S2 or S3 https://assets.publishing.service.gov.uk/media/5a80a774e5274a2e87dbb0f0/MHA_Code_of_Practice.PDF
which requires an Amhp and 2 approved doctors and for S3 no objection from nearest relative.

11

Patients are assessed by DOLs team,so it is not they are put on DOLs just like that.