Independent Mental Capacity Advocacy (IMCA)

As part of the Discharge Project, we provide Independent Mental Capacity Advocacy to Lewisham residents who are placed in University Hospital Lewisham and have been assessed as ‘lacking capacity’ to make specific decisions in regards to their discharge destination.

For all other decisions, and for people at the hospital who live outside Lewisham, please contact POhWER on 0300 4562370 or

Who should be referred to the IMCA service?

The local authority/NHS decision maker MUST refer people in the hospital if they have no ‘appropriate’ family and friends and lack capacity to make a decision about either:

  • Serious medical treatment.
  • Long term moves (more than 28 days in hospital/8 weeks in a care home).
  • Deprivation of Liberty Safeguards (DoLS).

The local authority/NHS decision maker MAY refer them if they lack capacity to make a decision about either:

  • Care review - with no ‘appropriate’ family or friends.
  • Safeguarding referral - victim or alleged perpetrator, regardless of family and friends.

How do you know if someone lacks capacity?

Someone may be assessed as lacking the ability to make a decision, and needing an IMCA, if they cannot do one or more of the following:

  • Understand information given to them about the decision.
  • Retain the information for long enough to make the decision.
  • Use or weigh up the information as part of the decision making process.
  • Communicate their decision (by any means, e.g. talking, sign language or blinking).

The assessment must be specific to the decision which needs to be made, for example their medical treatment, not a generic test of capacity. Whether and how such assessments are recorded may vary according to the seriousness of the decision made.

Deprivation of Liberty Safeguards (DoLS)

Managing Authorities (Care Homes or NHS Hospitals) and Supervisory Bodies (Local Authority) have a duty to consult an IMCA when assessing a potential Deprivation of Liberty if there are no appropriate family or friends to consult about the decision. In some situations it may also be appropriate for an IMCA to be requested to offer support to the person deprived of their liberty, or their Relevant Person’s Representative after a DoLS authorisation has been granted.

The DoLS IMCA will ensure that all relevant factors, including the person's wishes and feelings are taken into consideration, by those making decisions about whether or not to grant a deprivation of liberty. If an authorisation has been granted the IMCA can support the person deprived of their liberty or their Representative to understand what DoLS mean and how it is affecting them. They can also support the person or Representative to challenge the authorisation if appropriate. 

You can find out more about DoLS on our IMCA page.

How to Refer

If you are not sure whether an IMCA is relevant or not, call our referral line and we can talk you through the situation and advise you of the best route forward.

Referrals can be made by authorised staff in the local authority or the NHS to the IMCA service by answering some key questions about the person's capacity.

Alternatively, you can download our referral form below.