Independent Mental Capacity Act Advocacy (IMCA)

An Independent Mental Capacity Advocate is also known as an IMCA.

The role of an IMCA is part of the safeguards under the Mental Capacity Act.  There is a specific criteria for who can access an IMCA. In some circumstances there is a legal duty for a person to have support from an IMCA. The information below outlines:

  • Who has a legal right to an IMCA and when an IMCA must be appointed.
  • Who can make a referral.
  • What an IMCA does
  • How to make a referral

Social Care Institute for Excellence provides excellent further detailed information https://www.scie.org.uk/mca/imca/do

 

Who can access an Independent Mental Capacity Advocate( IMCA)?

People who have been found

  • To lack capacity in the specific decision (outlined below)
  • Have no appropriate person to consult e.g. family or friends who are not paid to provide support for the person.

When must an IMCA be appointed?

  • When a person is having an accommodation change which has been decided by NHS or local authority. This includes accommodation arranged by a local authority or NHS which is likely to be for longer than eight weeks and placement in hospital for a period that is likely to exceed 28 days.
  • When there are decision about a person’s serious medical treatment including withdrawing or withholding what is considered as serious medical treatment.

And

IMCAs are primarily intended to be a safeguard for people who do not have family or friends who can represent them.  The MCA identifies this as having no one other than paid staff with whom "it would be appropriate to consult".  The Code of Practice 10.74 - 10.78 provides more information about how this decision can be made.  For example, if someone has limited family contact or if family live some distance away an IMCA can be instructed

An IMCA can also be instructed for:

Care Reviews, where a person’s review is part of a Care Act process e.g. assessment or support planning then there is a duty to instruct a Care Act Advocate.

Adult Protection but generally a person will be eligible for a Care Act Safeguarding advocating instructed by the local authority.

 

Deprivation of Liberty Safeguards:

IMCAs must be instructed by the local authority supervisory body for people who are being assessed as to whether they are currently being, or should be deprived of their liberty where there is no-one “appropriate to consult”.

IMCAs must also be made available to people who are subject to a standard authorisation in the following circumstances:

  • To fill gaps between appointments of person’s representatives
  • If a person has an unpaid representative, when requested by the person, their representative, or if the Supervisory Body believes either could benefit from the support of an IMCA.

Who can refer for an IMCA:

IMCAs can only work with an individual once they have been instructed by an appropriate person/ body.  For accommodation decisions and care reviews this is likely to be the local authority or CCG responsible for the arrangements.  For serious medical treatment decisions this will be a medical practitioner who has responsibility for the person’s treatment.  For adult protection cases this will be the local authority coordinating the adult protection proceedings.  For the IMCA roles in DOLS this will be the Supervisory Body.  (https://www.scie.org.uk/mca/imca/do).

How to make a referral:

When making a referral it is important that key information is gathered.  Please use this link to Who we can help and referrals information page to access the relevant referral information for your area including the referral forms.

DAD ask referrers to take into account the time needed to undertake their role fully to get to know the person, gather further information and prepare a report.

The IMCA referral form should include the key information needed which includes:

  • Date of Capacity assessment for the specific decision
  • Confirmation there is no unpaid family and friends to consult with.
  • Some detail of the decision being made.
  • Any key dates that the IMCA report is due by e.g. the best interests meeting.

What does an IMCA do?

Gathering information:

  • Meet and interview the person (in private if possible).
  • Examine relevant health and social care records.
  • Get the views of professionals and paid workers.
  • Get the views of anybody else who can give information about the wishes and feelings, beliefs or values of the person.
  • Find out other information which may be relevant to the decision.  

Evaluating information:

  • Check that the person has been supported to be involved in the decision.
  • Try to work out what the person’s wishes and feelings would be if they had capacity to make the decision and what values and beliefs would influence this.
  • Make sure that different options have been considered.
  • Decide whether to ask for a second medical opinion where it is a serious medical treatment decision.

Making representations:

IMCAs should raise any issues and concerns with the decision maker.  This could be done verbally or in writing.  IMCAs are required to produce a report for the person who instructed them.  In most cases this should be provided to the decision maker before the decision is made.

People who instruct IMCAs must pay attention to any issues raised by the IMCA in making their decision.

Challenging decisions:

In many cases IMCAs will be able to resolve any concerns they have with the decision maker before the decision is made. Where this has not been possible IMCAs may formally challenge the decision-making process. They can use local complaint procedures or try to get the matter looked at by the Court of Protection

 

 
 

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