Eleanor Roosevelt, 1958

'Where, after all, do universal human rights begin? In small places, close to home -- so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person... Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.' Eleanor Roosevelt, 1958

The Small Places has moved...

The Small Places has moved to a new home here, including all the old posts. Any posts after 6th March 2014 will appear on the new website, but old posts are preserved here so that URLs linking here continue to work. Please check out the new site.

Thursday, 20 January 2011

Respite for Riven's daughter – comments from Re RK

I saw in the news today that the parents of a severely disabled child may be forced to put their daughter into care because – as a result of the cuts – they have lost the support they needed to care for her at home. The case has hit the headlines because the mother concerned had been visited by David Cameron in the run-up to the election, and he had pledged to provide more support for parents like her. Cameron, we are told, is very concerned about this case and has asked the local authority to provide the support the family need. You can read Riven's incredibly moving statement here. This is all very well and good, if it transpires, but what about all the other families who Cameron didn't visit? I'm not sure this case is so unusual, and a recently published judgment on the Mental Health Law online website suggests that – once a child is placed in care due to a lack of support – it may not be so easy to bring them home again.

In Re RK, the parents attempt to argue that their child is effectively deprived of her liberty in the care home they were forced to place her in. Deprivation of liberty is a human rights law concept stemming from Article 5 of the European Convention on Human Rights. If the judge had found that RK was deprived of her liberty, the consequences would have been far reaching, because it would not have been 'in accordance with a procedure prescribed by law' as the Convention requires. It is only lawful to deprive someone of their liberty in certain circumstances. Article 5 does make provision for criminals to be deprived of their liberty in prisons, and also for other groups including psychiatric patients, drug addicts and vagrants (although it's a bit vague on when and why). One of the problems with Article 5, for the government, is that it doesn't make provision for other things that might be a deprivation of liberty, for instance kettling or control orders. This means, for instance, that if kettling protestors were found by a judge to be a deprivation of liberty, the practice of kettling would have to be banned, because it's not one of the permitted uses under Article 5. You can see that this might place a judge under a certain amount of pressure to find that kettling is not a deprivation of liberty. Parliamentary sovereignty, activist judges, European law bossing us around and all that.

Back to RK. Right at the very start of the judgment, at paragraph 6, the council explain that if RK is found to be deprived of her liberty, so might many, many children placed in care homes under s20 of the Children's Act 1989. There is no provision to authorise deprivation of liberty of children under the deprivation of liberty safeguards, and so potentially local authorities would have to apply to the court every time they wanted to authorise placing a child in a care home under s20. They would then have to have this authorisation reviewed on a regular basis by the court. The implications of this could be huge, the council argues – not only because of the time and resources spent applying to the court to authorise all these cases, but because the parents of children deprived of their liberty under the existing framework might try to claim compensation (paras 11-12). This would be a massive drain on the finite, dare I say dwindling, resources of local authorities.

So, before the judge has even considered the situation of the girl at the heart of this case, a loud warning shot is fired by the local authority: if you find she has been deprived of her liberty, the result could be financially crippling to local authorities up and down the country. Are these considerations relevant, we might ask, when the judge has been asked to consider whether RK's situation, on the facts, is a deprivation of liberty? That's a fascinating question. In this great introduction to the Human Rights Act 1998, the authors (including John Wadham – previously director of Liberty, and currently legal director at the Equality and Human Rights Commission) state:

The Lord's approach to deprivation of liberty mirrors that adopted by the domestic courts in relation to Article 3. Faced with absolute rights, the courts apply a proportionality analysis normally reserved for justifying a breach of a qualified right to determine the scope and content of the article. The correctness of this approach is open to question and is likely eventually to be tested before the Strasbourg Court.

What they are commenting on is that when faced with a situation where there is no legal way to justify a deprivation of liberty, the courts apply a 'proportionality' approach to the question of whether a deprivation of liberty has in fact occurred at all. In relation to this case – the judge appears to be considering policy issues as a frame to considering the scope of Article 5. The quibble, in short, is how the financial situation of local authorities' can be relevant to whether this girl is or isn't deprived of her liberty – when surely it's just a question of looking at her situation?

