MENTAL CAPACITY ADVOCATES AND PAID PERSONS REPRESENTATIVE SERVICE

We provide an independent mental capacity advocate (IMCA) service and paid relevant persons representative (RPR) service.

The purpose is to provide a specialist IMCA service, including an RPR service, to individuals in relation to the statutory and discretionary requirements of the MCA. The Service will provide a full IMCA service in relation to sections 35 to 40 of the MCA and Part 10 of Schedule A1 (DoLS).

Our service encompasses five distinct parts:
Providing IMCAs to all eligible service users, as instructed by the authorising body, to undertake the roles set out in the MCA and associated regulations.
Providing an RPR service to all eligible service users
Providing information about the IMCA role and the requirements of IMCA instruction for people contacting the service regarding service users who may be eligible for an IMCA.
Providing awareness and training sessions to staff who may come into contact with people who are eligible for the service.
Supporting the local integration of the MCA into practice – e.g. contributing to Local Improvement Networks, safeguarding boards etc.

We provide a IMCA service to all individuals staying at the time of instruction within the local authority, regardless of the person's ordinary residence/funding authority.

Service principles
The MCA recognises the crucial role that independent advocacy plays in helping people gain a voice and ensure their rights are protected. It establishes an advocacy service for a marginalised and vulnerable group of society. The service is for those individuals who have no close family or friends or any other person with whom it would be appropriate to consult.
Under the legislation, NHS bodies and local authorities have an obligation to instruct and consult an Independent Mental Capacity Advocate (IMCA) when certain decisions are being made on behalf of people who lack capacity and who do not have any family or friends. The decisions in which an IMCA must be involved (where a person is deemed to lack capacity to make the following decisions and has no close family or friends or any other person with whom it would be appropriate to consult) are as follows.

Serious medical treatment
We advise when serious medical treatment is being considered for a person who has no close friends or family or any other person with whom it would be appropriate to consult and who lacks the capacity to consent. For the purposes of the Act, serious medical treatment is defined as follows (from the regulations which accompany the Act).
Serious medical treatment is that which involves giving new treatment; stopping treatment that has already started; or withholding treatment that could be offered. Is also be a fine balance between its benefits to the patient and the burdens and risks it is likely to entail; in a case where there is a choice of treatments, a decision as to which one is used is finely balanced; or what is proposed is likely to involve serious consequences for the patient.

Changes of accommodation
An IMCA is required when an NHS organisation or local authority decides to place a person who lacks capacity in a hospital (or move them to another hospital) for a period likely to exceed twenty-eight days or in residential accommodation (or move them to another residential accommodation) for a period likely to exceed eight weeks. NB: the term “residential accommodation” applies to care homes, nursing homes, ordinary and sheltered housing, or hostel accommodation.

Safeguarding cases and care reviews
An IMCA is required when an NHS organisation or local authority considers that the appointment would be of particular benefit to a person who is the subject of safeguarding procedure or care review, and where the person has no family or friends or other nominated person (apart from paid workers providing care or treatment) that are available and appropriate to consult with on the decision. In safeguarding adults cases access to the IMCA is not restricted to people who are "unbefriended". People who lack capacity who have family and friends can still have an IMCA to support them safeguarding adults procedures.

Examples include:
Where there are conflicts of interest involving family members, or conflict with or between professionals, or conflict of interest between the responsible body and the individual concerned.
Cases which involve a significant degree of risk and possible consequences for the person or other vulnerable people e.g. where the protective measures involve a life changing decision such as the person’s accommodation or serious exposure to risk.
Where there are available family or friends, but consulting with them is compromised by the reasonable belief that they will not have the person’s best interests at heart. This may be for a variety of reasons e.g:
Where relatives are themselves the alleged perpetrators or are in some way implicated in the abuse;
Where there may be disputes between different family members which have led to allegations of abuse;
Where there is or may have previously been a poor or hostile relationship between the individual and their relatives;
Where there may have been a history of domestic violence;
Where it may also be known that the individual did not, or would not, want particular relatives to represent them in any way or be privy to personal information about them.
In some adult safeguarding cases a decision may be needed as to whether the person without capacity needs to be moved into residential accommodation or from one care setting to another in order to protect them or others. In these circumstances, the statutory criteria for instructing an IMCA may come into play anyway if they are “unbefriended”.

In the case of safeguarding procedures, an IMCA can support and represent a person who lacks capacity to consent to the proposed measures where it is alleged that:
The person is being or has been abused or neglected by another person
The person is abusing or has abused another person.
In safeguarding cases, access to IMCAs is not restricted to people who have no one else to support or represent them. People who lack capacity who do have family and friends are still entitled to have an IMCA to support them in safeguarding procedures.

