IMCA and RPR

What is Independent Mental Capacity Advocacy (IMCA)?

When a doctor or social worker asseses someone as lacking capacity to make an important decision, they are entitled to the support of an IMCA. Under the Mental Capacity Act 2005 this is a legal right for all people aged over 16 in England, if they lack capacity and do not have an appropriate family member or friend to represent their views. An IMCA is only needed if the person cannot understand information relevant to a particular decision, retain it, weigh up the pros & cons and then communicate their decision.

An IMCA is independent of health and social care services and will represent the individual in discussions to work out whether the proposed decision is in their best interests, taking account of their current and previous wishes, beliefs and preferences.

You have the right to an IMCA if:

  • You have been assessed as lacking capacity to make certain important decisions at the time the decisions need to be made, and
  • you have nobody else to support or represent you, or to be consulted (other than paid staff).

An IMCA must be instructed, and then consulted, in relation to the following decisions:

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

An IMCA may be instructed, and then consulted, in relation to the following decisions:

  • care reviews, where nobody else is available to be consulted
  • adult protection (or 'safeguarding') cases, whether or not family, friends or others are involved.
How would an IMCA work with you?

The IMCA’s role

The IMCA will support and represent you in discussions to work out whether the proposed decision is in your best interests. The IMCA provides information to help work out what is in your best interests and to help with this they consult widely with people who know you, and those involved in your health and/or social care.  IMCAs have the right to see relevant healthcare and social care records to inform this process. IMCAs then raise questions or challenge decisions which appear not to be in your best interests. The information they provide to the decision maker must be taken into account when making the final decision.

An IMCA would work alongside you in the following ways:

  • visit you in hospital, a care home or wherever you are living. You should be able to speak in private, unless you would prefer someone else there.
  • help collect relevant information about the decision that needs to be made – for example  health or social care records.
  • with your consent, consult with health and social care professionals providing the care and treatment.  If appropriate, they can also consult other people who may be able to comment on your wishes, feelings, beliefs and values, if you are unable to comment yourself at the time.
    • support you to make decisions yourself – for example:
    • identifying your wishes, feelings, beliefs and values, or what these would be if you had the capacity to make the decision
    • explaining the options available
    • if the decision is about medical treatment, they can suggest whether it would be useful to get a second medical opinion
    • making sure that the Mental Capacity Act Code of Practice has been followed and the decision has been made in your best interests and is the least restrictive option.
    • writing a short report with their findings
  • If the IMCA believes that their opinion has not been taken into account by professionals, or if there is a disagreement between the professionals about what is in your best interests, they can:
    • make a complaint to the NHS body (the hospital or trust) or the local authority, or
    • take the matter to the Court of Protection for a decision.