So was RK deprived of her liberty? Would Celyn, Riven's daughter, be, if she were placed in a care home? Ordinarily, when we think of someone being deprived of their liberty, it is in relation to a conscious decision by someone in authority that they will be confined to a particular space and no one is permitted to let them leave. Think of kettling, or control orders, or the situation of prisoners and psychiatric patients. Somebody, somewhere, has decided that they are to be kept within that space. Now, the problem in RK is that s20(8) of the Children's Act 1989 permits the parents to remove her from the care home and bring her home. This means, according to the judge, she can't be said to be deprived of her liberty because no legal obstacle is preventing the family from removing her (para 31). There's the rub; no legal obstacle – that is to say, no court has decided that RK should be removed from her parents' care; the local authority have not applied for a care order or refused to let her go home again. Like Riven, the obstacle the parents face in bringing her home is a lack of support to care for her there. Their lawyers argue that this means that the s20(8) right to bring her home is 'empty', and thus can't be used to argue that the parents are free to bring RK home (paras 32-34). In this argument, RK is effectively deprived of her liberty by a lack of support to care for her at home.

This is where it gets even more interesting. If the judge were to agree that, in effect, RK is unlawfully deprived of her liberty because of a lack of support to care for her at home, he might also have to find that the local authority have a positive obligation to remedy this situation – either by applying for authorisation to detain RK in the care home (or, the more likely preferred option) by supplying those very resources needed to support her in the family home. It looks like this is what the family are trying to do: the proceedings were in fact brought by the family in order to challenge the home care plan the council offered as an alternative to the care home (para 34). Their choice of legal weaponry is interesting. If they thought the care plan was crappy, they could seek a judicial review of the proposed care plan (in fact, para 34 suggests they might). I wouldn't like to speculate how a judicial review would go in this case as I'm far from expert in community care law as it applies to children, but the courts would be forced to take into account RK and her parents' 'right to family life' under Article 8 of the Convention. However, unlike the right to liberty, the right to family life is qualified, and if it carried heavy financial implications it could be weighed against the 'economic wellbeing' of the local authority and the rights of all the other people it has to provide services for. That is to say, Article 5 – if found to be engaged – could be much more potent in releasing the funds.

But, the judge found it wasn't engaged. Despite the practical impossibility of bringing their daughter home, the judge found that their legal right to do so meant she wasn't deprived of her liberty. The judge says 'I do not believe that the means of the parents can as a matter of logic or principle inform the answer to the question of whether RK's liberty is being deprived.' (para 35). So there you have it, it is only the law and people – not a lack of financial means, not poverty – that can deprive one of one's liberty. Deprivation of liberty has to be effected by the decision of a legal subject – is has to be done by someone, not something or some situation.

What does this mean for Riven? Well, if she does decide to place her daughter, Celyn, in a care home, they would be unable to argue that she was deprived of her liberty there to get the local authority to release the funds. They could perhaps seek a judicial review of the local authority decision to cut respite which precipitated their agonising decision. It's unclear how successful they would be, given the sympathy the judges may well have for local authorities' dire financial straits. It's also unclear whether, under the legal aid reforms, they would still qualify for free help and advice – or whether they could afford it if they did not. So what could a family in such circumstances do? Get on the blower to David Cameron, and hope he sits up and listens.

Monday, 17 January 2011

An introduction to the deprivation of liberty safeguards

This posting is a brief summary of the deprivation of liberty safeguards for anyone who doesn't know anything about them, but would like some more information. I'm going to be talking a lot about the deprivation of liberty safeguards and the Mental Capacity Act in future postings, some in more technical detail, so it's handy to have a post for me to refer back to for anyone who's new to the concept.

What is a 'deprivation of liberty'?
It seems logical to being with explaining what a deprivation of liberty is, but unfortunately that's one of the hardest things to understand about the safeguards. It's probably easiest to talk you through their history and some examples, because there is no straightforward definition.

The 'deprivation of liberty safeguards' were introduced in 2009 following a famous court case, often called the 'Bournewood case'. The Bournewood case concerned a man called HL, who was autistic and lived in an adult foster placement in the community with two carers, Mr and Mrs E. One day at his day centre, HL became very agitated and distressed. His GP was called, who gave him a sedative and it was decided to take him to Bournewood Hospital. At Bournewood hospital he was admitted 'informally' for assessment and treatment. An 'informal' admission means the hospital don't have legal powers to detain someone; it basically means they are not 'sectioned' under the Mental Health Act. 'Sectioning' under the Mental Health Act means hospitals can detain people who refuse consent to be admitted and treated; the problem for people like HL is they are deemed to 'lack mental capacity' to either give or refuse consent to be treated. This means that when they are compliant, they were historically treated as if they had consented to being admitted. In law though, if someone lacks mental capacity, their being compliant doesn't mean they have consented. HL was very likely 'compliant' because he was heavily sedated, because he lacked the practical and communication skills to kick up a fuss about being incarcerated, and perhaps he was heavily institutionalised having grown up in a long-stay hospital (Bournewood hospital, in fact).

