Independent Mental Capacity Advocacy (IMCA)

Aims of the service

Following the 2005 Mental Capacity Act there is a legal requirement for local authorities to fund independent advocacy services for people who lack capacity to make decisions concerning changes of accommodation or serious medical treatment, where there are no appropriate friends or family members to consult.

Bath and North East Somerset Council has approved and funded Bath Mind to provide this independent service. All Independent Mental Health Capacity Advocates (IMCAs) are specifically trained professionals who represent their clients to those responsible for making 'best interest' decisions.

When should an IMCA be involved?

An IMCA must be instructed and then consulted, for people lacking capacity who have no-one else to support them (other than paid staff), whenever:

• An NHS body is proposing to provide serious medical treatment. Or
• An NHS body or local authority is proposing to arrange accommodation (or a change of accommodation) in hospital or in a care home and
• The person will stay in hospital longer than 28 days, or
• They will stay in the care home for more than 8 weeks.

An IMCA may also be instructed to support someone who lacks capacity to make a decision concerning:

• Care reviews, where no-one else is available to be consulted.
• Protection of Vulnerable Adult procedures, whether or not family, friends or others are involved.

Are there any exceptions?

The only exceptions when an IMCA need not be involved are situations where an urgent decision is needed, for example to provide emergency medical treatment to save a person’s life, or when the person would be homeless unless they were accommodated at a care home.

Who instructs an IMCA?

The person who instructs an IMCA is the professional who will ultimately have to make the decision concerning serious medical treatment or a change of accommodation, or is responsible for a care review or an adult protection case.

What will an IMCA do?

A full and definitive description of the IMCA service and the role of the IMCA is set out in Chapter 10 of the Mental Capacity Act 2005 Code of Practice and will include the following:

• Meeting in private with the person who lacks capacity and attempting to communicate with them, using whatever means appropriate
• Speaking with the decision maker and any other relevant professionals to understand what is being proposed
• Getting the views of anybody else who can give information about the wishes, feelings, beliefs or values of the person who lacks capacity
• Consulting any relevant records, including health and social care records and advance directives
• Finding out what the person who lacks capacity has had to help them make the specific decision
• Finding out what alternative options there are
• Writing a report on their findings for the decision maker.

Will the IMCA be part of the decision making process?

The IMCA’s role will be in many ways similar to that of a concerned relative of the person who lacks capacity. They will not be part of the decision making process, but will provide information that the decision maker must take into account when making the decision. The decision maker may choose to disregard the information or recommendation, but must show a reason why they have done so. If the IMCA is concerned about the decision that has been made, or is concerned that the decision maker is not acting in the best interest of the person who lacks capacity, they may go through the existing procedures to challenge the decision.