A person living with Alzheimer’s is under a DoLS in a dementia care home and a recent DOLs mental‑health assessor describes behaviour that is challenging — banging his head against the wall, kicking furniture, and verbal aggression. The assessor considers that his mental health and wellbeing are being impacted by the deprivation of liberty. Following discussion with the care home manager regarding a mental health assessment, I was told that they ‘manage mental‑health issues in‑house’, but they are not mental‑health specialists. Is this a red flag? If so, how can I raise concerns independently, and where can I get advice on dementia and mental‑health needs? Would a mental health assessment be appropriate under these circumstances? How do I initiate this myself?
Sorry Maggie, you don’t say if you are the person’s relative. If you are then you can ask the local mental health service AMHPs to assess them. The home have nothing to do with it.
I don’t quite understand what the assessor meant by saying his mental health and well being were being impacted by the Deprivation of Liberty? His liberty would equally be deprived if he was detained under the Mental Health Act.
The behaviour you describe is quite common with dementia and would not necessarily merit a mental health detention.
I was wondering whether a mental health assessment would be worth seeking as these behaviours only started in the new placement under the DoLS, which he’s objecting to. I wasn’t thinking about detention as an alternative.
I’m his partner, and an attorney under a Health & Welfare LPA.
To me there needs to be a separation of what is actually requiring attention.
Is the patient mentally unwell requiring section and then be housed in those hospital ward conditions?
Or
Are they someone who requires extra support surrounding their Alzheimers?
I think once this is established then you can obtain a clearer outlook of what needs to be done.
I was hoping that a mental health assessment would provide more clarity, as there has been a noticeable increase in distress, which has been described in a care plan as being due to”things not going his way”. He’s refusing personal care and has become very withdrawn when he was very gregarious while under a DoLS in a hospital setting before Christmas when he was transferred to this care home.
Sounds like this person needs an assessment (or re-assessment) of his mental health, rather than a “Mental Health Act assessment”, which is specifically to consider detention in hospital (being sectioned). The evidence is that he is distressed and is appears that it may well be as a result of his cognitive problems, and maybe also due to the restrictions he is currently under.
There are numerous issues raised here which can’t be adequately addressed in this forum, but the DoLS mental health assessor is required under the DoLS legislation to make a comment about whether s/he considers the deprivation of the person’s liberty will impact on their mental state, and that he why the assessor has made that statement.
Some trusts have specialist teams who provide direct support to care homes for people with behavioural difficulties. It’s worth exploring whether the local trust has such a team. If not, I still think a referral to the secondary mental health service which deals with people with dementia should be requested.
You may be aware of all this already, but as a donee of a health and welfare LPA, you will have the right to appoint a “Relevant Person’s Representative” (RPR) under the DoLS scheme - including yourself, once the DoLS authorisation has been granted. That person has a specific role to ensure the person’s statutory rights are protected, including requesting a review of the authorisation. There are online leaflets about this role.
If the DoLS authorisation has not yet been finalised, you could talk to the Best Interests Assessor (BIA), who has a duty to consult with you, to ask for a condition that the care home makes a referral to the secondary mental health service due to the person’s damaging behaviour.
Thank you to everyone who has responded. Thank you, Steve, for clarifying the distinction between a mental health assessment and mental health act assessment, as I wasn’t aware of this. The standard authorisation has been finalised. I had been the RPR for my partner under the 2 previous DoLS but the BIA has decided to appoint a paid representative. I brought a s21A challenge under the MCA in November 2025, and had non means tested representation because I was his unpaid RPR. I lost access to representation as soon as I was displaced by the BIA, and am now a party to the proceedings and litigant in person. I’ve just drafted a request for a mental health assessment via the GP pathway, and asked for a copy of any report or actions. I don’t know if they will allow me to be present during assessment.
I’m being cautious here, because this is a public forum and I don’t want to get too deep into individual detail, but your description of the RPR selection appears problematic.
The law states that as donee of a health and welfare LPA, if the resident themselves lacks capacity to choose their RPR, then the attorney has the right to choose, including choosing themselves. Now the BIA and the supervisory body (i.e. the DoLS team in the local authority) can say the person is not appropriate to be RPR, if they don’t believe they will support the person to exercise their statutory rights, but even if they do say that, they cannot simply appoint a paid RPR. They must go back to the attorney to ask them to select an alternative person. The attorney retains the authority to choose the RPR (even though it has to be finally approved by the DoLS team).
This is set out clearly in a 2019 Court of Protection judgement: London Borough of Hillingdon v JV and others. [2019] EWCOP 61. You can either look up that citation to get the whole judgement or this is a useful summary. https://www.39essex.com/information-hub/case/london-borough-hillingdon-v-jv-ors
As you have stated, the choice of RPR has significant consequences, as the RPR has non-means tested legal aid, but other people don’t have that available to them. I suggest it is worth raising this with the relevant local authority, or alternatively obtain some legal advice from a solicitor who has expertise in mental capacity.