Things came to a head because the hospital refused to let Mr and Mrs E, HL's carers, visit him. They said this was because they didn't want HL to think he could go home with them. Mr and Mrs E took up court proceedings, demanding that HL be returned to their care. They didn't give up, even when the House of Lords said that HL had not been detained (because he'd never actually tried to run away and been prevented) and that even if he had, professionals had acted out of 'necessity'. They fought the case all the way to the European Court of Human Rights, who agreed with Lord Steyn that it was a 'fairy tale' that HL had been free to leave. The European court heavily criticised the UK system of 'informal' detention, because it lacked any proper safeguards for people and their families to appeal inappropriate detention. In response to this judgement, the UK government drafted the 'deprivation of liberty safeguards'.

Since the 'Bournewood case', there have been many other cases where the courts have been asked to determine whether a person is deprived of their liberty or not. The courts found, for instance, that a man in a care home who was not allowed to return home to his wife was deprived of his liberty. They found that a woman with dementia, who was to be removed from her home because her wandering placed her in danger, was deprived of his liberty when moved to a care home. They found a young man with learning disabilities, who was removed from the care of his mother against his and her wishes, was deprived of his liberty. They found that when Manchester Council removed a young man with learning disabilities from his foster carer on 'safeguarding' allegations, and placed him in supported living, they unlawfully deprived him of his liberty.

However, they also found that another young man with learning disabilities who was removed from his mother's care by police was not deprived of his liberty, in no small part because he didn't want to go back to her. They found that adults or children with learning disabilities who live with their parents or foster carers are generally no deprived of their liberty, even if they are locked in their rooms at night and under their carers' constant monitoring. It's really difficult to give any general rules about what constitutes a deprivation of liberty; in my view the courts haven't really produced a consistent line on this, and it's something I'll try and write about in the future. For now though, if you have any suspicions that you or someone you care about is deprived of their liberty, please read on for information about your rights.

What are the 'deprivation of liberty safeguards'?

The deprivation of liberty safeguards, often called the DoLS, are a set of administrative and legal procedures which are there for the protection of anyone who is deprived of their liberty in care homes or hospitals in the UK. Before going on to outline them, it's important to remember that just because the DoLS only apply in care homes and hospitals, people can be found to be deprived of their liberty in supported living or other types of accommodation as well (see below for more on this).

If a care home or hospital deprives someone of their liberty, they have to apply to their local 'supervisory body' for authorisation. For hospitals, the supervisory body is the local Primary Care Trust. For care homes, the supervisory body is the local authority. Most supervisory bodies have a specialist team who deal with these applications, and the ones I am acquainted with are very approachable and friendly and happy to answer questions from professionals or members of the public with specific concerns. So, once the care home or hospital has applied to the supervisory body for 'authorisation', the supervisory body has to carry out a number of assessments to ensure that the deprivation of liberty a) is actually occurring, b) is appropriate. These include checks on the age of the relevant person, whether they have a qualifying mental disorder that warrants 'detention', how restrictive the type of care being provided is and whether it's in the person's 'best interests' to meet their care or treatment needs in that way. If all the qualifying criteria are met, the supervisory body must grant authorisation to the deprivation of liberty for a maximum period of a year, and ensure that they appoint a 'representative' and/or an Independent Mental Capacity Advocate (IMCA) to ensure the relevant person's rights are upheld (more on this below).

The assessment process

There are two key figures in this assessment process: the mental capacity assessor (often, but not always, a medical doctor) and the 'best interests' assessor. Mental capacity assessors check whether the relevant person has the mental capacity to make decisions about their own care – if they have capacity, they might, for instance, decide they want to stay in the care home or hospital (they 'consent' to it), or they might want to discharge themselves. Best interests assessors make sure the care plan is the 'least restrictive' it can be in order to provide the necessary care, and that it is in the person's best interests to provide care in that way. They should consider alternatives, although there seems to be some confusion about how wide the range of alternatives should be. In one case, the judge said that local authorities should always ensure placements with family carers are the top priority of any possible placements, which suggests that supervisory bodies should be considering whether care could be provided with families – if they are willing, and with appropriate support – rather than placing someone in residential care against their family's wishes.

