Surge in use of Independent Mental Capacity Advocate service

The number of people receiving representation from the Independent Mental Capacity Advocate (IMCA) service rose by 27% in its second year of operation to 6,582, research has revealed.

Set up under the Mental Capacity Act 2005, the service represents and supports people without capacity, and mainly without family or friends to support them, in important decisions. The Act also introduced a legal duty on NHS bodies and local authorities to refer eligible people to the service.

More than half (3,496) of the IMCA service’s representations for 1 April 2008 to 31 March 2009 related to accommodation moves – an increase of 14%. However, much greater growth was seen in relation to care reviews (up 102% to 387), decisions about serious medical treatment (up 43% to 968) and adult protection proceedings (an increase of 29% to 960).

The Department of Health said it was pleased at the increase in referrals as it was a sign of greater awareness of the IMCA service. But, the report added, “at the same time, a greater rate of increase had been expected, and it is not thought that the IMCA service is reaching all the people it needs to as yet”.

Key areas of concern include continuing low levels of referral for serious medical decisions in the NHS and the low level of adult protection referrals. “It is not clear that local authorities understand they must consider for each adult protection referral received whether the individual would benefit from an IMCA,” the report found.

The researchers also pointed to large variations between different geographical areas, both in relation to total number of referrals and numbers of referrals for serious medical conditions.

A study of stakeholder experiences found that MCA leads in local authorities were positive about the professionalism of advocates and the benefits to their clients. This was in contrast to the NHS where there were concerns that involving an IMCA would lead to delayed treatment. There were also calls for advocates to be more available and to deliver IMCA reports faster.