Autism adult services: recognising when care becomes a deprivation of liberty
Many providers unintentionally drift into deprivation of liberty because restrictions are introduced gradually, justified individually, and never viewed collectively. Recognising when care crosses the legal threshold is essential to protect rights and avoid regulatory failure. This article explains how providers identify deprivation within restrictive practices, DoLS, LPS and legal safeguards, and how lawful application must align with real service models and care pathways rather than paperwork alone.
What deprivation of liberty looks like in practice
Deprivation of liberty is not defined by intent, setting or diagnosis. In adult autism services it often arises when:
- The person is under continuous supervision and control.
- The person is not free to leave.
- The arrangements are imputable to the state.
These elements must be considered together. Focusing on individual restrictions in isolation is a common error.
Why deprivation is often missed
Providers frequently miss deprivation because restrictions feel “normal” or “necessary”. Common blind spots include:
- Staff presence justified as support rather than supervision.
- Locked environments described as “for safety”.
- Lack of explicit refusal masking lack of freedom.
Failure to recognise deprivation exposes providers to legal, regulatory and safeguarding risk.
Operational example 1: supported living with continuous control
Context: An autistic adult lives in supported living with staff present at all times. Doors are locked due to perceived vulnerability.
Support approach: The provider reviews arrangements against the acid test rather than intent.
Day-to-day delivery detail: Staff map supervision, freedom to leave, and decision-making control. A DoLS/LPS application is submitted. Parallel work begins to reduce restriction through graded access and skills development.
How effectiveness is evidenced: Legal authorisation is in place, restrictions are reviewed, and reduction is planned rather than ignored.
Operational example 2: community restriction creating deprivation
Context: A person is allowed out only with staff due to risk concerns.
Support approach: The provider recognises continuous control despite community presence.
Day-to-day delivery detail: LPS is pursued. Risk enablement plans are introduced to reduce staff reliance over time.
How effectiveness is evidenced: Increased independent access and reduced staff presence are documented alongside lawful safeguards.
Operational example 3: deprivation masked by consent assumptions
Context: A provider assumes consent because the person does not object.
Support approach: Capacity and consent are assessed properly, separating agreement from ability to choose freely.
Day-to-day delivery detail: Best interests decisions are documented where needed, with clear review dates.
How effectiveness is evidenced: Records show lawful authority and ongoing reduction of restriction.
Commissioner expectation
Commissioners expect providers to identify deprivation early and apply safeguards lawfully. They will look for proactive applications, not reactive responses following complaints or inspections.
Regulator and inspector expectation (CQC)
CQC expects providers to recognise and authorise deprivation correctly. Inspectors will review restriction practice, authorisation status, and efforts to reduce deprivation over time.
Governance and assurance
- Deprivation screening tools used routinely.
- Central oversight of DoLS/LPS applications.
- Tracking of authorisation conditions and reviews.
- Restriction reduction plans linked to legal safeguards.
What good looks like
Good practice shows that deprivation is recognised early, authorised lawfully, and actively reduced. Providers can evidence that restriction is never ignored, never hidden, and never allowed to drift without scrutiny.