We all face many decisions every day. Some decisions are harder to make than others, and sometimes we could all benefit from having somebody to help us to understand the outcomes and impacts of those decisions before we have to make them.

Some people are assessed as lacking capacity to make decisions for themselves. The Independent Mental Capacity Advocacy Service (IMCA) is a service provided under the Mental Capacity Act (2005) which aims to support those people.

What is lack of capacity?

Whenever the term ‘a person who lacks capacity’ is used, it means a person who is without the ability to make a particular decision at the time it needs to be made due to a disturbance or impairment of the mind or brain. This may be because they have a mental health diagnosis, or cognitive condition, is unconscious or barely conscious, perhaps as a result of an accident, or use/misuse of drugs or alcohol.

A person’s capacity may vary over time or may depend on the type of decision that needs to be made.

Some people may always lack capacity to make some decisions, for example, due to a condition or severe learning disability that has perhaps affected them from birth.  Some such people may, however, go on to learn new skills that enable them to gain capacity and make decisions and take actions for themselves as their lives progress. 

What is the role of an IMCA?

The role of an IMCA is to:

  • Support a person who lacks capacity to get involved in decision making.
  • Put across a person’s wishes and feelings.
  • Find relevant information on behalf of the person they are supporting.
  • Speak with any individuals who know the person well - including medical professionals and family members
  • Look at alternative plans of action.
  • Help the person in question to access all the facts relating to their decision.
  • Challenge the decision-maker where appropriate.
  • Our IMCAs can also support people through the Court of Protection process.

Who can have an IMCA?

  • People who are defined by medical professionals as "lacking capacity".
  • A person who is "deprived of liberty".

What is deprivation of liberty?

When a person lacks the capacity to make decisions about the care or treatment they are having or need, it is sometimes in their best interests to take away their freedom to decide.  This is known as depriving them of their liberty.  The aim of this process is to prevent that person from coming to harm in any way, and is never done without good reason.  That person will still always have their rights, however, and an IMCA will help that person promote and protect those rights.   

Who can make a referral for an IMCA?

Referrals can be accepted from any party, but we can only take formal instructions from the decision-maker in question.

Advocacy in Action

Patricia* is an elderly lady diagnosed with Dementia and learning difficulties. She also suffers with Sigmoid Volvulus, a condition causing abdominal pain, constipation and expanding and swelling of the stomach. Urgent surgical treatment (a colostomy) was required to provide an alternative channel for bodily functions, this would require a stoma bag being fitted which is external to the body. Patricia underwent a Capacity Assessment around the decision and was deemed to lack capacity. Consultants were concerned that Patricia may be confused with having a bag attached to her body and could pull at the tubes causing internal bleeding and infection. Continue reading...

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