Safeguarding practice guidance: Mental Capacity Act and DoLS

The Mental Capacity Act 2005 came into force in April 2007 to empower and protect people who do not have the ability to make their own decisions, especially about things like finance, social care, medical treatment and living arrangements.

Deprivation of Liberty Safeguards (DoLS) are intended to protect people who lack mental capacity from being detained when it is not in their best interests.

Mental Capacity Act 2005

Having mental capacity means being able to understand and retain information and to make a decision based on that information. Someone might not have capacity because they have:

a learning disability
dementia
a mental health problem
a brain injury or a stroke
are under the influence of substances such as alcohol

Mental capacity can be temporary or permanent. Each decision must be considered separately and are specific to the time that the decision needs to be made.

The law aims to ensure that people who lack capacity to make decisions by themselves get the support they need to be as involved as possible in decisions about their lives. It also outlines how an assessment of mental capacity should be made, in which situations other people can make decisions for someone who cannot act on their own and how people can plan ahead in case they become unable to make decisions in the future.

There are five principles at the heart of Mental Capacity Act which should be used to underpin all actions and decisions taken in relation to those who lack capacity:

Principle 1: a presumption of capacity. Every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise. Do not assume that someone cannot make a decision for themselves just because they have a particular medical condition or disability.

Principle 2: individuals being supported to make their own decisions. Make every effort to encourage and support people to make the decision for themselves. If lack of capacity is established, it is still important to involve the person as far as possible in making decisions.

Principle 3: unwise decisions. People have the right to make what others might regard as an unwise or eccentric decision.

Principle 4: best interests. If a person has been assessed as lacking capacity then any action taken, or any decision made for, or on behalf of that person, must be made in his or her best interests.

Principle 5: less restrictive option. Someone making a decision or acting on behalf of a person who lacks capacity must consider whether it is possible to decide or act in a way that would interfere less with the person's rights and freedoms of action, or whether there is a need to decide or act at all.

Deprivation of Liberty Safeguards (DoLS)

The Deprivation of Liberty Safeguards (DoLS) is the procedure prescribed in law when it is necessary to deprive of their liberty a resident or patient who lacks capacity to consent to their care and treatment in order to keep them safe from harm and ensure that the least restrictions are placed on them.

The Deprivation of Liberty Safeguards are intended to:

protect people who lack mental capacity from being detained when this is not in their best interests
prevent arbitrary detention
give people the right to challenge a decision
ensure that the least restrictions are placed upon the person

The legislation sets out a procedure for care homes and hospitals to obtain authorisation to deprive someone of their liberty. Without that authorisation the deprivation of liberty will be unlawful. These safeguards are intended to protect people from being deprived of their liberty unless it is in their best interests to protect them from harm and there is no other less restrictive alternative.

If you think someone is being deprived of their liberty without authorisation, contact the DoLS Coordinator

Mental Capacity Act survey - reflections and progress

Background

In April 2023, in response to our priority to embed a good understanding of the Mental Capacity Act (MCA) within the practice of our partners, we launched a survey. The aim was to better understand the support available and the challenges faced by those working with vulnerable adults around issues of mental capacity.

We received an impressive 199 responses, and the findings were reviewed by the Board in June 2023. Here is a Icon for pdf copy of the 2023 MCA survey presentation [1MB] .

Key findings from 2023

The survey highlighted a lack of confidence in:

assessing executive function when determining capacity
understanding the criteria for referring to advocacy services
assessing capacity in individuals with fluctuating capacity

When asked what would help improve understanding and practice, the most common response was training, particularly scenario-based training.

January 2025 survey update

To monitor progress, the survey was repeated in January 2025, with 194 responses. The Learning and Development Subgroup reviewed the results and shared the following reflections:

confidence levels have generally improved across all areas, except for advocacy
the Mental Capacity Act remains a key training priority for all partner organisations
while training provides a foundation, peer support is essential for applying the MCA in complex, real-world scenarios - in response, drop-in sessions have been introduced
workforce capacity continues to impact the effective application of the MCA
partners are encouraged to share recurring challenges or themes with the Learning and Development Subgroup for further consideration
insights from this survey will inform the upcoming Advocacy Audit, to be presented at the Safeguarding Adults Board in 2025
the MCA should continue to serve as a 'golden thread' throughout all partnership initiatives

The findings were reviewed by the Board in June 2025. Here is a Icon for pdf copy of the 2025 MCA survey presentation [915KB] .

