Independent mental capacity advocates (IMCAs) are mainly intended to be a safeguard for people who do not have family or friends who can represent them. The Mental Capacity Act (MCA) identifies this as having no one other than paid staff with whom it would be appropriate to consult. This is for decisions about where the person lives, serious medical treatment and care reviews.
The Code of Practice (10.74–10.78) provides information about how this decision can be made. It says that there will be times other than when a person has no friends or family that an IMCA should be involved. For example, a family member may not want to be consulted or feel unable to confidently represent the person for the decision. Similarly, a family member may live far away or have little contact with the person.
If an IMCA is involved it does not mean that any family members or friends will not be contacted to give their views. Possibly the IMCA may do this themselves to find out, for example, important information that the family holds about the person which is relevant to the decision.
IMCAs should not be involved just because a family disagrees with what the decision maker is proposing, or if different family members hold very different views. For example, where a doctor is trying to decide whether to provide cancer treatment to a woman with Down’s syndrome and is faced with a mother who supports the treatment and a father who does not because of the discomfort she would endure.
Case study: Having an IMCA when a family member is involved
Mavis has dementia. She will have to move to a new residential care home because the one she lives in is closing. She has a sister Iris who lives over one hundred miles away. She keeps in contact by sending cards and presents. Occasionally she will phone the home to find out how Mavis is (Mavis being unable to speak on the phone herself). Iris has been unable to visit Mavis because of her own health for a number of years. The social worker asks for an IMCA to be involved as they do not feel that Mavis will be well represented without this safeguard. For example, Iris would not be able to visit any of the new homes they are considering. The IMCA contacts Iris and asks for her thoughts about Mavis living closer to her.
Adult protection and IMCAs
The requirement of having ‘no one with whom it is appropriate to consult’ does not apply for people involved in adult protection cases. For example, if there are concerns that a person is being assaulted by another resident in a care home. In such cases IMCAs can be asked to support and represent a person (whether they are the alleged victim or perpetrator) regardless of any involvement of family or friends.
Whose decision is it to involve an IMCA if the person has family or friends?
It is for the people who instruct IMCAs to decide whether an IMCA should be involved when the person has family or friends.
- For accommodation decisions and care reviews, the decision is likely to be made by the person’s care manager or social worker.
- For serious medical treatment decisions, the decision is likely to be made by a doctor.
- For adult protection cases, the decision is likely to be made by the chair of the adult protection proceedings.
The decision about involving an IMCA where there are family or friends is not the responsibility of the IMCA or IMCA service.