What is an Independent Mental Capacity Advocate (IMCA)?

An Independent Mental Capacity Advocate, shortened to IMCA, is someone appointed to support and represent a person who lacks capacity to make specific important decisions. In England and Wales, the Mental Capacity Act 2005 introduced this role to protect people who do not have close family or friends to speak up for them.

What is the Purpose of an Independent Mental Capacity Advocate?

The IMCA service exists to ensure people’s voices are heard when they cannot speak for themselves. Many people living in care homes, hospitals, or supported accommodation may not have anyone to act in their best interests if they lack capacity. Some people have no close friends or relatives. Others may find themselves alone or without someone suitable to support them if they lose the ability to make important decisions.

The IMCA stands up for them, puts forward their views, and makes sure that decision-makers take those views and rights into consideration.

Legal Background

The Mental Capacity Act 2005 sets out a framework for making decisions for those who lack mental capacity. Under this law:

• A person is considered to lack capacity if they cannot understand, retain, weigh, or communicate information needed to make a certain decision at a certain time.
• Everyone involved must follow a set of principles which prioritise helping the person to make their own decisions wherever possible.

It is a legal requirement in specific situations — such as major medical treatment decisions or long-term moves — to refer to an IMCA if the person has no close relative or friend to represent their views.

Who Can Be Supported by an Independent Mental Capacity Advocate?

IMCAs work with adults over 16 years old who lack capacity to make certain decisions. The law applies to people who may have conditions affecting their ability to understand, such as:

• Dementia
• Learning disabilities
• Serious brain injuries or neurological conditions
• Mental health conditions

An IMCA gets involved only when the person has no family or friends who are able or suitable to speak for them about the decision in question.

Decisions Where an IMCA Must Be Involved

There are specific legal duties for NHS bodies and Local Authorities to instruct an IMCA for individuals who lack capacity for the decision and have no appropriate family or friends to be consulted.

Mandatory Instruction (Duty to Instruct):

1. Serious Medical Treatment (MCA s.37): When an NHS body proposes providing or withdrawing serious medical treatment for a person lacking capacity to consent. ‘Serious’ includes treatments with significant consequences, burdens, or complex choices (defined further in the MCA Code of Practice).
2. Long-Term Accommodation Changes (MCA s.38):
   • When an NHS body arranges a hospital stay longer than 28 days for the person.
   • When a Local Authority arranges residential care accommodation for the person for longer than 8 weeks.
   • This includes moves into such accommodation or between different establishments.

Other Situations (Power to Instruct or Duty in Specific Circumstances):

Deprivation of Liberty Safeguards (DoLS) (MCA s.39A, s.39B): An IMCA must be appointed for individuals under a standard DoLS authorisation if they lack capacity regarding the arrangements, have no relevant person’s representative (RPR), or if the person or their RPR requests IMCA support. (Note: DoLS is currently operational but planned to be replaced by Liberty Protection Safeguards (LPS), where advocacy roles will adapt.)

Care Reviews (MCA s.39C): A Local Authority or NHS body must instruct an IMCA for reviews of accommodation arrangements covered by s.38 if the person lacks capacity regarding continued residence and has no appropriate person to consult (other than paid staff). There’s also a power to instruct an IMCA for other care reviews.

Adult Safeguarding (MCA s.39D): A Local Authority must instruct an IMCA during safeguarding enquiries or reviews if the person lacks capacity regarding protective measures and has no appropriate person to consult (other than those implicated or paid staff). Crucially, under MCA s.40, the Local Authority also has a discretionary power to instruct an IMCA in safeguarding cases even if the person has family or friends, if the authority believes it would be beneficial for the person.

Who Can Be an Independent Mental Capacity Advocate?

IMCAs are qualified professionals who have completed specialist training on the Mental Capacity Act, advocacy, and relevant laws and ethics. They must work independently from organisations providing care or treatment to people — this independence is a key part of their role.

Qualities and skills include:

• Good communication and listening skills
• The ability to explain things clearly and in plain language
• Understanding of legal rights under the Mental Capacity Act 2005
• Unbiased approach, acting only in the best interests of the person

IMCAs have to work according to a code of practice, and their service is free to the people they support.

What Does an IMCA Do?

An IMCA has a clear set of duties which they carry out on behalf of the person lacking capacity. Their aim is to collect information, understand the person’s wishes as much as possible, and challenge decisions if required.

Main tasks of an IMCA are:

• Meeting with the person in private, where possible, to find out their views, wishes, feelings, and values.
• Reviewing care records, medical notes, assessment reports, and other documents.
• Gathering information from staff, carers, or others who know the person well.
• Making sure the person’s rights are respected and decision-makers fully consider their preferences.
• Providing relevant information, both written and verbal, to decision-makers.
• Writing a detailed report on the decision, which must be taken into account.
• Challenging the decision if the person’s rights or best interests are not being properly protected.

In some cases, IMCAs may raise objections or refer matters to the Court of Protection if they believe decisions are being made unlawfully.

The IMCA’s Role in Supporting Decision-Making

An IMCA is not a substitute decision-maker. That is, they do not decide for the person. Their job is to make sure the decision-maker has all the necessary information about the individual’s wishes and best interests.

Decision-makers — usually doctors or local authority staff — must still make the actual decision. They are required by law to take the IMCA’s report and views into account before going ahead.