Next steps

The Learning and Development Subgroup will continue to review the partnership's training offer on mental capacity and provide further recommendations to the Board to ensure ongoing improvement and support.

Legal decision-making powers and advocacy

In November 21, the board hosted a 90-minute virtual workshop on legal decision-making powers and advocacy. Icon for pdf The session was held to support the partnership in regards to learning identified in the John SAR [792KB] . Four presenters provided information on:

what is a Lasting Power of Attorney (LPA) and what are their decision making powers?
when and how to bring in advocate when there is an LPA
managing challenging conversations with an LPA
guidance on how to address concerns regarding an LPA

There was a question and answer session at the end which gave attendees the opportunity to ask specific questions around working with LPAs.

The session was a great success, there were over 200 attendees and feedback was positive. Icon for pdf The presentation slides are already available and can be found here [939KB] .

Mental Capacity Act Programme of Events 2026

Lunch and learn sessions

Hosted by the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board, these sessions are open to all health and social care professionals across Buckinghamshire, Oxfordshire and and West of Berkshire.

Please see the selection of topics and dates on which you can book to join via the link next to the topic area.

These sessions will be held across the year and may contribute to your professional CPD. The sessions are Mental Capacity Act focused within the context of health with an opportunity for questions and answers.

If you have any questions, contact the Berkshire West ICB Safeguarding team via email bobicb-bw.safeguarding@nhs.net.

Practical application of the Mental Capacity Act

29th January 2026, 12pm to 1pm

A session to support the practical application of the Mental Capacity Act.

Speakers:

Jordan Vine - Adult Specialist Speech and Language therapist, Buckinghamshire Healthcare NHST Trust
Mary Keats - Best Interests Assessor - Deprivation of Liberty Safeguards (DoLS) Early Resolution, Safeguarding and DoLS, Buckinghamshire Council

Join the meeting now

MCA case study - diabetes

11th March 2026, 12pm to 1pm

A case study exploring how the MCA applies when a patient has diabetes including relevant factors to consider when assessing capacity and making best interests' decisions.

Speakers:

Amy Allen-Mental Capacity Act Lead, Oxford Health NHS Foundation Trust
Tatiana Silvestre-Named Professional Safeguarding Buckinghamshire Healthcare NHS Trust

Join the meeting now

Assessing Mental Capacity for People with Acquired Brian Injury (ABI)

13th May 2026, 12pm to 1pm

Assessing adults with brain injuries is extremely complex due to the difficulties this population experiences in processing and retaining information (including about themselves and events that have happened to them), reasoning and problem solving; and difficulty in weighing up known information and using it at the time/in the circumstances in which they need to use it.

This training aims to provide an overview on common difficulties including explaining the Frontal Lobe Paradox, and give practitioners additional skills to be able to structure and carry out an MCA for this population, that accurately captures their ability/inability to weigh the decision at the time at which they will need to make that decision - which often is during function, not at the time of the MCA.

Speaker:

Clara Buckle, Specialist Occupational Therapist, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust

Join the meeting now

A Case study presentation

10th June 2026, 12pm to 1pm

Case study-based session exploring drug and alcohol presentations in the Emergency Department and their impact on decision-making under the Mental Capacity Act.

Speaker:

Fatmata Mansaray-Adult Safeguarding Lead Practitioner, Royal Berkshire Foundation Trust

Join the meeting now

Mental Capacity Act - Documentation

16th September 2026, 12pm to 1pm

Practical session designed to strengthen confidence in MCA documentation, covering proportionate approaches to documenting capacity assessments in different situations; with a focus on physical health presentations / medical treatment.

