Practice Practice Pointer

Identifying and managing deprivation of liberty in adults in England and Wales

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.c7323 (Published 10 January 2011) Cite this as: BMJ 2011;342:c7323
  1. William J Cutter, consultant old age psychiatrist1,
  2. Karla Greenberg, consultant old age psychiatrist2,
  3. Timothy R J Nicholson, clinical research worker and honorary specialist registrar in general adult psychiatry3,
  4. Ruth Cairns, Chadburn lecturer in liaison psychiatry4
  1. 1Directorate of Older People’s Mental Health, Hampshire Partnership NHS Foundation Trust, Gosport PO13 0GY, UK
  2. 2Department of Older Persons’ Mental Health, Solent Healthcare, Langstone Centre, St James Hospital, Portsmouth, UK
  3. 3Section of Cognitive Neuropsychiatry, Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
  4. 4Department of Psychological Medicine, Institute of Psychiatry, King’s College London
  1. Correspondence to: W J Cutter wjcutter{at}gmail.com
  • Accepted 1 November 2010

Clinicians are required by law to be able to identify and manage deprivation of liberty—this article explains how to do so

Summary points

  • Two pieces of legislation in England and Wales deal with deprivation of liberty in the hospital and care home: the deprivation of liberty safeguards and the Mental Health Act

  • The deprivation of liberty safeguards allow deprivation of liberty of people in hospitals or care homes who lack capacity to consent to physical or mental healthcare

  • The Mental Health Act (under some of its sections) allows the deprivation of liberty of people in hospital for the purposes of assessment or treatment of a mental (not physical) disorder

  • Where the purpose of detention in hospital is for the assessment or treatment of mental disorder and the patient objects to admission or treatment, use of the Mental Health Act should be considered before deprivation of liberty safeguards

  • The Mental Capacity Act allows restriction, but not deprivation of liberty

  • Decisions should be carefully considered and documented. Always consider whether care could be provided in a less restrictive way that could avoid the need for application of a legal framework

Why read this article?

In England and Wales, depriving an adult of their liberty without a legal framework in place is unlawful. In recent years, the law governing restriction and deprivation of liberty has undergone several important changes, which have resulted in more safeguards for adults lacking mental capacity when it comes to deciding on their place of accommodation. This new legislation has also considerably increased the complexity of the legal framework that clinicians have to engage with. Healthcare professionals have a legal duty to be aware of this legislation; claiming ignorance is not defensible. However, they will be protected from legal liability provided the guidance in the relevant code of practice is adhered to and decisions, including …

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