In the case of care reviews, an IMCA can support and represent a person who lacks capacity when:
They have arranged accommodation for that person
They aim to review the arrangements (as part of a care plan or otherwise)
There are no family or friends whom it would be appropriate to consult

SGL’s Service ensures that all provision is compliant with the five key principles of the MCA:
▪ A presumption of capacity - every adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise;
▪ The right for individuals to be supported to make their own decisions - people must be given all appropriate help before anyone concludes that they cannot make their own decisions;
▪ That individuals must retain the right to make what might be seen as eccentric or unwise decisions;
▪ Best interests – anything done for or on behalf of people without capacity must be in their best interests; and
▪ Least restrictive intervention – anything done for or on behalf of people without capacity should be the least restrictive of their basic rights and freedoms.

Our MCA service is a a generic service, for a wide variety of service users, including people with learning disabilities, dementia, mental health needs and acquired brain injury.

A person should be referred to the IMCA if they meet all of the following criteria:
▪ They are the subject of a decision around serious medical treatment or a change of accommodation; or around a care review or safeguarding investigation, or they are subject to a DoLs assessment.
▪ They have been assessed (under the key principles of the MCA) as lacking the capacity to make that decision.
▪ They are over 16 years old.
▪ There is nobody else who the decision-maker considers willing and suitable to be consulted on the decision.

At the time when the referral is made, it must be evident that:
▪ A person lacks the capacity to make the particular decision
▪ The decision is either concerned with serious medical treatment, a change in accommodation, a care review, a safeguarding case or is subject to a DoLs assessment.
▪ There is nobody who can appropriately support and represent the person (this does not apply to safeguarding)

Exclusions for people subject to the Mental Health Act 1983
▪ An IMCA may be required to represent a person when they are discharged from hospital. This includes when the accommodation is made under Section 117 (aftercare arrangements), if there is no requirement for the person to live in the proposed accommodation – i.e. the person, if they had capacity, would be able to exercise a choice.
▪ An IMCA should be instructed if it is proposed that a person will remain in hospital for more than 28 days as an informal patient, including after being discharged from a section of the MHA1983.


Our IMCAs are:
▪ People of integrity and good character. This is evidenced by two written references, including, where applicable, a reference relating to the IMCA's last period of employment,
▪ Have an enhanced criminal record certificates issued pursuant to section 113B of the Police Act 1997. This should be sought a minimum of every three years for existing IMCAs.
▪ Have attended training to undertake the role. This is either the four-day IMCA training originally provided by Action for Advocacy or all of the training/taught components of unit 305 of the national advocacy qualification available through City & Guilds.
▪ Has successfully completed the assessment of unit 305.

Continuing professional development
In addition to completing units 305 and 310, our IMCAs access further relevant training.
SGL’s IMCA service must understands that mental capacity is broad and relates to many diverse groups of people. It requires skills in communicating in non-standard ways, for example with people who have no spoken language. It requires a holistic approach to working with people, not relying on their ‘instructions’ but on an assessment of their rights and needs.
The service provided is appropriate to people’s needs, including their disability, race, culture, religion, sexuality, age and gender. The service must also recognise that individuals’ needs can change over time and respond accordingly.
Our IMCA service works in partnership with other agencies: statutory, independent and voluntary. This will include hospital staff, doctors, nurses, social workers, care managers, and managers of care homes. It must assist staff and service managers who are likely to refer their patients and service users, to understand the role of the Independent Mental Capacity Advocate and know how and when to access the service.

Our service meets all statutory standards that might apply to it at any given time and is be able to evidence this, including in written policy statements. This includes standards relating to independence, CRB checks and training.

Referrals can come from any NHS, Local Authority or non-statutory service provider. Referrals will contain sufficient information and evidence to address the eligibility criteria as set out in eligibility criteria section below, i.e. in terms of person’s social circumstances, capacity, age, Mental Health Act status etc.

The main functions of our IMCA is to:
▪ Support to assist in participation
▪ Obtain and evaluate relevant information
▪ Ascertain wishes and feelings
▪ Obtain further medical opinion (if necessary)

The IMCA will stop being involved in a case once the decision has been finalised and they are aware that the proposed action has been carried out. They will not be able to provide ongoing advocacy support to the person. If it is felt that a person needs advocacy support after the IMCA has withdrawn, it may be necessary to make a referral to a local advocacy organisation.


Sankofa_Group

We work throughout the UK our offices are located at
New Broad Street House, 35 New Broad Street, London, EC2M 1NH
Call us
+44 (207) 096 0250