Representatives and IMCA's

Supervisory bodies should appoint an appropriate friend or relative of the relevant person to be their 'representative' under the DoLS. The representative is a very important figure in the DoLS, and they have lots of special rights that are key to making sure the safeguards operate fairly. A guide for representatives by the Department of Health is available here. Representatives have the right to see any reports or assessments about the relevant person, they must also be consulted by the assessors and kept informed of the status of any deprivation of liberty authorisation procedures. If a representative does not agree with the outcome of the supervisory body's authorisation process, they have the right to seek free legal advice and representation, and appeal in the Court of Protection. These are really really important rights, because otherwise it can be very expensive to get legal advice about a deprivation of liberty case, and you might have to pay a lot of money even to ask permission to take the case to the Court of Protection (if this is your situation, don't give up, see below for more suggestions).

Sometimes people who lack mental capacity don't have any friends or family who would make an appropriate representative. In this case, the supervisory body must appoint them an Independent Mental Capacity Advocate (an 'IMCA') who can stand up for the relevant person's rights. The IMCA is an independent figure, who can scrutinise the DoLS process and make sure everything is going as it should – IMCA's can also refer the case to the Court of Protection if they have any concerns.

Section 39D IMCAs: Vital help for representatives and carers

If you are appointed to be a representative, the DoLS can still be very bewildering and it can be difficult to know what your rights are and how you can protect them. Supervisory bodies have a duty to offer representatives the support of a 'section 39D IMCA'. These are people with considerable experience and knowledge of the DoLS, who are appointed to help both the relevant person and their representative navigate the safeguards. An IMCA could, for instance, come to meetings with professionals and offer support, or could help you understand assessments or legal documents. This is a great resource, but not all supervisory bodies remember to offer this help – in fact, some might not even be aware that you have this right. If you are a representative and you think an IMCA might help you, don't be afraid to ask for one - they can be an invaluable source of support and make the entire DoLS process operate more smoothly.

If you're not a representative

A recent report by the Mental Health Alliance found that some supervisory bodies were deliberately picking representatives who supported the deprivation of liberty, and overlooking carers or relatives who opposed it. This is a bit sneaky, because unless you are appointed to be the representative you don't have access to the reports and information you would need to challenge the deprivation of liberty, and you don't have access to free legal advice or representation to bring the case before the Court of Protection. If this is your situation, and you oppose a deprivation of liberty, there are few avenues left open to you. The best first option is probably to politely raise it with the supervisory body, and request that they consider making you the representative or write to you explaining why you were not considered an appropriate choice. If that does not succeed, you may have to seek further advice from local advocacy services or specialist solicitors (see below for guidance on finding solicitors).

If you think someone is being unlawfully deprived of their liberty

If you think you, or someone you know, is being deprived of their liberty without authorisation, the first people to raise this with are the managing authority of the organisation providing the care. In a hospital, this would be the hospital management. In a care home, this would be the registered care manager. If this is occurring in another setting, for instance 'supported living' accommodation that is not a registered care home (you can check this by looking at their CQC inspection report to see if it says 'care home' or 'domiciliary care'), then you should still raise it with the management but bear in the mind that the DoLS will not apply (read on for more information).

Once you have raised it with the managing authority, they have a duty to consider making an application for authorisation from the supervisory body. If they do this, then the assessment process will be triggered as described above. If they do not, and you still believe the relevant person may be being deprived of their liberty without authorisation, then any member of the public has the right to directly request that the supervisory body assess whether the relevant person is being deprived of their liberty. You can do this by contacting the local authority or PCT directly, saying that you think an unlawful deprivation of liberty is occurring and providing the details. There is also a template letter available in this guidance for carers, provided by the Department of Health.

If the DoLS don't apply

When the DoLS were set up they were intended to apply in care homes and hospitals. Even at the time, the Commission for Social Care Inspection (now the CQC) and various other agencies reminded the Department of Health that lots of people who lack mental capacity – particularly people with learning disabilities – actually live in supported living accommodation rather than care homes. Unfortunately, the Department of Health did not take this advice on board and the DoLS do not apply in care homes. This means that there is no assessment process, no free legal aid for representatives and no free right to take the case before the Court of Protection for concerned relatives. It's a big old mess. Some supported living services actually believe that because the DoLS don't apply to them, it's impossible for them to deprive someone of their liberty. It's not. It's happened in this case, and this. If you think that you or someone you know is being deprived of their liberty in supported living accommodation, or perhaps even in their own home by domiciliary care staff, then probably the best first port of call is to contact the local authority and see if they will initiate an investigation under 'safeguarding' procedures. Some local authorities take deprivation of liberty very seriously, and will do this.

