Independent Mental Capacity Advocacy (IMCA)

Support with best interests decisions

Your compassion, expertise and professionalism are a credit to you. We are now all working together to make sure Lucy’s needs are met exactly how she wants.

Marie, complex care nurse specialist, who referred Lucy for advocacy

Independent Mental Capacity Advocates (IMCAs) support people when they are assessed to lack capacity to make a best interest decision and they do not have family or friends appropriate to consult about the decision.

When can an IMCA help?

An IMCA can support someone with best interests decisions about

  • long-term accommodation (to hospital for more than 28 days or to other accommodation for more than 8 weeks)
  • serious medical treatment (this can be a decision about whether to stop or withhold treatment, as well as a decision to start it)

Also, if the person is or may be deprived of their liberty, the IMCA can provide support

  • during an assessment under Deprivation of Liberty Safeguards (DoLS)
  • between the appointment of Relevant Person’s Representatives (RPRs) when an authorisation is in place
  • to the person, RPR or both when the authorisation is in place

An IMCA can also support with these, although sometimes a Care Act referral is more appropriate

  • a care review following a long-term accommodation decision (sometimes known as a placement review), 4-6 weeks after placement
  • safeguarding issues

In the case of a care review or safeguarding, a Care Act referral can sometimes be more appropriate than an IMCA referral. The Mental Capacity Act gives professionals the power to make an advocacy referral in these situations, whereas the Care Act gives them a duty.

Responsible Bodies are expected to take a strategic approach to when they will use IMCAs for care reviews and safeguarding and when they will use Care Act advocates. This may vary locally and we are happy to advise about what applies in your area. 

What does lack capacity’ mean?

An assessment that someone lacks capacity’ means that

  1. the person has an impairment or disturbance that affects the way their mind or brain works (such as a brain injury, dementia, autism, learning disabilities, mental health problems)
  2. the impairment or disturbance means that they are unable to make a specific decision at the time it needs to be made

Both conditions must apply.

What does an IMCA do?

The advocate’s role is, as far as possible, to

  • make sure that the person’s views and wishes are taken into account in the best-interests decision
  • support the person to be involved in the decision, or to represent them if necessary

Even when someone can’t tell their advocate what they want, our advocates will use a range of approaches to establish their views and wishes as far as possible and secure their rights.

In some circumstances, an advocate has the right to access medical or care records on behalf of the person they are supporting. An advocate may write a report that must be taken into consideration by professionals.

Information in Easy Read