MCA resources

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Webinar: Liberty Protection Safeguards

A discussion and Q&A webinar on the introduction of the Liberty Protection Safeguards (LPS).

Last updated on hub: 29 March 2021

Webinar: Delivering safe, face-to-face adult day care

This webinar gives and overview of SCIE’s guide to delivering safe, face-to-face adult day care as well as some practical examples from the sector.

Last updated on hub: 11 March 2021

Scared, angry, discriminatory, out of my control: DNAR decision-making in 2020

The British Institute of Human Rights

Findings from a study to gather information from people who have experienced Do Not Attempt Resuscitation (DNAR) decision making, both since and prior to the Coronavirus pandemic. The report shows a worrying picture around the rights of involvement in care and treatment decisions, including DNARs. The evidence depicts serious issues of discrimination related to disability and age, and the intersection between the two, as well as other factors. Coronavirus has shone a spotlight on this, and some reported an increase in worrying DNAR decisions; but none of this is new, these problems are ongoing. The report’s key findings are: 100% of people involved said there needs to be more easily accessible information about human rights; almost 60% of people involved said they had received no information about their right to life during Coronavirus; 65% of people involved said that they (or a person they care for/about) had a DNAR order put on your medical file. 21% said they didn’t know; of those who had seen a DNAR order put in place almost half (47%) were not related to end-of-life care; less than a third of people (29%) who were involved in DNAR decision-making felt fully listened to, most felt listened to a bit (46%), and 25% felt not listened to; 91% of people involved felt that discrimination was an issue in the DNAR decisions they’d experienced.

Last updated on hub: 03 March 2021

Frustrated, angry and unfair: staff experiences of DNAR decision-making in 2020

The British Institute of Human Rights

This report provides findings and recommendations from research with staff working across health, care and social work, who have shared their experiences of Do Not Attempt Resuscitation (DNAR) decisions. The findings show a worrying picture around the people’s rights to involvement in care and treatment decisions, including DNARs, and in staff confidence and ability to ensure human rights considerations are part of everyday decision-making. Of the people who attended the research workshop and completed a survey: 97% said there needs to be more easily accessible information about human rights; whilst 78% felt supported to meet the legal duty to uphold human rights in their day-to-day work, only 46% said they felt supported to uphold human rights in their day-to-day work during Covid-19; only 8% said people’s right to involvement in care and treatment decisions is explicitly discussed with them, an only 25% felt supported to involve people in DNAR decisions; over 40% of participants said it is assumed that people who have had a DNAR order placed on their file do not have mental capacity (only 26% said capacity assessments (a legal requirement) had been conducted); almost 30% of participants felt DNAR decisions during Covid-19 are worse (14% said they had not changed but were usually poor). 20% had made more challenges to DNAR decisions during Covid-19; only 16% felt fully listened to; more than 50% of participants felt that discrimination at least sometimes happening in DNAR decisions. The recommendations set out in this report focus on both the current Covid-19 context and the wider use of DNAR orders in “ordinary” times, and the need for them to be framed exactly as they are, as human rights issues.

Last updated on hub: 03 March 2021

Understanding clinical decision-making at the interface of the Mental Health Act (1983) and the Mental Capacity Act (2005)

King's Fund

This report explores the context in which the decision of whether to use the MHA or the MCA to authorise a deprivation of liberty is made and the different factors that practitioners use to assess and weigh up which Act is most appropriate and ‘least restrictive’ for the individual concerned. The research used a mixed-methods approach with an online survey to capture the diversity of factors that influence decision-making across clinical groups, and qualitative interviews with clinicians and professionals to explore in depth their understanding of the interface and experiences of making this decision in practice. A large proportion of participants in this research report encountering people to whom this decision applies at least once a month, if not weekly. This decision most commonly applies to people who have dementia, but also to people with a wide range of mental disorders, including those with functional mental illnesses, neurodevelopment and neurological conditions. Participants report most commonly applying this decision to people in community settings, but application also occurs in mental health and acute hospitals including in the emergency department. There is a lack of common understanding around fundamental issues on which this decision is based including core concepts of capacity and objection. Blanket rules exist within professional groups and across different settings that restrict decision-making. The rights afforded to people admitted and treated in some settings and areas of England may not be afforded to those in others. The majority of participants report that their training covered decision-making at the interface of the Acts. However, codes of practice and case law are described as difficult to understand and keep up to date with. Understanding clinical decision-making at the in. Practitioners highlight a number of different ways in which patients are unlawfully deprived of their liberty as a result of the factors outlined above.

