Yesterday the First Annual Report of the Independent Mental Capacity Advocate (IMCA) was published. I have had some experiences of using IMCAs over the last 18 months but with increasing frequency and it’s probably the same for most of my colleagues within the service I currently work in.
The role of the IMCA was created by the Mental Capacity Act to provide a statutory advocacy service to someone who lacks mental capacity when serious decisions are made. The referral to an IMCA is mandatory in two circumstances
– Where serious medical treatment is considered
– Where a move or change to long term accommodation
and it may be used
– in adult protection proceedings
– Care reviews
With the exception of Adult protection, the service is aimed at those without family or friends to provide this support or voice.
In our team we’ve made some use of the services available to us and built up some good working relationships with our IMCA service but some of the results are curious all the same.
To summarize very basically, the most common types of referrals seem to be regarding long term care placements – which is wholly unsurprising to me, at least, as that’s the most common reason that I’ve made referrals.
The report though states that referrals for serious medical treatment is lower than expected. Stating that
Six hundred and seventy five people were referred to the IMCA service for representation in relation to serious medical treatment in England during the year April 2007-March 2008. This is an average of four and half cases per PCT in a year – or one every three months
Rather damningly, the reasons proposed were as follows
i Some doctors do not understand that there is a statutory duty to make referrals. They perceive it as discretionary.
ii Some doctors do not agree with the statutory duty to make referrals. They choose to disregard it
With some IMCAs claiming that they were disregarded as some doctors felt that a non-medical person having input into a medical decision was ‘a waste of time’. Clearly an area in which further awareness and input needs to be concentrated.
Most IMCAs were positive about the input that they were able to provide and sufficiently confident that it was a new service and something in addition to other advocacy services or social work services who might have an advocacy role but have other demands.
One of the interesting cases given, an IMCA explains that they were able to find distant family of an individual merely because they had had hours to be able to investigate and go back through notes – something a professional might not have had time to be able to do.
Another exercise as a part of the review that the IMCAs were asked to do was to sum up their role. Many of them had been advocates prior to the new legislation and they claimed that the Mental Capacity Act had given them more power to ask questions on behalf of the people that they were advocating for – after all, their role is now legally entrenched. However they also claimed a powerlessness as ultimately their role is an advisory one and the decision-maker is still the decision-maker.
Personally I’ve found the IMCA reports provided to be useful for me to push my own commissioning and finance managers to provide care needed for an individual. In one situation, I discussed the recommendations that an IMCA made and it included the provision of a service that didn’t actually exist in our local authority – but by taking the report to our funding panel, I was able to point this out, markedly and explain that it was a poor reflection on our services that we were not able to meet the needs presented by an IMCA.
There are some interesting statistics at the end of the report which break down the referrals and decisions by month, need, decision type, ethnicity and finally a council-by-council breakdown of how many referrals were made.
I’m not sure if it’s the first time that an advocacy service has actually been created by legislation, I’d venture a guess that it is – but it won’t be the last time.
Indeed, the new Independent Mental Health Advocates created by the 2007 Mental Health Act can probably learn a great deal from the experiences of some of the IMCAs already in place.
One step at a time and moving, at least, in the right direction.