The IMCA Process

The process usually follows these steps:

• Referral: The responsible body (NHS or local authority) identifies the need and refers the person to the IMCA service.
• Initial Contact: The IMCA arranges to meet the individual and gathers information.
• Consultation: The IMCA consults all relevant people, including professionals involved, sometimes family, or those close to the person.
• Representation: The IMCA represents the person’s known wishes and interests, communicating any information that should influence the decision.
• Report: The IMCA submits a written report for the decision-maker, outlining their findings and any recommendations.
• Follow-up and Challenge: If necessary, the IMCA can challenge the decision or escalate concerns.

The Impact of Having an IMCA

For those with no one else to represent them, an IMCA can make a real difference.

Benefits include:

• Making sure the person’s views are truly considered
• Preventing decisions that are not in the person’s best interests
• Promoting the rights and dignity of very vulnerable individuals
• Safeguarding against abuse, neglect, or poor decisions

Their independence means they focus only on expressing the individual’s perspective, not institutional needs.

Examples of IMCA Involvement

Below are a few sample scenarios to help explain what an IMCA might do:

Example 1: Major Medical Treatment

David, who has advanced dementia, is admitted to hospital needing surgery. He cannot understand what is involved. He has no close family. The hospital appoints an IMCA, who meets with him, discusses with staff, reviews his history, and submits a report to ensure any factors important to David are respected in the doctor’s decision.

Example 2: Change of Accommodation

Linda, 55, has a learning disability and lives in supported accommodation. The local authority proposes she moves to a new care home in a different town. Linda has no relatives in contact. The council refers her to the IMCA, who speaks to Linda about what she likes or dislikes, checks care arrangements, and represents Linda’s wishes concerning the move.

When an IMCA Is Not Needed

The primary trigger for mandatory IMCA instruction under MCA sections 37 (Serious Medical Treatment) and 38 (Long-Term Accommodation) is that the person lacking capacity has no one appropriate to support or represent them for that specific decision, other than people engaged in providing care or treatment in a professional capacity or for remuneration.

• “Appropriate” Person: This means family members or friends who are willing and able (in terms of capacity, skills, knowledge, and frequency of contact) to be consulted and represent the person’s likely views. The decision-maker must assess appropriateness (MCA Code of Practice 10.16-10.20). If such an appropriate person exists and is consulted, there is generally no duty to instruct an IMCA for s.37 or s.38 decisions.
• Exceptions Where IMCA May Still Be Involved: Even if family/friends exist, an IMCA might still be instructed in specific circumstances:
  • Adult Safeguarding: A Local Authority has the discretionary power (MCA s.40) to instruct an IMCA if they believe it would benefit the person, regardless of family involvement. There is also a duty (s.39D) if no appropriate person is available during safeguarding processes.
  • Deprivation of Liberty Safeguards (DoLS): An IMCA must be instructed (under s.39A, s.39B, s.39D) if the person meets criteria (e.g., has no RPR, or the person/RPR requests one), irrespective of other family/friends.
  • Care Reviews: Similar duties (s.39C) apply if no appropriate person is available for consultation regarding ongoing accommodation.

Therefore, while IMCAs primarily support the ‘unbefriended’, their involvement isn’t always excluded just because family or friends exist, particularly in safeguarding and DoLS contexts.

Independent Safeguards

IMCAs play a key safeguarding role in health and social care. Their independent status means they can look beyond organisational interests and focus only on what counts for the person. They are not part of the care team or decision-making body.

Legal Rights and Complaints

Everyone referred to an IMCA is entitled to a high standard of service. If the person — or someone on their behalf — is unhappy with the IMCA’s work, they can make a complaint through the service provider’s complaints process.

All IMCA services must meet standards set by the government and professional bodies.

Conflicts of Interest

The law and professional guidelines make it clear that the IMCA must show no conflict of interest. They must not work for or be connected to the organisation making the original decision.

If a conflict exists, a different IMCA should be appointed.

Training and Regulation

IMCAs are required to complete nationally recognised training before carrying out duties. Regular supervision and checks are also in place.

Regulations include:

• The Mental Capacity Act 2005 and Code of Practice
• The Mental Capacity (Independent Mental Capacity Advocates) (General) Regulations 2006
• Regular audits from commissioning bodies

How to Access an IMCA

Health and social care professionals refer people for IMCA services, based on legal requirements. The service itself is free of charge for the person.

Points to remember:

• A person cannot refer themselves for an IMCA. It must come from NHS or local authority staff.
• The appointed IMCA will contact the person directly to arrange meetings and begin their work.

Good Practice for Working with IMCAs

Professionals can support effective working by:

• Referring promptly when required
• Sharing relevant information and records
• Including the IMCA early in discussions about the decision
• Respecting the IMCA’s independence

IMCA and the Wider Advocacy System

IMCAs are part of a broader system of advocacy services. These may cover different needs, such as:

• Independent advocates under the Care Act
• Non-statutory advocacy (for example, general health or welfare advocacy)

The IMCA service has its own strict legal framework and rules, all focused on mental capacity issues.

Final Thoughts

IMCAs provide strong support and a clear voice for adults who cannot make certain big decisions for themselves, and who have no one else to represent them. They work to protect rights, promote dignity, and help professionals carry out their legal responsibilities. Working independently, their input helps ensure that decisions are truly centred around the person’s own wishes, beliefs, and best interests.