If contacting the local authority or PCT does not resolve the problem, the only option may to bring the case before the Court of Protection. Because the DoLS don't apply, you won't have an automatic right to legal aid, although you may still qualify if you are on a low income (contact the Community Legal Service for more advice on this). If you want to attempt to bring a case without legal representation, you would still have to pay a fee yourself to the court. If you plan to go to court alone, you might find the Personal Support Unit's services helpful. There is guidance here on applying to the Court of Protection; the number for the Court of Protection is 0300 456 4600.

Finding solicitors

People who are deprived of their liberty under the safeguards, and their representatives, have an automatic, non-means-tested right to legal aid.  If you are a representative, or you want legal advice on these matters, you will need to find a solicitor who specialises in the deprivation of liberty safeguards. This may be harder than it sounds, as most high street solicitors do not practice in this specialist area. There are no listings of solicitors who practice in this field, but contacting solicitors from the Mental Health Lawyers Association's regional directory is probably a good start. The Law Society also has a 'find a solicitor' search engine, where you can enter your postcode and choose 'mental health and incapacity' from the dropdown menu. Not all solicitors practicing in mental health law will have expertise in the DoLS, but it is probably worth asking them for recommendations of anyone in the area who can. You may have to phone a great many solicitors firms before you find someone who can take on your case, if this occurs please don't be disheartened and keep persevering. And good luck!

Saturday, 15 January 2011

One month before heartbreak: The human rights cost of the cuts

This blog post is dedicated to the Broken of Britain's One Month Before Heartbreak blogswarm campaign to raise awareness of the impact of the cuts on people with disabilities and their carers. The campaign invites blog posts on related topics from all members of the community; as a researcher in human rights for adults with disability and dementia this is my contribution.

Today in Parliament Maria Miller gave us her assurances that the DLA reforms would not directly violate human rights law. I confess, I haven't examined the small print and don't feel able to comment on whether these particular cuts will be found to directly infringe human rights. As a wider issue though, it seems inevitable to me that in the course of time the cumulative impact of cuts to welfare, social care and related public services will be implicated in human rights violations for some of the UK's most vulnerable citizens. Trying to spell out exactly how the austerity cuts will impact on human rights in the UK is like trying to predict the consequences of global warming: almost every informed sane individual on the planet admits they will cause devastation to thousands of lives, but it's very hard to predict exactly how and where. Loving a challenge, I'm going to try and outline some of the ways the cuts are likely to impact on human rights in social care.

