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Pushing for Section 3 as opposed to DoLs

Eaexh01

Registered User
Jul 6, 2020
33
My mother is currently an inpatient under Section 2 for rapid onset delerium and self harm. She is seriously confused,
paranoid and aggressive to staff.
Her Sectiom 2 comes to an end in 10 days but her psychiatrist has advised that despite no diagnosis as yet, she will be there for some time. Dementia is one of several conditions under consideration.

Currently DoLs is being mentioned but a friend who is a mental Nurse has said I should push for a Section 3 as this is better suited to Mum’s situation and would put her in a stronger position with aftercare.
To be honest depsite reading up I am still
Confused by the difference between S3 and DoLs and need to be clear before I can have a clear discussion with the consultant. Also how do Go about making my preferences known and does that make any difference?

any help or clarity much appreciated.
 

Bella6

Registered User
Jul 25, 2020
20
Hi @Eaexh01

There is another thread where you can find out quite a lot about Section 3 and aftercare funding https://forum.alzheimers.org.uk/threads/dad-on-section-3-117-meeting-next-week.123524/

Are you the 'Nearest relative' for your mother? I was my husband's 'Nearest relative' when he was sectioned (S2 and then S3) and I was asked both times if I would be objecting. I didn't know about the aftercare funding until after my husband was put on a S3, but it has made a huge difference as his care is fully funded now, without any means testing.
 

karaokePete

Registered User
Jul 23, 2017
5,635
N Ireland

Eaexh01

Registered User
Jul 6, 2020
33
Thank you. I have read through the various links but still can’t get clarity on why/when one path would be used over the other when a S2 finishes.

So a Dols is being suggested for my mum whereas I’ve heard accounts of a section 3 being given to other people in exactly the same circumstances.

Is a DoLs always the default preference for the LA so they don’t have to fund aftercare?
 

Bella6

Registered User
Jul 25, 2020
20
It isn't clear what the difference is between DoLs and S3, and the Alzheimer's Society factsheet says "There is overlap between DoLS and the Mental Health Act. This is a very complex area of law and is not always straightforward – particularly around whether it is most appropriate to follow DoLS or the Act."

As far as I'm aware, the aftercare funding would not apply if there is a DoLs. The decision to section someone in hospital is made by the medical team, and approved by an independent panel. In my husband's case the social worker was very happy that the hospital had decided on a S3. My husband and I were lucky because we had a very good social worker organising his hospital discharge.
 

canary

Registered User
Feb 25, 2014
13,420
South coast
As far as I'm aware, the aftercare funding would not apply if there is a DoLs.
Yes, this is correct, but perhaps not the best way of looking at it.
First of all comes the decision of whether or not someone should be sectioned.
If they do not need sectioning, but are at risk of coming to harm if they are not kept secure, then that is the point at which a DoLS is applied for. People who are under a section do not need to have a DoLS because they are already not at liberty. This is the scanario that my mum was under. She was in a secure dementia unit because she was a wanderer - before she moved into this unit she would go out at night, very inadequately dressed, would get lost and was at risk of harm. She was not aggressive/violent so she did not need sectioning, but she needed a DoLS to allow her to live in a secure unit and keep her safe.
 

Eaexh01

Registered User
Jul 6, 2020
33
Thank you and the link is really useful. Bellao The suitability of one over the other exactly what I’m Clumsily trying to get to the crux of......why Mum would be given a DoLs rather than S3?

She has multiple chronic health conditions, deliriim, confusion, paranoia, has been self harming and shown aggression to staff. There is no diagnosis nor will there be until the delerium passes but I have been warned she is likely to be in the psychiatric ward for some morphs.
Surely this comes under the criteria of Section 3?
 

Veritas

Registered User
Jun 15, 2020
62
Thank you and the link is really useful. Bellao The suitability of one over the other exactly what I’m Clumsily trying to get to the crux of......why Mum would be given a DoLs rather than S3?

She has multiple chronic health conditions, deliriim, confusion, paranoia, has been self harming and shown aggression to staff. There is no diagnosis nor will there be until the delerium passes but I have been warned she is likely to be in the psychiatric ward for some morphs.
Surely this comes under the criteria of Section 3?
I would have thought so, at least for now until they do get to the bottom of what's going on. She can be discharged from the Section 3 at any point once they are satisfied she's ready to move on, provided 117 aftercare arrangements are in place.

I find it hard to see how a DoLS would apply at this point when she doesn't have a firm diagnosis and they think she needs to be in hospital for some time.
 

Eaexh01

Registered User
Jul 6, 2020
33
I was finally able to visit Mum yesterday after 2 weeks isolation and was totally floored by her appearance and mental state. Way worse than when I last saw her, utterly terrified and confused. She spent the whole visit sobbing and making accusations that the staff were trying to kill her. It was awful to watch.
They are not giving her any meds as she is still being abserved in her ‘natural state’. Understandable but part of me wishes they would give her something just to calm her down and take some distress away.

