Independent Mental Capacity Advocate (IMCA)

The IMCA service is created by section 35 of the Mental Capacity Act 2005, which requires the responsible authority to 'make such arrangements as it considers reasonable to enable persons ... to be available to represent and support persons' who lack capacity in the specific circumstances the Act sets out. In practice, IMCAs are instructed by NHS bodies and local authorities as decision-makers, not chosen by the person themselves, and the Act builds independence into the arrangements: the responsible authority 'must have regard to the principle that a person to whom a proposed act or decision relates should, so far as practicable, be represented and supported by a person who is independent of any person who will be responsible for the act or decision'. Once instructed, an IMCA has statutory investigative powers - they 'may interview in private the person whom he has been instructed to represent', and may examine and copy relevant health and social care records.

The two situations named in this glossary's short definition are set out precisely in the Act. Section 37 covers serious medical treatment proposed by an NHS body: where the body 'is satisfied that there is no person, other than one engaged in providing care or treatment for P in a professional capacity or for remuneration, whom it would be appropriate to consult' about the person's best interests, 'the NHS body must instruct an independent mental capacity advocate to represent P' before treatment is provided (subject to an urgency exception). Section 38 imposes a parallel duty on NHS bodies proposing to place a person in, or move them between, a hospital or care home, again where there is no appropriate family member or friend to consult. Functionally, an IMCA's role is not simply to object or agree, but under section 36 regulations to take steps 'providing support to the person whom he has been instructed to represent (P) so that P may participate as fully as possible in any relevant decision', to gather and evaluate relevant information, and to ascertain what the person's wishes, feelings, beliefs and values would likely be if they had capacity.