The Independent Mental Capacity Advocate Service

The IMCA Service was introduced by the Mental Capacity Act 2005. From 1st April 2007, professionals in Local Authorities and NHS Bodies are required by law to consider the instruction of an IMCA when making certain types of decision (see below). The Act was amended by the Mental Health Act 2007 to provide additional safeguards; these 'Deprivation of Liberty Safeguards', or DoLS, were introduced from 1st April 2009.

From 1st April 2011 the IMCA Steering Group comprising commissioners, operational leads from the commissioning bodies and Asist, has agreed that during times of high demand Asist will give priority to referrals concerning serious medical treatment and deprivation of liberty decisions as described below.

• SERIOUS MEDICAL TREATMENT: An IMCA must be instructed when the decision involves the provision, withdrawal, or withholding, of serious medical treatment.
• CHANGE OF ACCOMMODATION: An IMCA must be instructed when the decision involves long term accommodation in a hospital, residential nursing or other supported care environment.
• DEPRIVATION OF LIBERTY DoLS: the relevant authorities must consider instructing an IMCA where it is deemed necessary to deprive somone of their liberty in order to deliver treatment or care in circumstances which do not warrant a detention under the Mental Health Act 1983.
• PROTECTION OF VULNERABLE ADULTS: the relevant authorities must consider instructing an IMCA where it is proposed to take protective measures under Adult Safeguarding Procedures (over 18 years only). Note that this can be irrespective of whether there are family or friends, and that a referral to the IMCA Service will not generally be necessary where the person already has a Generic Advocate.
• ACCOMMODATION REVIEW: the relevant authorities must consider instructing an IMCA where it is proposed to review the suitability of accommodation, particularly where the placement took place as part of a decision supported under the Act as above. Note that a referral to the IMCA Service will not generally be necessary where the person is already working with a Generic Advocate.

Hospitals and Care Homes must apply for an authorisation to deprive someone of their liberty where this is necessary to deliver treatment or care and the circumstances would not warrant a detention under the Mental Health Act 1983.

All referrals to the IMCA Service must come through the appropriate Supervisory Body. In the case of Care Homes, this will be the Local Authority, in the case of Hospitals this will be the responsible NHS Body.

For the avoidance of doubt, Hospitals and Care Homes cannot make referrals directly to the IMCA Service for DoLS support, but must approach the Supervisory Body in the first instance. The Supervisory Body to be approached is the one in which the person will be located at the time of the proposed deprivation of liberty.

Staffordshire and Stoke-on-Trent Supervisory Bodies have established single contact numbers and Hospitals and Care Homes can contact them on the numbers below:

Staffordshire – 01889 256088

Stoke-on-Trent – 01782 236130

Referrals can only be made by the decision maker, often a doctor or social worker, or someone authorised by them. The referral should be made in writing by completing a referral form (see below) and sending it by e-mail, post or fax to:

• EMAIL: imca@asist.co.uk [NB - in line with guidance from the Information Commissioners Office, Asist would request that organisations emailing referral forms as attachments should password protect the form and phone our office with the password or send it in a separate email] 
• POST TO: IMCA, ASIST, Winton House, Stoke Road, Stoke-on-Trent, ST4 2RW
• FAX TO: 01782 746647
• TELEPHONE ENQUIRIES: 01782 845584

Asist will confirm acceptance of referrals within one working day of receipt.

Click here to download a referral form in Word

Most authorities are providing local training on the Mental Capacity Act, including the IMCA Service, and you should check for availability on notice boards and with Team Managers. Asist also offers awareness training, please email or ring for more details.