Going back to S3/DoLs I raised the matter with her nurse who said as she is currently not resisting being there she would be the least restrictive path ie DoLs. Still doesn’t make sense to me though as there is no diagnosis and it was reconfirmed that she is likely to be an inpatient for months.
 

Veritas

Registered User
Jun 15, 2020
62
@Eaexh01 Call me cynical but that sounds like a funding ploy to me. My understanding was that you couldn't take a failure to 'run away' as implying consent to treatment - in which case it ought to be a S3 - but my knowledge of this is well out of date now. I'd suggest you contact the AS helpline and discuss your specific circumstances with them, so that you can check this out properly and if necessary advocate on your mother's behalf.
 

Eaexh01

Registered User
Jul 6, 2020
33
I rang the AS helpline who were very helpful this morning.

on another note I am in a bit of a shock as the ward nurse has just phoned to say that as of this morning Mum’s S2 was recinded and DoLs put in place. All done without any discussion with me! I wasn’t invited to be part of any of it.
Can they do that? I still think Mum needs to be under Section 3 and strongly suspect they have bypassed me to avoid 117 aftercare.

what, if anything can I do? I have left a message for her psychiatrist to ring me but need to know next steps for challenging this unilateral decision
 

Veritas

Registered User
Jun 15, 2020
62
I rang the AS helpline who were very helpful this morning.

on another note I am in a bit of a shock as the ward nurse has just phoned to say that as of this morning Mum’s S2 was recinded and DoLs put in place. All done without any discussion with me! I wasn’t invited to be part of any of it.
Can they do that? I still think Mum needs to be under Section 3 and strongly suspect they have bypassed me to avoid 117 aftercare.

what, if anything can I do? I have left a message for her psychiatrist to ring me but need to know next steps for challenging this unilateral decision
Looks like it - I'd be pretty assertive about following this up if it was my relative. At the very least they need to explain their thinking.
 

Eaexh01

Registered User
Jul 6, 2020
33
I have just come off a lengthy call with Mum’s psychiatrist who was quite put out by me raising concerns about
1 why I wasn’t consulted at all or at least given heAds up
2 why she has been given a DoLs rather than S3

Firstly, she said legally I don’t need to be consulted (okaaay)
Secondly, As she firmly believes DM doesn't qualify for S3 (despite no capacity, likelihood of being an inpatient for many months, and a risk to herself) it was solely her who undertook the DoLs assessment - nobody else was involved.

She was clearly annoyed by my questions but I feel like I’ve hit a brick wall and not sure if realistically I can do anymore to challenge the decision.
 

Veritas

Registered User
Jun 15, 2020
62
It may be well be true that it's not a legal requirement to consult you - but it would be good practice if nothing else. As to whether it's best practice for a DoLS to be decided upon alone, rather than by a multi-disciplinary team, it doesn't sound ideal. I'd suggest getting hold of the PALS team at the hospital in question and having a chat with them. At the very least this psychiatrist could do with some feedback about engaging positively with relatives. She sounds highly defensive and that's not appropriate.
 

canary

Registered User
Feb 25, 2014
13,420
South coast
As to whether it's best practice for a DoLS to be decided upon alone, rather than by a multi-disciplinary team, it doesn't sound ideal.
It is the way it is done. DoLS is a safeguarding thing to assess whether the deprivation of liberty that is already happening is appropriate, It is done by an outside impartial assessor who will inform the next of kin about the results. This happened to mum as she was in a secure dementia unit, but the decision that she should be in a dementia unit and therefore deprived of her liberty, was made by a best interests team after a stay in hospital. I believe that a DoLS was also applied for while she was in hospital as she kept trying to leave.
 

Veritas

Registered User
Jun 15, 2020
62
It is the way it is done. DoLS is a safeguarding thing to assess whether the deprivation of liberty that is already happening is appropriate, It is done by an outside impartial assessor who will inform the next of kin about the results. This happened to mum as she was in a secure dementia unit, but the decision that she should be in a dementia unit and therefore deprived of her liberty, was made by a best interests team after a stay in hospital. I believe that a DoLS was also applied for while she was in hospital as she kept trying to leave.
Thanks - I understand what the DoLS is for - but in this case the psychiatrist is claiming to have made the decision (that warrants a DoLS being put in place) alone. That seems odd. And no mention of an independent assessor so far either.
 

Eaexh01

Registered User
Jul 6, 2020
33
No independent assessor - I’ve learnt a little more today that the psych deemed that as of yesterday morning a S2 was no longer appropriate and therefore the DoLs was put in place.
Mum doesn’t have capacity and as she isn’t apparently ‘resisting care’ a section 3 is section 3 was discounted. I would argue that just because she isn’t physically able to stand and walk out that doesn’t mean she is consenting. Having just is convinced everyone is trying to kill her and is refusing to be washed or showered.