Advocacy · England
Help when you cannot make an important decision
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An independent mental capacity advocate is often called an IMCA.
This guide is about people aged 16 and over.
You should get help to make your own decisions.
Sometimes you cannot make a particular decision, even with help.
This is called lacking capacity for that decision.
An IMCA helps protect your rights in some of these situations.
The law sets rules about when an IMCA must help.
Some rules concern important health and care decisions.
Examples include serious medical treatment or a long care home stay.
Usually, there must be no suitable unpaid person to ask about your wishes.
This might be a relative or friend who knows you.
Ask the service to check the rules for your decision.
There are also rules about help when abuse or neglect is suspected.
An IMCA may help even when family or friends are available.
The IMCA finds out what matters to you.
They consider how you communicate and what help you need.
The IMCA can question the proposed decision.
They give information to the person making the decision.
The IMCA does not make the decision for you.
Ask the doctor or council worker responsible for the decision about IMCA support.
They must check whether the rules apply.
What you can do next
Ask whether you should have an IMCA.
Ask the service to explain its answer.
Read the official IMCA guide Web pageThis link opens another website.
It may use harder words.
Independent mental capacity advocacy — IMCA
A safeguard for certain important decisions when you cannot decide for yourself.
People aged 16 and over · specific Mental Capacity Act decisions · England
The main legal entitlement
An IMCA is normally required for qualifying NHS serious medical treatment or certain NHS or council arrangements for long-term accommodation if you lack capacity for that decision and there is no appropriate unpaid person to consult. A diagnosis alone does not establish lack of capacity.
Accommodation and urgent decisions
For the main accommodation duty, the expected stay is over 28 days in hospital or over 8 weeks in a care home. Urgent decisions and care or treatment under the Mental Health Act have special rules. Staff should check the relevant duty rather than assuming every move needs an IMCA.
Care reviews and safeguarding
The NHS or council can also arrange an IMCA for qualifying accommodation reviews and adult safeguarding decisions. Safeguarding referrals can be appropriate even when family or friends are available. These additional powers have different conditions from the main duty.
What the advocate does
The IMCA meets you, explores how you communicate, considers your wishes and relevant information, and checks the options. They can question or challenge the proposed decision. The decision-maker must take the IMCA's information into account.
Family, attorneys and deputies
Having a relative does not settle whether there is someone appropriate to consult. A relevant nominated person, welfare attorney or welfare deputy may affect the IMCA duty. A person appointed only to manage money does not automatically replace this safeguard.
Getting a referral
Ask the person responsible for the NHS or council decision to check IMCA eligibility and explain their decision. Separate IMCA duties apply to Deprivation of Liberty Safeguards; see the guide to representation when liberty is restricted.
Words you could use
“Please check whether an IMCA must be involved in this decision, and explain the result to me in writing.”
Where the information comes from
Links checked 26 October 2026.
These links open other websites.
They may use harder words.
- Office of the Public Guardian: IMCA service Web page
Official explanation of the main duties, additional powers and exceptions.
- Mental Capacity Act 2005, sections 35–41 Web page
Legal framework for independent mental capacity advocacy.
- Mental Capacity Act 2005, section 37 Web page
Serious medical treatment decisions.
- Mental Capacity Act 2005, section 38 Web page
NHS accommodation arrangements and qualifying periods.
- Mental Capacity Act 2005, section 39 Web page
Local authority accommodation arrangements.