Independent Mental Capacity Advocates (IMCAs)

If you're not able to understand information or make certain decisions, you're legally entitled to an IMCA. They can help you with big decisions, such as what treatment to have for your mental health.

What is an IMCA?

An Independent Mental Capacity Advocate (IMCA) is an advocate who can act for you if you lack capacity to make certain decisions. 

Your mental capacity means your ability to understand information and make decisions about your life. It can also mean the ability to communicate decisions about your life. Our pages on the Mental Capacity Act have more information on what lacking capacity means.

If you're entitled to an IMCA, they will be appointed to act on your behalf. In England, local authorities appoint IMCAs. In Wales they're appointed by a local Health Board or other NHS body. 

When am I entitled to an IMCA?

You have the right to an IMCA if:

• You're 16 or over, lack capacity to make certain decisions for yourself and do not have a close family member or a person who cares for you to support you
• You have no one to represent your views, and an NHS body or local authority is reviewing or planning for you to go into a hospital or care home long-term
• It would help you when there is an allegation that you've been abused

Usually, you won't be given an IMCA if:

• You've appointed someone to make your decisions for you, such as an attorney under a lasting power of attorney
• The Court of Protection has appointed a deputy to make your decisions for you
• You've nominated someone to be consulted about matters that affect you
• You have a close family member or unpaid carer who can support you to make decisions
• You're detained under the Mental Health Act

Our pages on sectioning have more information if you've been detained under the Mental Health Act. In this case, you may have the right to support from an independent mental health advocate (IMHA).

How can an IMCA help me?

An IMCA should help you in these situations:

• The NHS wants to provide serious medical treatment to you. For example, a treatment where there's a fine balance between the possible benefits and risks. So you might benefit from it, but equally you might experience problems. Or when there's a choice of treatments but there isn't one that's clearly best for you. And the good and bad things about each need to be considered. 
• The NHS wants to withhold or stop a treatment, and this has serious consequences for you.
• There are plans to give you long-term accommodation in hospital or a care home. But if the arrangements are urgent, the NHS or local authority does not have to appoint an IMCA. 'Long-term' means more than 28 days in hospital, or more than 8 weeks in a care home. 
• In some cases, if the professionals apply for a standard or urgent authorisation to deprive you of your liberty under deprivation of liberty safeguards. You might already have a relevant person's representative helping you challenge an authorisation. Even so, both you and your relevant person's representative are entitled to an IMCA.

And your IMCA can do these things to support you:

• Visit you in a care home, hospital or other place. They should be able to speak to you in private, unless you want someone else there to support you. If you find it hard to make your views known verbally, spending time with you and seeing how life is for you right now may help the advocate.
• Help collect relevant information to make a decision – for example your health records.
• Consult with health professionals providing your care and treatment, if you agree.
• If appropriate, consult other people who may be able to comment on your wishes, feelings, beliefs and values. For example, if you're unable to comment yourself at the time.
• Support you to make decisions for yourself. For example, they can tell you what your options are. Or if your decision is about medical treatment, they might suggest you get another medical opinion.
• Make sure that the least restrictive options for your care and treatment have been considered.
• Make sure that relevant guidance has been followed. This includes the best interests checklist and the Mental Capacity Act Code of Practice.
• Write a short report with their findings, giving their opinion on how the decision should be made in your best interests.
• Help you complain. This could happen if the IMCA believes that health professionals have not considered your wishes or their opinion about what's in your best interests. Or if there is a disagreement between the professionals about what's in your best interests. The IMCA can complain to the NHS hospital or trust, or the local authority. Or they could ask the Court of Protection for a decision.