Last updated on hub: 23 February 2021

Mental Capacity Act 2005, Deprivation of Liberty Safeguards England, 2019-20

These official statistics provide findings from the Mental Capacity Act 2005, Deprivation of Liberty Safeguards (DoLS) data collection for the period 1 April 2019 to 31 March 2020. DoLS are a legal framework that exist to ensure that individuals who lack the mental capacity to consent to the arrangements for their care, where such care may amount to a "deprivation of liberty", have the arrangements independently assessed to ensure they are in the best interests of the individual concerned. The data is collected from local authorities in England, who are the supervisory bodies for authorising deprivations of liberty of adults in care homes and hospitals. There were 263,940 applications for DoLS received during 2019-20, relating to 216,980 people. The number of applications has increased by an average of 13.9% each year since 2014-15. The proportion of completed applications in 2019-20 that were not granted was 51.0%. The main reason was given as change in circumstances, at 62.0% of all not granted cases. The proportion of standard applications completed within the statutory timeframe of 21 days was 23.6% in 2019-20. The average length of time for all completed applications was 142 days.

Last updated on hub: 17 February 2021

Mental Capacity (Amendment) Act: impact assessment (IA)

Department of Health and Social Care

Assessment of the amendment, which introduced the liberty protection safeguards to replace the deprivation of liberty safeguards. the liberty protection safeguards (LPS) were introduced in the Mental Capacity (Amendment) Act 2019. LPS will provide the framework to determine whether a deprivation of liberty is necessary and proportionate for the care or treatment of an individual who lacks the mental capacity to consent to their arrangements, in England and Wales. They will replace the deprivation of liberty safeguards (DoLS) system, which was found to be “bureaucratic” and “too complex” by a House of Lords Committee in 2014. This impact assessment is an updated assessment of the Mental Capacity (Amendment) Act 2019. It provides an assessment of DoLS at present and fully funded, as well as for LPS as set out in the act.

Last updated on hub: 01 February 2021

Webinar: Best Interests Decisions - Supporting Primary Care in Difficult Times

The National Mental Capacity Forum will hold its 7th 'Rapid Response' webinar. The webinar will focus on best interests decision-making in primary care settings during the pandemic.

Last updated on hub: 20 January 2021

Rapid response guidance note: vaccination and mental capacity (first update)

39 Essex Chambers

A general discussion examining to the legal position in relation to testing for COVID-19, especially as testing (a) starts to be more generally available; and (b) is increasingly been rolled out as mandatory in certain settings. It primarily relates to the position in England in relation to those aged 18 and above; specific advice should be sought in respect of Wales and those under 18.

Last updated on hub: 12 January 2021

Advocacy with people with learning disabilities and autistic people, who are subject to seclusion, segregation or restraint

VoiceAbility

Independent advocacy is crucial to make sure a person’s voice is heard and their human rights are protected. This is especially important when a person is subject to compulsory and restrictive powers. Consistent and effective advocacy must be provided to people who most require it, whenever they require it, including to people with learning disabilities, autism or both, who are subject to long term segregation. Improvement to the delivery and commissioning of advocacy is required to achieve this. This briefing highlights the key features of advocacy for people with learning disabilities, autism or both who are in long term segregation, which must be accessible, highly competent, holistic, independent and perceived to be so, connecting, supporting and joined up. The paper also sets out two commissioning options: national commissioning – the model could be specified clearly, activated promptly, its delivery easily monitored, and there would be a clear line of sight on the resources; and local commission – this would allow locally commissioned services to align with most existing statutory provision. Irrespective of the commissioning arrangements, the service must be able to undertake the full range of statutory advocacy duties, rather than referring the person on and requiring that they relate to several advocates. The paper conclude with eight recommendations, including ensuring that advocacy for people in long term segregation is provided on an opt-out basis, to ensure a greater number of people in long term segregation receive the timely advocacy support and representation they need for their voice to be heard and their rights upheld.

Last updated on hub: 05 January 2021

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