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Mental Capacity Act 2005
DEPRIVATION OF LIBERTY FORM No. 10
BEST INTERESTS ASSESSMENT
PART A — WHY THIS FORM IS BEING COMPLETED
Place a cross in ONE of the boxes below Ø
A1 This form is being completed in relation to a request for a standard authorisation.
(If you place a cross in this box you must also take the person being assessed
through the steps necessary to appoint a representative and complete Form 24.)
A2 This form is being completed in relation to a review of an existing standard
authorisation under Part 8 of Schedule A1 to the Mental Capacity Act 2005.
Note: Where the supervisory body decides that the best interests requirement should
be reviewed solely because details of the conditions attached to the authorisation need
to be changed, and the review request does not include evidence that there is a
signi cant change in the person’s overall circumstances, there is not need for a full
reassessment of best interests. This form does not need to be completed in such a case,
and the supervisory body can simply vary the conditions attached to the authorisation in
such ways, if any, as it considers appropriate. In making any decision whether a change
is signi cant, regard must be had to the nature of the change and the period that the
change is likely to last for.
PART B — BASIC INFORMATION
Name, address and profession of the assessor
Full name of the person being assessed
Their date of birth (or estimated age if unknown)
Name of the hospital or care home in which the
person is, or may become, deprived of their liberty
Name of the PCT or local authority that is the
supervisory body
Name
Address
Profession
Name
DOB
Est. age Years
Name
Name
ddm
m
yyyy
CASE
NUMBER
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The present address of the person being
assessed
(Place a cross in the relevant box and, where
applicable, state the address)
Address of the hospital or care home in which the
person is, or may become, deprived of their liberty
(Place a cross in the relevant box and, where
applicable, state the address)
PART C — PERSONS CONSULTED AND MATTERS TAKEN INTO ACCOUNT
I have assessed whether the person meets the best interests requirement.
C1 PERSONS WHO HAVE BEEN CONSULTED
Note: before embarking on the full best interests assessment consultation process, the best interests
assessor may rst wish to check that there is prima facie evidence that a deprivation of liberty may be
occuring, or is likely to occur, since, if it is apparent that there is no deprivation of liberty, the full best
interests consultation process will be unnecessary.
Place a cross in the boxes below to con rm the statements in A, B or C Ø
A I have spoken to the person to whom this assessment relates, in accordance
with section 4(6) of the Mental Capacity Act 2005.
B I have consulted the managing authority of the hospital or care home and
taken their views into account.
C In carrying out this assessment, I have also consulted the following interested persons:
Note: before completing the rest of Part C, please read the notes at the end of the form, and in particular
the de nition of ‘interested persons’.
As stated on the request for a standard
authorisation
As stated immediately below
Address
As stated on the request for a standard
authorisation
As stated immediately below
Address
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D I have consulted the following additional individuals who were named by the person being assessed
as people to be consulted in relation to the matters now under consideration, and have taken their
views into account:
Name Address
1
2
3
4
5
If
more than ve interested persons were consulted, please give the names and addresses of any
other individuals in Part G of this form.
Name Address
1
2
If more than two people in this category were consulted, please give the names and addresses of
any other individuals in Part G of this form.
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E I have consulted the following additional individuals, who are engaged in caring for the person being
assessed or are interested in their welfare, and have taken their views into account:
C2 MATTERS THAT I HAVE CONSIDERED AND TAKEN INTO ACCOUNT
I have considered what I believe to be all of the relevant circumstances and, in particular, the
matters referred to in section 4 of the Mental Capacity Act 2005.
I have taken into account the conclusions of the mental health assessor as to how the person’s
mental health is likely to be affected by their being deprived of liberty.
I have taken into account any assessment of the person’s needs in connection with accommodating
the person in the hospital or care home.
I have taken into account any care plan that sets out how the person’s needs are to be met while
the person is accommodated in the hospital or care home.
In carrying out this assessment, I have taken into account any information given to me, or
submissions made, by any of the following:
(a) any relevant person’s representative appointed for the person
(b) any IMCA instructed for the person in relation to their deprivation of liberty.
Note: if this form is being used to record a Part 8 review assessment, and the best interests requirement
is being reviewed solely because details of the conditions attached to the standard authorisation need to
be changed in a situation in which there is a signi cant change in the person’s overall circumstances, now
proceed directly to Part F4 of this form.
Name Address
1
2
If more than two people in this category were consulted, please give the names and addresses of
any other individuals in Part G of this form.
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PART D — WHETHER PERSON MEETS THE BEST INTERESTS REQUIREMENT
Note: if the answer to ANY of the questions D1 to D4 is No then the person is NOT eligible to be deprived of
their liberty under the Mental Capacity Act 2005. Only if the answer to ALL of the questions below is Yes is
the best interests requirement met.
