Skills for People Independent Mental Capacity Advocate IMCA Service

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Skills for PeopleIndependent Mental Capacity
Advocate (IMCA) Service
May 2008
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What is IMCA?

• The Independent Mental Capacity Advocate (IMCA)
  is a new advocacy service that comes from the
  Mental Capacity Act 2005 and has been law since
  April 1st 2007.

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Mental Capacity ActKey Objectives

• To protect people who lack capacity when
  important decisions are being made about their
  health or care
• To empower people to make their own decisions
• To give people more choice when making a decision

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When is an IMCA involved?

• If someone lacks capacity to make a certain
  decision and
• Does not have family or friends who can support
  them in the decision and be consulted by the
  decision maker
• An IMCA will be instructed by the decision maker
  to provide information towards a best interests
  decision

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How is an IMCA instructed?

• The decision maker carries out the
  functional/capacity test with the person to
  confirm that they lack capacity
• This is to test the persons capacity only in
  relation to the decision that is to be made
• The guidance in the Mental Capacity Act 2005
  Code of Practice should be followed

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Who is the Decision Maker?

• The professional involved in making the best
  interest decision from the NHS or local authority
• When a multi disciplinary team is making the
  decision a decision maker should be nominated

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Lack of capacity, the functional test

• The functional test focuses on how the decision
  is made rather than the outcome.
• The Act says that a person is unable to make a
  decision if they are not able to
• Understand the information relevant to the
  decision
• Retain that information
• Use or weigh up that information as part of the
  process of making the decision or
• Communicate the decision (whether by talking,
  sign language or any other means)

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What important decisions?

• Serious medical treatment
• or
• Changing their care home or making a long term
  move
• An IMCA can also be request to be involved in
  Adult Safeguarding decisions and Care Reviews (re
  accommodation)

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Serious Medical Treatment Decisions

• Providing, withholding or stopping serious
  medical treatment
• Could include
• Chemotherapy and surgery for cancer
• Electro-convulsive therapy
• Therapeutic sterilisation
• Major surgery
• Major amputations
• Treatments which result in permanent loss of
  hearing or sight
• Withholding or stopping artificial nutrition and
  hydration, and
• Termination of pregnancy
• Emergency treatment is exempt from involving IMCA

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Change of Accommodation Decisions

• Long term accommodation provided or arranged by
• the NHS,
• the L.A. under section 117 of the Mental Health
  Act
• A move between such accommodation

• An L.A. carries out an assessment under section
  47 of the NHS and Community care Act and decides
  to
• Provide services in a care home
• Move a person to another care home

Over 28 days in hospital or 8 weeks in a care
home Includes Supported Living
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Adult SafeguardingDecisions

• An IMCA can be instructed to support and
  represent a person who lacks capacity in Adult
  Safeguarding cases where it is alleged that
• The person is or has been abused by another
  person, or
• The person is abusing or has abused another
  person
• Protective measures need to have been proposed or
  already taken
• The IMCA is not involved in any investigations
• A person with family or friends is not excluded
  from IMCA involvement in Adult Safeguarding cases

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The Role of the IMCA

• To ascertain the persons wishes, feelings,
  rights and cultural beliefs in relation to the
  decision to be made
• To include the person in the decision making
  process and encourage participation where
  possible
• Provide information that must be taken into
  account by the decision maker when they are
  working out the persons best interests
• Raise questions or challenge decisions which
  appear not to be in the persons best interests.

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What will the IMCA do?

• The IMCA has an average of 8 hours to work on
  each referral. The IMCA will
• Meet with the person
• Talk to other people who know them
• Find out about the persons views, wishes, values,
  religion, spiritual and cultural beliefs
• Look at all possible options available
• Provide a report to the decision maker

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How will the IMCA work?

• The IMCA will work in a person
• centred way
• By using communication aids
• By involving specialist support workers
• By using Person Centred Planning tools such as
  Essential Lifestyle Planning

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What else will the IMCA do?

