Independent Mental Capacity Advocacy (IMCA)

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The Independent Mental Capacity Advocate (IMCA) service was created under the Mental Capacity Act 2005. The Act provides the legal framework for acting and making decisions on behalf of people aged 16 and over who lack the mental capacity to make particular decisions for themselves (at the time the decision needs to be made).

The IMCA service provides safeguards for people who:

  • Lack capacity to make a specified decision at the time that it needs to be made


  • have no family or friends who are willing and able to represent them or to be consulted in the process of working out what is in someone’s best interests in relation to accommodation and serious medical treatment issues.

  • In relation to an alleged perpetrator subject to safeguarding proceedings IMCA’s can still act on behalf of those who DO have family members and friends.

The issue in relation to assessing capacity covers three areas.

  • A person’s ability to understand information relevant to the decision being made

  • Retaining that information

  • Using and weighing up the information in order to make a decision.

If a person is unable to do one or more of the above and is unable to communicate that decision in any way, they are deemed to lack capacity.

The IMCA provides safeguards for people who:

  • are facing a decision on a long term move

(A long term move is defined under the MCA as people staying in hospital for longer than 28 days, or staying in a care home for more than eight weeks).

However, it must be noted that since the MCA was introduced, the Care Act came into force in 2015. This has resulted in the fact that before an IMCA is instructed to act in relation to a long term move an assessment needs to be carried out under the Care Act to determine what the person's level of need is, and how and where it can be best met. The IMCA (if required) would then work with the service user and relevant parties to input into the decision as to where the service user will move to.

The IMCA provides safeguards regarding:

  • serious medical treatment

Serious medical treatment is defined under the act as giving new treatment, stopping treatment that has already started or withholding treatment that could be offered in circumstances where

There is a fine line between likely benefits and burdens to the patient and risks involved

A decision between treatments is finely balanced

What is proposed is likely to have serious consequences for the patient (both physically and psychologically).

  • Alleged perpetrator in relation to safeguarding proceedings (alleged victims are represented under care act legislation).

What is the IMCA’s role?

  • To support people who lack capacity by representing their views to those who are working out what is in their best interests.

They can do this by:

  • Meeting in private the person who lacks capacity

  • Acting in accordance with the principles of the Mental Capacity Act

  • Examining any records relevant to the decision

  • Obtaining the views of professionals and paid workers who care for and treat the person who lacks capacity

  • Finding out what support the person who lacks capacity has had with regard to making the decision

  • Trying to find out what the person's wishes and beliefs would be if they had capacity

  • Finding out possible alternative options

  • Considering if another medical opinion would help the person who lacks capacity

  • Writing a report on their findings to the decision maker

How to make a referral for an IMCA

Click here to make a IMCA referral