The Mental Capacity Act Code of Practice chapter 10 explains the IMCA Service. It is available on the Ministry of Justice website at: www.justice.gov.uk/guidance/protecting-the-vulnerable/mental-capacity-act/index.htm [NB - clicking this link will open the site in a new page]

The Department of Health website also provides a useful information on IMCA at: www.dh.gov.uk/en/SocialCare/Deliveringsocialcare/MentalCapacity/IMCA/index.htm [NB - clicking this link will open the site in a new page]

The IMCA Service leads for Stoke on Trent City Council and Staffordshire County Councils are given below. These persons represent the Councils on an IMCA Steering Group which will monitor the performance of the Service and provide a forum for any issues to be addressed. These are:-

Peter Hampton, Adult Protection Co-ordinator, Staffordshire County Council on 01785 278531or email peter.hampton@staffordshire.gov.uk

Sue Griffiths, Adult Protection Co-ordinator, Stoke on Trent City Council on 01782 232396 or email sue.griffiths@stoke.gov.uk

Why do I have to fill in the referral form if I have already given you details by telephone?
The form represents a formal instruction under the terms of the Mental Capacity Act 2005 and Asist is obliged to receive and retain a completed form for each case. We regret any inconvenience this may cause and trust that persons making referrals will understand that we must request the form in order to comply with the terms of our contract to supply the service.

What are Authorised Officers, Client Contacts and Decision Makers?
An Authorised Officer is a person who has been given approval to instruct an IMCA by the body responsible for the decision. This is at the discretion of the responsible body, however, examples of Authorised Officers might include Consultants, Doctors, Psychiatrists, Social Workers, Team Managers and Nurses or, indeed, anyone who is acting with the Decision Maker’s approval.

A Client Contact is the person most appropriate for the IMCA to contact in order to make arrangements to visit the person who is the subject of the decision. They need not be involved in the decision process but should be able to make arrangements for access.

The Decision Maker is the person who has the ultimate responsibility for making the decision, and is the person to whom the IMCA will present their findings and report.

It is important to recognise that the Authorised Officer, Client Contact and Decision Maker may all be the same person, however, the referral form has to allow for the fact that they may be different.

Which IMCA Service is instructed when a person lives in one geographical area and is subject to a decision being made in another?
In respect of persons requiring Serious Medical Treatment it is envisaged that the responsible body will instruct the IMCA Service covering the location where the person is being treated. In respect of long term care, section 10.12 of the Code of Practice states that “The organisation that must instruct the IMCA is the one that is ultimately responsible for the decision to move the person. The IMCA to be instructed is the one who works wherever the person is at the time that the person needs support and representation.” The Department of Health lead on the IMCA Service, Paul Gantley, put this succinctly when he stated that the service is instructed where the person is, not where they live.

Is the IMCA a Decision Maker?
No. The IMCA does not make decisions and, for the avoidance of doubt, does not propose solutions or choose from a range of options. The Act makes it clear that the role of the IMCA is solely to provide information which the Decision Maker may take into consideration in reaching a decision.

Is the IMCA Service an emergency response service?
No. The service is commissioned on a 9-5 Monday to Friday basis, and Asist will confirm acceptance of a referral within one working day of receipt. Asist will make every effort to be flexible and to provide a quick response where necessary, however, we trust our referrers will appreciate that, at times of high demand, it may be necessary to prioritise referrals as indicated above.

What constitutes Serious Medical Treatment?
The definition of Serious Medical Treatment is contained within the Mental Capacity Act Code of Practice sections 10.43 through 10.45. The Code of Practice is available on the Ministry of Justice website at: www.justice.gov.uk/guidance/protecting-the-vulnerable/mental-capacity-act/index.htm [NB - clicking this link will open the site in a new page]

When are friends or family inappropriate to consult?
In general terms, the IMCA Service is only available to persons who lack capacity and have no friends or family to support them, however, there can be exceptions. The most obvious exception is where the IMCA is being instructed in relation to procedures for the protection of vulnerable adults and friends or family are involved in the situation.

It is not possible to give definitive guidance on other situations where friends or family may be available yet considered inappropriate as each case must be judged on its merits, however, the following is offered as general guidance on situations where an exception might be considered reasonable.

Friends or family could be considered inappropriate to consult if…

• They also lack capacity
• They are not available, perhaps as a result of geographical distance
• They do not wish to be involved, perhaps as a consequence of relationship breakdown
• There is tangible evidence that there may be a conflict of interest

Please note that where friends or family are involved, an exception cannot be made solely on the grounds that they disagree with the proposed course of action - one or more of the above criteria would also have to apply.

If it is decided that friends or family are inappropriate to consult, it is the responsibility of the Decision Maker to record the reason why they have made this decision.