Independent Mental Capacity Advocate

An IMCA must be appointed when the person who lacks capacity has no family or friend available to consult, AND the decision involves: serious medical treatment, an NHS-funded change of accommodation for 28+ days, a care home placement for 8+ weeks, a DoLS authorisation, or section 42 Care Act safeguarding. The IMCA gathers information, ascertains the person's wishes (as best they can), and prepares a written report for the decision-maker. The IMCA's role is to give the person a voice, not to make decisions. Funded by the council in most cases.

In practice, the trigger for an IMCA is not how serious the decision feels but whether there is anyone appropriate to consult. A person with a large family who are all estranged or unwilling to be involved is just as unbefriended, for these purposes, as someone with no relatives at all. A paid carer or care home manager does not count as someone appropriate to consult, however well they know the person, because they are not independent of the body making the decision.

Worked example: Winston lives alone, has advanced dementia and no contactable family. The hospital wants to discharge him to a care home rather than back to his flat, which would be a change of accommodation lasting more than eight weeks. Because he lacks capacity to decide and has nobody to consult, the council must instruct an IMCA before the decision is made — not afterwards to rubber-stamp it. The IMCA meets Winston several times, reads his records, finds a letter in which he had written about wanting to stay in his own home, and submits a report setting out that evidence and questioning whether a package of home care had been properly explored. The decision-maker must take the report into account and record how it did so.

The pitfalls are mostly about timing and scope. Instructing an IMCA after the decision has effectively been taken defeats the purpose and is a common ground of complaint. An IMCA cannot make the decision, cannot consent on the person's behalf, and cannot override a properly reached best interests judgment — but they can challenge it, including by supporting an application to the Court of Protection. In safeguarding cases the duty to instruct is discretionary rather than mandatory, and applies whether or not the person has family. And an IMCA is not the same as an IMHA, which comes from the Mental Health Act and covers detained patients.

The IMCA role is created by the Mental Capacity Act 2005, is engaged by serious best interests decisions and by DoLS authorisations, and overlaps with adult safeguarding. Read our guides to the Mental Capacity Act and best interests decisions, and ask in writing for an IMCA if nobody has been instructed.