Using IMCAs

I was surprised when I spoke with colleagues who were working in a local CMHT, that few of them were aware of the IMCA (Independent Mental Capacity Advocate) service and none had used them.

I have used IMCAs a few times over the last 8 months or so and generally found the process to be very positive and helpful so thought I’d relate a little on my experiences.

Initially, when someone meets the requirements to have an IMCA:

– They are ‘unbefriended’ (yuck – could there be a less pleasant term)

– A significant decision (major health implications i.e. surgery or long term decision about place of residence)

the referral is made via one of the deputy directors.

We can’t make the referral directly but this process is certainly in the cases I’ve worked on, a rubber-stamping issue, where the Trust wants to keep track on how many IMCAs they are using, rather than any issue of control of resources.

I then await contact from the IMCA, explain a bit about the situation, background and decision. We meet with the service user and I’ll make the introductions – this part depends very much on what the situation is. I like to leave the IMCA on their own at this point and not get involved in any of the direct meetings again.

It doesn’t always happen that way though.

They have an idea of the timescale and after a few decisions I have a good idea of what way we’re going with the decision.

And then we click into action.

Positives of the IMCAs

It allows us more time with the service user and they have more time to devote to collating additional information that I would have.

Just talking things over and over and over, really does help to clarify things

It is actually quite positive not to feel so completely responsible (although I am still the decision-maker, I can’t imagine not going with the advice of the IMCA!).

It can be used as leverage with commissing panels to agree funding that they otherwise would automatically refuse.

Advocacy as a legal right (wonderful idea!)


Although sometimes the ideals expressed by the IMCA as an outcome are impossible in a practical sense (for example, one of the IMCAs suggested a supported housing placement that the commissioning panel would not agree).

Timescales. I know the theory is these things can be done quickly but when hospital discharges are being held up – and delayed discharge fees are being charged, there is immense pressure to make decisions quickly.

Of course, the disadvantages of advocacy pale into insignificance when compared to the benefits. I hope it is rolled out in a more extensive way and not limited just to these particular decisions which are specified in law.

2 thoughts on “Using IMCAs

  1. I currently work in a hospital for people with moderate to severe learning disabilities and mental health problems, some with acquired brain injury thrown in. All have advocates and of the ones I’ve seen in action, many are amazing. In most CPAs involving commissioning, there’s also a lawyer present – negotiating with commissioner’s representatives without one seems a nightmare.

    When I worked in adult mental health, I didn’t meet an advocate once, possibly because the people having psychological therapies were too able to trequired one.

  2. Hopefully with the new Mental Health Act, advocates will become much more visible and accessible because, honestly, I think that everyone however ‘able’ could benefit! I know I’d like an advocate myself if I were in that position! Perhaps the system of advocates is better developed over the years in learning disabilities services but it sounds like it is definitely the way to go!

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