Identifying a deprivation of liberty in the psychiatric setting: quick reference guide

The following are examples of potentially liberty-restricting measures that may apply in psychiatric hospitals generally (this includes acute and rehabilitation or ‘step down’ wards):

• wards are busy places where there may be a high turnover of patients and significant pressure on staff time. This can result in blanket restrictions. These include: limited access to bedrooms during the day; restrictions on access to parts of the ward such as kitchen areas
• setting of observation and monitoring levels
• requirements for patients to be escorted in certain parts of the ward or site
• the physical environment (e.g. wards not on ground level) may limit patients’ access to the outdoors
• the prescription and administration of medication to a patient who lacks capacity to consent to it, in particular medication to sedate and/or to control the behaviour of the patient
• the extent to which the patient is required to adhere to a timetable
• locked doors, or use of “baffle locks”, unless patients have the code and are able to come and go as they please
• the concept of “protected time” is a valuable means of ensuring that patients have quiet periods during the day but also represents control over the activities of patients
• limited visiting time
• lack of easy access to telephones, internet, equipment for hobbies and interests such as art or music materials, possibly on safety or availability grounds
• use of seclusion, especially where such seclusion is regular and/or prolonged
• use of physical restraint, especially where such restraint is regular
• sanctions, such as time out, for behaviour that causes concern
• restriction of access to finances

In addition to the measures described above that apply in psychiatric hospitals generally the following are examples of potentially liberty restricting measures which may apply in an assessment and treatment unit (ATU):

• physical restraint
• seclusion (often described in misleading terms, not recognized as such and thus not reviewed in accordance with the Code of Practice to the MHA 1983)
• blanket rules which are rarely justified by the needs of the individual patient. This can be exacerbated by pressure on staff through low numbers
• routine and clear boundaries, which can be beneficial and a source of reassurance, but can also entail assuming control over what the individual does with their time

In addition to measures described above that apply in psychiatric hospitals generally the following additional measures may apply in a dementia specialist unit:

• the need for restraint and other physical interventions, in the patient’s best interests, to deliver personal care
• blanket restrictions to avoid risks such as falls