Supporting People with Learning Disabilities.
Independent Mental Capacity Advocacy (IMCA)
What is an IMCA?
When individuals are unable to make certain important decisions for themselves due to a lack of mental capacity, the law provides a vital safeguard: Independent Mental Capacity Advocacy (IMCA). This service ensures that people who are most at risk and without close family or friends to represent them have a dedicated, independent voice in key decisions about their lives.
An Independent Mental Capacity Advocate (IMCA) is a trained professional appointed to support and represent people who:
-
Lack the capacity to make specific decisions (as defined by the Mental Capacity Act 2005 in England and Wales)
-
Have no appropriate family or friends to consult
-
Are facing decisions about serious medical treatment or changes in accommodation, such as moving into a care home or hospital for long-term care
The role of an IMCA is not to make decisions on behalf of the person but to ensure that their rights, wishes, and best interests are at the center of the decision-making process.
What IMCAs Do
An IMCA will:
-
Meet with the person to understand their views, preferences, and past experiences
-
Consult with professionals involved in the person’s care
-
Review relevant records and information
-
Write a formal report that must be considered by decision-makers (e.g., doctors, social workers)
-
Challenge decisions if necessary, including through formal appeals or complaints
When is an IMCA Required?
An IMCA must be involved in decisions regarding:
-
Serious medical treatment when the person lacks capacity and has no one appropriate to consult
-
Long-term accommodation moves in NHS or local authority care
Local authorities may also involve an IMCA in other decisions, such as care reviews or safeguarding processes, even if not legally required.
Who Can Refer for an IMCA?
Referrals for an Independent Mental Capacity Advocate (IMCA) must be made by health or social care professionals involved in the person's care. These are typically decision-makers who are responsible for making serious decisions about the person's treatment or accommodation when the person lacks the capacity to decide for themselves.
When Should a Referral Be Made?
A referral is required by law when:
-
The person lacks capacity to make a serious medical treatment decision or a long-term move (e.g. into a care home or hospital)
-
The person has no appropriate family or friends to consult
IMCAs may also be involved in other situations (such as adult safeguarding or care reviews) at the discretion of the local authority, even if the person has family or friends.
Deprivation of Liberty Safeguards IMCA
What are DOLS?
DOLS were introduced by the Mental Capacity Act 2005 and came into effect in April 2009. They provide a legal framework and right to appeal for vulnerable people to ensure they are not deprived of their liberty unless it is in their best interests. They do not apply to anyone who is subject to the Mental Health Act except in rare circumstances. DOLS only apply within care homes and hospitals, to people who are 18 and over and who
- lack capacity to agree to care or treatment, and
- are suffering from a disorder of the mind, and
- their carers believe it is in their best interests to deprive them of their liberty to protect them from harm.
If someone is going through the DOLS process and does not have someone who is appropriate to consult, under the Mental Capacity Act they have the legal right to an IMCA. There are three IMCA roles in the DOLS process:
The IMCA DOLS has a very similar role to the original IMCA role. The advocate will;
- make representations about a person’s wishes, feelings, beliefs and values in relation to the decision being made
- enable the person to participate as fully as they can in the decision making process
- obtain and evaluate the relevant information to the decision
- ascertain any alternative courses of action that may be available
- obtain a further medical opinion if necessary
- bring all factors relevant to the decision to the attention of the decision maker(s)
- challenge decisions if appropriate
- produce a report commenting on the decision to be made and how the individual’s best interests can be promoted
The IMCA DOLS must be instructed by the supervisory body if the person subject to the DOLS has no-one who is appropriate to consult, namely family or significant friends. The S39A IMCA has additional rights and responsibilities to the original IMCA role. The S39A IMCA should be given the relevant paperwork concerning the case, for instance assessments from the supervisory body. They also have the right to apply to the Court of Protection for permission to take the person’s DOLS case to court.
If the DOLS are authorised, a representative must be appointed by the supervisory body to remain in contact with the person and represent them in all matters relating to the DOLS. There are two instances when an IMCA may be instructed:
- If a representative cannot be identified, then a paid representative can be nominated. This can be an IMCA.
An IMCA can also be nominated if there is a gap while a representative is being replaced. This is called a S39C IMCA.
The person who is subject to DOLS and / or their representative have the right to access an IMCA if they wish. The IMCA can provide information and support around the DOLS process and how to access a care review or the Court of Protection. This service is not available to a paid representative.
How to refer
All of these IMCA roles have to be instructed through the supervisory body (the local authority or PCT DOLS office). Anyone else who is aware that an IMCA is required should direct their concerns to the supervisory body DOLS office.
For Plymouth:
DoLs Office, Plymouth City Council, Windsor House, Tavistock Road, Plymouth, PL6 5UF
Tel: 01752 308889