• Ensure that Advanced Statements, decisions and
  living wills are respected
• Remember that people can make unwise decisions
• Remember that for some people capacity could be
  regained
• Apply to the Court of Protection in circumstances
  where there is disagreement

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What rights does the IMCA have?

• For the IMCA to carry out
• their job they have the right
• to
• Interview the person in private
• To examine and take copies of health and care
  records
• Hold discussions with professionals providing
  treatment or care for the person

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Best Interest Decisions

• Check list
• Encourage participation
• Identify all relevant circumstances
• Find out the persons views
• Avoid discrimination
• Assess whether the person might regain capacity
• If the decision concerns life-sustaining
  treatment-do not make assumptions about the
  persons quality of life
• Consult others
• Avoid restricting the persons rights
• Take all this in to account

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To make a referral to the IMCA Service

• Carry out the functional test for capacity
• Follow best interest guidance
• Confirm
• an IMCA decision
• no family and friends to consult
• Complete in IMCA referral Form
• Contact the IMCA Service
• The IMCA coordinator will assess all information
  to agree whether referral appropriate
• An IMCA will be appointed and will contact you

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Case Scenario 1Mr X a 76 year old man in
hospital detained under Sec.3 of the Mental
Health Act

• IMCAs Points to Consider
• Mr Xs Person Centred Plan from 2 years earlier
  when he was well, stated that he did not wish to
  have any treatment or investigations in the event
  that he developed any life threatening illness
  and that he did not wish to have any
  interventions.
• There was no indication that Mr Xs views had
  changed
• Best Interest Decision
• Mr Xs decision to refuse treatment was respected

• Proposed Decision
• Investigation of suspected Carcinogenic Mass In
  Lower Abdomen
• IMCA Involvement
• Met with Mr X 3 times
• Spoke to various professionals
• Reviewed Medical notes, and person centred plan
  relevant to the proposed decision.

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Case scenario 2 Mrs B, a 78 year old woman with
dementia and depression

• Proposed Decision
• Do Not Attempt Resuscitation
• IMCA Involvement
• Met Mrs B
• Spoke to medical team, reviewed notes
• Spoke to manager of nursing home
• Read DNAR Resuscitation Council guidance

• IMCA Points of Consideration
• Would not withhold treatment, but would not
  intervene if heart stopped.
• Right to die with dignity and right to be free of
  inhuman and degrading treatment
• Best Interest decision
• DNAR to be placed on Mrs Bs file

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Case Scenario 3 Mr C, an 85 year old gentleman
with ischaemia to his toes and lower limb

• Proposed Decision
• Mr C to have an investigative Angiogram and if
  required a below knee amputation
• IMCA Involvement
• Met with Mr B twice
• Spoke to Medical Team re the procedures and
  reviewed relevant medical records.
• Spoke to staff at Nursing Home

• IMCA Points to consider
• Daughter in Australia to be consulted if
  amputation to go ahead.
• Best Interest decision
• Investigative Angiogram to go ahead

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Case Scenario 4Ms H, a 41 year old woman with
Dysphagia following stroke

• IMCA points to consider
• There were too many risks to health including
  marked weight loss and several recurrent hospital
  admissions for aspiration pneumonia. Eating was
  potentially life threatening.
• Once the PEG was inserted she could continue to
  enjoy hobbies and outings without the constant
  fear of choking which was having a negative
  effect on her.
• Best Interest decision
• For Ms H to have a PEG tube to be inserted

• Proposed Decision
• To have a PEG tube inserted
• IMCA Involvement
• Met with Ms H
• Spoke to professionals involved
• Read through medical records relevant to the
  decision being made

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Skills for PeopleIMCA Service

• Skills for People provide
• the IMCA service in
• Durham
• Darlington
• Gateshead
• Hartlepool
• Middlesbrough
• Newcastle
• North Tyneside
• Redcar/Cleveland
• Stockton

• Terri Clibery
• Skills for People
• Key House
• Tankerville Place
• Jesmond
• Newcastle upon Tyne
• NE2 3AT
• Tel [phone]
• Fax [phone]
• Email terri.clibery_at_skillsforpeople.org.uk

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Meet the IMCAs