IMCA

Also called Independent Mental Capacity Advocate, Independent mental capacity advocacy

An advocate the law says must be appointed when a person lacks capacity for a serious decision and has nobody independent to consult.

What it is

An Independent Mental Capacity Advocate is a specific role created by sections 35 to 41 of the Mental Capacity Act 2005, for England and Wales. When a person has been assessed as lacking capacity for certain serious decisions and there is nobody appropriate to consult, apart from paid staff, the NHS body or council making the decision must instruct an IMCA before it decides.

The IMCA does not make the decision. They represent the person, gather their wishes and feelings, check the decision-maker has followed the Act, and can challenge the decision if it has not. Scotland and Northern Ireland do not have IMCAs by that name; Scotland relies on the general advocacy right and on the Adults with Incapacity Act's safeguards.

Who it can help

A person aged 16 or over, who lacks capacity for the decision in question, where the decision is about serious medical treatment or a move to hospital for more than 28 days or a care home for more than eight weeks, and who has no family or friends it would be appropriate to consult. In those cases instructing an IMCA is mandatory, not optional.

Councils and NHS bodies also have a power, not a duty, to instruct an IMCA for care reviews and adult safeguarding, and in safeguarding cases the person may have family. It is not for people who have capacity, and it is not for people who have an attorney or deputy able to act on that decision.

How it works

The IMCA meets the person, in private if possible, and finds out everything they can about the person's wishes, feelings, beliefs and values, using whatever communication the person has. They read the records, talk to staff, and can get a second medical opinion for treatment decisions. They write a report which the decision-maker must take into account.

For a person who communicates without speech, the IMCA's first task is to find the people who know how that person communicates and to spend enough time to see it for themselves. A good IMCA will ask for the person's communication dictionary and passport and will spend time with the person on more than one day. Where the decision-maker ignores the report, the IMCA can use the complaints process or apply to the Court of Protection.

Getting started

If you are a care worker or a nurse and a serious decision is being made for someone with no family who lacks capacity, ask out loud whether an IMCA has been instructed. Every NHS trust and council has a contracted IMCA provider and a referral form; the duty to refer sits with the decision-maker but anyone can prompt it.

If you support the person, hand the IMCA everything you have about how they communicate: what a smile means, what turning away means, which symbols they use, what their device says. Offer to be present the first time the IMCA meets them, then step back so the meeting can be private.

If you think an IMCA should have been instructed and was not, say so in writing to the decision-maker. A serious decision made without a mandatory IMCA is unlawful and can be reopened.

Where to get help

SCIE publishes the standard IMCA guidance and training. The Mental Capacity Act Code of Practice, chapter 10, sets out the duty. Mencap and Age UK can explain how to find the IMCA service in your area. For the wider picture see independent advocacy and best interests.