Advocacy in mental health

Explains what advocacy is and how it can help you. Gives information on different types of advocacy, including statutory advocates, what sort of situations an advocate can help you with, and how to find an advocate.

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What are Independent Mental Capacity Advocates (IMCAs)?

What is an IMCA?

An Independent Mental Capacity Advocate (IMCA) is an advocate appointed to act on your behalf if you lack capacity to make certain decisions. (See our pages on the Mental Capacity Act 2005 for more information what ‘lacking capacity’ means.)

In England, IMCAs are appointed by a local authority, and in Wales they are appointed by a local Health Board or other NHS body in Wales.

When am I entitled to an IMCA?

You have the right to an IMCA in these situations:

If you are 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.
If you have no one to represent your views and an NHS body or local authority is reviewing or planning to review your accommodation, or it would be helpful to you when there is an allegation that you have been abused.

You will usually not be given an IMCA if:

you have appointed someone to make your decisions for you, such as an attorney under a lasting power of attorney.
the court has appointed a deputy to make your decisions for you
you have nominated someone to be consulted about matters that affect you
you have a close family member or unpaid carer who can support you in the process of making decisions
you are detained under the Mental Health Act 1983 (see our pages on sectioning for more information). However, you may have the right to get help from an independent mental health advocate (IMHA).

How can an IMCA help me?

An IMCA should help you:

When an NHS body wants to provide serious medical treatment to you.
When there are plans to give you long-term accommodation in hospital (more than 28 days) or in a care home (more than 8 weeks). However, if the arrangements are urgent, the NHS body does not have to appoint an IMCA.
In some cases, if the professionals apply for a standard or urgent authorisation to deprive you of your liberty under the deprivation of liberty safeguards. You have the right to help from an independent mental capacity advocate with challenging an authorisation even if you have a relevant person’s representative helping and supporting you to do this. Both you and your relevant person's representative would be entitled to get help and support from an independent mental capacity advocate.

Your IMCA can:

Visit you in a care home, hospital or other place. If they have been appointed to help you, they should be able to speak to you in private, unless you want someone else there to support you.
Help collect relevant information about the decision that needs to be made about you – for example your health records.
Consult with health professionals providing your care and treatment, if you agree. If appropriate, they can 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 so that you can make decisions for yourself. This includes support like:
- identifying your wishes, feelings, beliefs and values, or what these would be if you had the capacity to make the decision
- telling you what your options are
- if your decision is about medical treatment, they can suggest whether it would be useful to get another medical opinion about the treatment
- making sure that the best interests checklist has been followed, the least restrictive options for your care and treatment have been considered, and that the Mental Capacity Act Code of Practice has been followed
- writing a short report with their findings, giving their opinion on how the decision should be made in your best interests.
Help you complain. If the independent mental capacity advocate believes that their opinion has not been taken into account by the health 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.