In my opinion:
Place ONE cross in each row (no need to complete questions D2 to D4 if the answer to
question D1 is No) Ø
D1 The person is, or is to be, kept in the hospital or care home for the purpose Yes No
of being given care or treatment in circumstances that amount to depriving
them of their liberty.
D2 This is in the person’s best interests. Yes No
D3 This is necessary in order to prevent harm to the person. Yes No
D4 This is a proportionate response given the likelihood that the person will Yes No
otherwise suffer harm and the seriousness of that harm.
Reasons for opinion
D5 The reasons for my opinion concerning whether or not the proposed arrangements for the person’s
care and/or treatment amount to depriving them of their liberty in the hospital or care home are:
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D6 If the proposed arrangements amount to depriving the person of their liberty, the reasons for my
opinion that they are, or are not, in the person’s best interests are:
Note: you should consider the provisions of section 4 of the Mental Capacity Act 2005, the additional factors
referred to in paragraph 4.61 of the deprivation of liberty safeguards Code of Practice and all other relevant
circumstances. Remember that the purpose of the person’s deprivation of liberty must be to give them care
or treatment. You must consider whether any care or treatment the person needs can be provided effectively
in a way that is less restrictive of their rights and freedom of action.
D7 If the proposed arrangements amount to depriving the person of their liberty, the reasons for my
opinion that they are, or are not, necessary in order to prevent harm to the person are:
Note: include particulars of the harm that will be avoided by depriving the person of their liberty.
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D8 If the proposed arrangements amount to depriving the person of their liberty, the reasons for my
opinion that they are, or are not, a proportionate response to the likelihood of the person otherwise
suffering harm and the seriousness of that harm are:
Note: include why the risk of harm, and the seriousness of the harm, justi es deprivation of liberty.
Please go on to:
Part E of the form if the best interests requirement is not met; OR
Part F of the form if the best interests requirement is met.
PART E — BEST INTERESTS REQUIREMENT IS NOT MET
Part E must be completed if you decided that the best interests requirement is not met.
Place a cross in EITHER box E1 or E2 below Ø
E1 For the reasons given above, it appears to me that the person IS, OR IS LIKELY TO BE,
deprived of their liberty. In my view, the deprivation of their liberty under the Mental
Capacity Act 2005 is not appropriate. Consequently, unless the deprivation of liberty
is authorised under other statute, the person is, or is likely to be, subject to an
unauthorised deprivation of liberty.
E2 For the reasons given above, it appears to me that the person IS NOT, OR IS NOT LIKELY
TO BE, deprived of their liberty. Consequently, the person is not, or is not likely to be,
subject to an unauthorised deprivation of liberty.
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If you have put a cross in box E1, please offer any suggestions that you have that may be bene cial to
the commissioners and/or providers of services in deciding on their future action. This might, for example,
include a recommendation about an alternative approach to care or treatment that would avoid deprivation
of liberty:
PART F — BEST INTERESTS REQUIREMENT IS MET
If you are recording a Part 8 review assessment simply record the maximum
authorisation period already granted and ignore Box F2
F1 MAXIMUM AUTHORISATION PERIOD
State period in the box below. This must not exceed one year Ø
In my opinion, the maximum period it is appropriate for the
person to be deprived of liberty under this standard authorisation is:
F2 DATE WHEN THE STANDARD AUTHORISATION SHOULD COME INTO FORCE
I recommend that the standard authorisation should come into force:
Place a cross in box A or enter the date in row B Ø
A As soon as possible
B On (date):
ddm
m
yyyy
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F3 RECOMMENDATIONS AS TO CONDITIONS
Complete F3 if you are completing this form in connection with a request for a standard
authorisation.
Complete F4 INSTEAD if you are completing this form to record a Part 8 review assessment.
Do NOT complete both F3 and F4.
See the notes at the end of this form for guidance on imposing conditions.
Place a cross in box A or box B Ø
A I have no recommendations to make as to the conditions to which any standard
authorisation should or should not be subject (proceed to Part G of this form).
B I recommend that the conditions speci ed immediately below should be attached
to any standard authorisation that is given.
Any standard authorisation given should be subject to the following conditions:
(If more than six conditions are recommended, please add any additional conditions in Part G.)
1
2
3
4
5
6
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Should any recommended conditions not be imposed:
If you have made recommendations about conditions, place a cross in one of the boxes below Ø
A I would like to be consulted again, since this may affect some of the other
conclusions that I have reached in my assessment.
B I do not need to be consulted again, since I do not think that the other conclusions
reached in this assessment will be affected.
F4 RECOMMENDATIONS AS TO VARYING ANY CONDITIONS
Only complete F4 if you are using this form to record a Part 8 review assessment. In all other cases,
do not complete F4.
Place a cross in EITHER box A OR box B Ø
A I am of the opinion that the existing conditions to which the standard authorisation is
subject are appropriate and should not be varied.