Speaker:

Edward Bartlett-Mental Lead Capacity Act Professional, Berkshire Healthcare NHS Foundation Trust

Join the meeting now

Useful information

DoLS APP - added February 2024

Edge have launched a DoLS App, which is available in App Stores (search DoLS App) or Google Play (search DoLS). The app contains an overview of the Deprivation of Liberty Safeguards (DoLS).

Content includes: the key legal criteria such as the 'acid test', time limits, forms, process, and rights. It also includes numerous resources to aid learning such as short, animated videos, tables, and a quiz. Plus, links to additional free resources and one click access to the statutory Codes of Practice and our popular DoLS case law summary sheet.

The App is written by the authors, Steven Richards and Aasya F Mughal. Find more information on the Edge training website.

Mental Capacity Act guidance

Produced by Wokingham Borough Council and published by the SAB in February 2024, practitioners are encouraged to use the following documents to support in their application of the Mental Capacity Act. Please note that there is reference to agencies specific to Wokingham Borough Council, so please ensure you refer or contact other agencies that they cover the area you are working in.

Mental capacity in maternity

A practitioners experience, reflection and shared learning. Click to view a recorded webinar delivered by NHS England South East in 2023: Maternity and MCA Case study - East Safe Guarding Learning Platform

Executive function

Worcestershire Safeguarding Adults Board have had a short animation on executive function produced. The animation helps us to understand what the term executive function means, recognise signs of decreased executive function and offers advice and tips about how to support someone showing signs of decline in executive function in relation to the journey of dementia.

Mental Capacity Act guides - added October 2022

With Bournemouth University, The National Centre for Post-Qualifying Social Work and Professional Practice, our partnerships independent chair Professor Keith Brown has produced the following guides on the application of the Mental Capacity Act:

Mental Capacity Toolkit - added August 2022

In March 2022, Bournemouth University published a Mental Capacity Toolkit to support health and social care professionals working with individuals whose decision-making process is impaired.

The Mental Capacity Toolkit is a free resource for health and social care professionals and for friends or family who may have to make decisions on behalf of another person.

As part of a wider research project funded by the Burdett Trust for Nurses, BU developed the toolkit to enable ethical, legal, and informed professional practice and ensure professionals are confident in their understanding of the Mental Capacity Act 2005.

The toolkit contains sections of the Mental Capacity Act 2005:

reflecting on values and bias within mental capacity decision making
the history and current context of mental capacity legislation and policy
the concept of mental capacity
best interests
supporting decision making
deprivation of liberty: human rights
MCA in clinical decisions for care and treatment
MCA and the Office of the Public Guardian (OPG) role

These sections are underpinned by interactive user experiences such as videos and quizzes.

Community Deprivation of Liberty Safeguards (DoLS)

The Hampshire and Isle of Wight Integrated Care Board have created the following fact sheets to support individuals and their families in their understanding of the Community DoLs process:

Mental Capacity and Executive Functioning when there is self-neglect and or alcohol use - June 2024

The Mental Capacity and Executive Functioning when there is self-neglect and or alcohol use webinar was delivered by Kathy Kelly ICB Berkshire West Designate for Safeguarding Adults and Professor Keith Brown Chair of the Berkshire West Safeguarding Adults Board and Edd Bartlett MCA Lead Professional on 11th June 2024.

It was created and credit to Wokingham LA Rebecca Berry and Suzanne Rhodes Adult Safeguarding Quality and Development Manager and Suzanne Rhodes DoLs Manager. The session was delivered in response a Tina SAR Recommendation: the safeguarding adult board to request assurances that all partner agencies are trained in applying the Mental Capacity Act 2005 and completing formal Mental Capacity Assessments, specifically regarding decisional and executive capacity when working with self-neglect and alcohol use. Ensuring that local guidance and training is in place so that mental capacity assessments and reassessments are undertaken where appropriate and, in a manner consistent with the guidance set out in the Mental Capacity Act Code of Practice.

Icon for pdf View/download a copy of the executive capacity and self neglect presentation [1MB] .