  1. Cuts to mobility DLA in care homes will reduce opportunities for residents to access the community; the Mencap report gives convincing evidence that local authorities will not make up this shortfall. For some individuals who lack mental capacity, whose choices and freedoms in residential care are already very limited, this loss of opportunities to access the community and keep up social contacts may tip the balance towards a deprivation of liberty. The DoLS draft code of practice explicitly stated that if people are not supported to access the community, this could lead to a deprivation of liberty. When Steve Scown from Dimensions UK writes that people may become prisoners in their own home, lawyers' ears should prick up. The European Convention on Human Rights Article 5 gives a range of reasons why it might be permissible for someone to be deprived of their liberty – because it's cheaper isn't one of them.  Article 8 rights to development of the personality may also be infringed without opportunities to be involved in the community and activities; the right to family life may also be implicated if loss of mobility DLA results in significantly impaired opportunities to visit family members.
  2. As the population ages and councils face massive cuts to their central government grant, it seems inevitable that local authority funded social care will be – indeed is being – badly hit. This is likely to have a range of knock-on consequences. With the loss of the ILF and massive cuts to Supporting People grants it will be increasingly difficult for local authorities to fund expensive packages of care in the community, and these care plans may be overlooked in favour of cheaper placements in residential care. This is a retrograde step after decades of working towards improving opportunities for independent living. Families may well be ripped apart as carers are no longer given the support they need to look after their loved ones at home. Just reflect on that for a minute – what is the point of Article 8 of the Convention if not to keep families together wherever possible? Consider this case, of parents who want to bring their child home from residential care but can't do this without an adequate package of care from the local authority. How many more cases like this will see?
  3. When people rely on the local authority to fund their care, the local authority has a duty to consider its resources and find the cheapest way of meeting those needs. We already saw, in a much publicised court case about ballerina Elaine McDonald, how a local authority refused to continue to provide carers to help her with getting to the toilet at night – forcing her to use incontinence pads even though she was actually continent. McDonald, understandably, found this a huge affront to her dignity, but the court found the overriding need to consider resources to be more important. McDonald stated '"I can speak up for myself, but what worries me is what's going to happen to people who can't, people who might have dementia, if they are treated like this?"
  4. Sometimes residential care is a necessity, and community options are unviable. Under unprecedented financial pressure to find the most cost effective placements, local authorities may be forced to overlook issues like keeping families within reasonable travelling distance of each other. For some families this may make it extremely difficult for them to see each other at all. Particularly for those in rural areas and who are dependent on public transport (also likely to be drastically cut), it may be near to impossible to find a way to visit their loved ones. Imagine this: your husband or wife moves into residential care, and you never see them again because you can't find a way to get there. It sounds outlandish, but I promise you it does happen. Or, more commonly, you can get there but it requires you to take an entire day's travel – meaning your visits are limited to weekly or less. Even at the moment, out of county placements are not unheard of for people with very specialist needs. Not so very long ago a court forced the London Borough of Sutton to build a specialist home for a very disabled young woman themselves, so she could sustain regular essential contact with her family. I wonder if the courts would find that way today?
  5. As care providers compete to provide cheaper care they will be forced to make efficiencies themselves, which in turn may result in more restrictive care practices in a variety of ways. As someone who has worked in care for many years myself I can testify that when care providers make cuts to staffing levels or staff hours it becomes increasingly difficult to provide care in a way that is respectful of people's dignity and maximises their freedom. When there aren't enough staff in a care home, for instance, people may be left for long periods of time sitting in soiled clothing, in their own waste, before staff can get to them. When I worked for a domiciliary care provider I remember social workers refusing to fund an extra emergency call for an immobile woman who had been incontinent with diarrhoea: she could wait three hours until the next visit, they said. I wonder how many more times that would occur now (in this case care staff went in their own time, on an uninsured and unpaid visit, to help her out). When service users present with 'challenging behaviour', staff under extreme time pressures are far more likely to reach for the Risperidone than try and figure out what the cause of that behaviour is and find ways to meet the service users' needs. When there aren't enough staff to man a service properly, residents may be shepherded into a single room and the garden will be out of bounds. Activities co-ordinators will probably be among the first to lose their jobs in cash strapped services. Staff training will suffer as council's scale back free courses on dementia care, person-centred planning, the Mental Capacity Act and human rights. In a thousand indirect ways, more than I can detail here, less staff and more poorly trained staff will mean less freedom and less dignity for service users.
  6. As Johann Hari points out in this eloquent piece, brutal cuts to the Care Quality Commission have translated over the years into 75% fewer inspections of care homes. Serious human rights abuses are increasingly likely to be missed under this 'light touch' regime. For people with profound learning disabilities or dementia, for those whose friends and family are not able to visit, not able to recognise the signs of abuse, or not in a position to make a fuss when they do, are at increasingly extreme risk of abuse in a system that relies on the most vulnerable and least able to whistleblow, to raise the alarm themselves.
  7. And finally, I could hardly end this piece without mentioning that for those individuals who do suffer abuse, who are injured or subjected to indignity or are unlawfully deprived of their liberty, cuts to the legal advice and representation they need to access justice may be the most cruel of all. Some, very limited, areas have escaped the legal aid cuts (for instance, those who are subject to the deprivation of liberty safeguards, but not those who are subject to unauthorised deprivation of liberty), but the vast majority of sources of legal help and advice have fallen under the axe. Extra-legal advice services like the Citizen's Advice Bureau has announced closures; advocacy services commissioned by local authorities are coming under threat.  The Court of Protection, already under-resourced from the moment it came into being, is likely to come under increased pressure as more packages of care collapse under the strain. The already lengthy delays to resolve these cases will grow in the face of increasing demand and diminishing resources, often at great personal cost to those involved, and no small cost to the state.
So, I hope this post have given food for thought for any austerity sceptics out there, who would have you believe the Coalition's cuts can be met by greater efficiencies and no suffering. The sad reality that will be borne out over the next few years, unless the government undergoes a radical change in direction, is that the austerity cuts may come at great cost to human rights, to human lives.