B I recommend that any existing conditions to which the standard authorisation is subject
should be varied in the way shown immediately below.
The conditions to which the standard authorisation is subject should be varied so that the person is now
subject to the following conditions and to no others:
(If there are more than six conditions, please add any additional conditions in Part G of this form.)
1
2
3
4
5
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PART G — ANY OTHER RELEVANT INFORMATION
Please use the space below to record any other relevant information, including any additional conditions
that should or should not be imposed and any other interested persons consulted by you.
PART H — THE AGE ASSESSMENT
Place a cross in ONE of the four boxes below Ø
H1 The person’s date of birth is given on the rst page of this form and this form
also constitutes the age assessment that is required.
H2 I have not been able to ascertain the person’s exact date of birth. However, I am
satis ed that they are aged 18 or over, and this form also constitutes the age
assessment that is required.
H3 It is not clear whether or not the person is aged 18 or over. In my opinion, a more
detailed age assessment is required and Form 5 should be completed.
H4 In my opinion, an age assessment is not required. The current request is for a
replacement standard authorisation and there is no reason to believe
that the age assessment previously done is not accurate.
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Signed
Dated
WHAT TO DO NOW
It is essential that you give a copy of this assessment to the supervisory body as soon as you have
completed it. This is because the supervisory body may not give a standard authorisation unless and until it
has written copies of all the assessments.
If the person does not meet the best interests qualifying requirement, a standard authorisation may not be
given and all other on-going assessments should stop. You should immediately notify the supervisory body,
and then provide them with a copy of this assessment as soon as practicable. You must keep a written
record of the assessment.
Unauthorised deprivation of liberty
See below concerning the steps that must now be taken.
NOTES
Providing the eligibility assessor with relevant information
The eligibility assessor, if they are not also the best interests assessor, must ask the best interests assessor
to provide them with any relevant eligibility information that the best interests assessor may have, and the
best interests assessor must comply with the request. Relevant information might, for example, include:
(a) whether the person is subject to guardianship under the Mental Health Act 1983
1
or meets the
statutory criteria for being detained under section 2 or 3 of that Act; and, if so
(b) whether they object to being accommodated in hospital in order to be given the treatment that it is
proposed to give them there for their mental disorder; and, if they do
(c) whether any donee of a lasting power of attorney or deputy appointed by the Court of Protection
has consented to each matter to which they themselves object.
De nition of ‘interested persons’
Any of the following is an interested person:
(a) the relevant person’s spouse or civil partner
(b) where the relevant person and another person of the opposite sex are not married to each other but
are living together as husband and wife: the other person
(c) where the relevant person and another person of the same sex are not civil partners of each other
but are living together as if they were civil partners: the other person
(d) the relevant person’s children and step-children
(e) the relevant person’s parents and step-parents
(f) the relevant person’s brothers and sisters, half-brothers and half-sisters, and stepbrothers and
stepsisters
(g) the relevant person’s grandparents
1 References in this form to provisions of the Mental Health Act 1983 include provisions of other enactments that have the same effect
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(h) a deputy appointed for the relevant person by the court
(i) a donee of a lasting power of attorney granted by the relevant person.
One person is another’s partner if the two of them (whether of different sexes or the same sex) live as
partners in an enduring family relationship.
Recommending that conditions are or are not imposed
According to the law, the best interests assessor may recommend that conditions should be attached to a
standard authorisation, but should not specify conditions that do not directly relate to the issue of deprivation
of liberty. Conditions could, for example, deal with contact issues, issues relevant to the person’s culture or
other major issues related to the deprivation of liberty, without which deprivation of liberty would cease to be
in the person’s best interests. Conditions may also be recommended to work towards avoiding deprivation
of liberty in future.
Unauthorised deprivation of liberty
The supervisory body and managing authority must address the situation urgently where there is an
unauthorised deprivation of liberty. The possibility of legal proceedings may arise.
Paragraph 5.24 of the deprivation of liberty safeguards Code of Practice states as follows:
‘Where the best interests assessor comes to the conclusion that the best interests requirement is
not met, but it appears to the assessor that the person being assessed is already being deprived of
their liberty, the assessor must inform the supervisory body and explain in their report why they have
reached that conclusion. The supervisory body must then inform the managing authority to review the
relevant person’s care plan immediately so that unauthorised deprivation of liberty does not continue.
Any necessary changes must be made urgently to stop what would be an unlawful deprivation of
liberty. The steps taken to stop the deprivation of liberty should be recorded in the care plan. Where
possible, family, friends and carers should be involved in deciding how to prevent the unauthorised
deprivation of liberty from continuing. If the supervisory body has any doubts about whether the matter
is being satisfactorily resolved within an appropriately urgent timescale it should alert the inspection
body.’
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